Exercise can be nearly as effective as therapy for depression | Hacker News Reader

Exercise can be nearly as effective as therapy for depression

sciencedaily.com

402 pointsmustaphah393 comments

This is a finding that keeps coming up, and I've certainly found it true in my life, but there's a significant chicken-and-egg problem in that depression frequently precludes the motivation to exercise, and if you don't already have a deeply-disciplined routine to overcome the lack of motivation, people won't do it.

Exhortation to develop those good habits in the good times, I suppose.

Motivation is fleeting but routine persists.

When there is something that you want to do regularly (exercise, doing the final boring part of some sideproject, cleaning the house...) you remove willpower from the equation and set a day and a time.

For example, everyday from 18 to 19 I work on my sideprojects, or saturdays from 16 to 18 is house cleaning time. There is no question if I want to do it, it is set at that time and I have to do it, period.

The nice thing about routine is that the first times it is hard, but after some repetitions your mind (and body) begin to get used and it transforms into a routine and then it's like it's written in stone. That time period of that day X is for Y and it is what it is.

Routine can be used for bad things but also for good things.

> There is no question if I want to do it, it is set at that time and I have to do it, period.

Gosh it must be nice to have at least an ordinary amount of executive function skills. Is it really this easy for neurotypical people to build routines? That's really all it takes?

I don't see how this removes willpower at all. It just determines what time you have to use it.

All you need to do is go to sleep before 12 every single night and wake up at 7am without fail, hit the gym and crank out a few sets of squats, hit the pool and the sauna, read a chapter of that book, and then cook yourself an amazing breakfast, all before 9am.

If you're a real go-getter, though, you'd wake up at 6am and do some vibe coding for an hour on that side hustle.

Super simple.

This but unironically. I don't post on LinkedIn or anything. But sometimes it seems like all the agonizing people sometimes do over whether or not they should follow their plan (fitness, diet, productivity) makes it ten times worse.

It can be possible to decide to do something in advance, and then... just do it. The more times you do it the easier it gets. My wife comments on this sometimes. I guess not everyone has this? Maybe it can be learned? I don't know.

The list of things I must do is large and growing. Much of it outside my control. Yes, I could sell the house but rent is quite high. Yes, I could divorce the wife but that actually makes for more work. Yes, I could abandon the children but I've grown attached; and that's only legal after finding someone else willing to adopt them and a judge willing to approve it. Yes, I could deny any help with the elderly parents on both sides of the family but that seems extreme and carries a social cost. Yes, I could spend a few decades trying to cure the medical issues I've collected but that leaves little time for anything mentioned earlier.

Then there are the things I'd like to do.

I mean, yes. That's true for everyone. Different people have different life circumstances. It's equally important not to decide to do things that one can't realistically do, for whatever reasons there may be. I'm not sure what your point is.

Don't sell your house if you don't have a realistic place to live lined up. Don't divorce your wife if it's not worth the work.

I'm not saying everyone can or should be grindset hustle bro. Probably no one. I'm just saying that it is sometimes possible to decide what you're going to do in advance. If you already have too many obligations, that could include deciding which ones to fail. That's probably better than trying to do everything and just rolling the dice.

It's surprising how controversial this idea is, but it works for me. I hope you find something that works for you.

Don't forget to spend a few minutes journalling self-affirmations.

https://m.youtube.com/watch?v=_o7qjN3KF8U

Was waiting for this to come up lol

I know you’re being smart but these things are all possible if you want to make them happen

People would rather blame external factors and not take responsibility.

It’s actually insulting to people who work hard that some people assume they have it easy somehow, like the “must be nice” comment upstream. Not everyone takes the view that you can’t control what happens to you, it’s pretty easy to see who does.

It's also pretty insulting to assume that everything is equally easy for all people.

No its not.

"smart"? I'd say "sarcastic"

Agreed, and then I just jump back in time two hours so that I can get to work on time, because that is what successful people do.

and not have any kids.

Nah, you can do it with kids! I have two that are about to be 4 and 6, here are my weekdays:

- Alarm at 4:30. 5 mins of breathing exercises, 20 mins of meditation.

- Make coffee, have breakfast, out the door to work by ~5:30.

- Get to work's gym by 5:45, cardio for 60 mins.

- In my office by 7:00-7:15.

- 3:30, 25 mins of breathe work and meditation again. Tuesdays and Thursdays, this is 3:15 so I can fit in ~30 mins of strength training.

- Head on out, pick up my youngest from school, home by ~4:15-4:30-ish. Ballpark depending on traffic, actual gym times, etc.

- Cook dinner (kiddos often like to help), eat with family, hang out with and play with my kiddos until 7:00PM.

- Kiddo bath and bed time, wife and I take turns doing this every night. Whether I'm "done" at 7 or 8, it only takes me ~30 mins to shower and prep my shit (clothes, lunch, etc.) for the next day.

- Leaves me with ~1-2 hours each night to hang out, read a book, and enjoy my wife's company before heading to bed at ~9:30.

It's busy, but I don't feel like I'm overstretched and I don't feel like it leaves me missing out on anything.

Organized people have kids, too.

It still requires willpower, but to use a metaphor, it's much easier to travel down a well-trod path than it is to cut a new path through the jungle. Repetition and consistency establishes the path, so the willpower required to travel down it the next day is reduced over time. Establishing a pre-set time and committing to that time ahead of time removes the "will I or won't I" decision at "go time", when you're most likely to falter.

This method requires a significant amount of executive function.

My body doesn't feel the passage of time consistently. So my mind is never prepared to switch activities when it needs to.

And there are times my brain stops working on a particular task and nothing can get it started again. It's like a leg going out, you just can't stand on it.

This isn't occasionally where habit could be picked back up. This has been a problem every day of my life.

In my experience, this has been the death of every bit advice I've gotten from a neurotypical person. A lot of them keep circling back to discipline or trying harder as a solution to a problem they can't make sense of. Lack of understanding isn't their fault, this is so far outside their frame of reference they can't make sense of it in a single conversation. Fortunately understanding isn't required, only the acceptance that other people have limits they don't have themselves.

Do you ever feel unmotivated to go to the toilet despite needing to? Has this lack of motivation ever stopped you from getting from your chair?

What modern people usually lack is not time, but lack of energy. Usually this is thought as the energy to do stuff (like coding a side hussle in the evening). But often it manifests in a lack of energy:

1. to make a decision (to do something)

2. to slow down, to stop the current activity and to think with the rational mind.

So you need to recognize these things and do certain decisions beforehand to solve the problem. Stuff like:

1. Go to the gym in the morning, when you still have the decision energy.

2. Create a habit, linking a new habit with the old ones, in order to decrease the energy expenditure

3. Increase the stakes, like getting a gym buddy

4. Decide stuff beforehand. Pack the bag, set up the alarm clock (to go to gym, to go to sleep)

5. When you are tired, actually rest. Don't turn the tv on, don't scroll social media, stop touching yourself via phone. If you are tired, eat, go to gym or a walk, go to sleep or simply sit in your chair or lay on the sofa looking at the walls. I guarantee, watching at the wall for 30 minutes straight will give you great motivation to do something else more productive. Don't let the monkey in you convince you to do the unproductive things I mentioned. Stay strong and make a rational decision what to do instead of looking at the wall. Do the right thing, not the thing that may feel nice in the midst of it.

6. Take care of the nutrition/sleep in order to increase the energy reserves

I hope that helps.

I struggle daily to urge myself to eat after years of habitual starvation. The process of storing and making food through-out the week is extremely difficult for me to say the least... I also don't have room in my finances to out-source this completely. To combat this, I have been successfully meal prepping on the weekends; however, I still often struggle with the basic task of eating the food, prepped and served. It is a common experience for me to get part-way into eating a dish, move on to another task, and neglect the food until it's spoiled only to realize so when I pack up for the day. Sometimes I will even notice the food, deep into a task, but the thought to address it is hardly formed.

In this regard neurotypical advice _did_ actually help me I suppose. However, when applied to a habit not immediately linked to your existence, it is quite alienating to receive.

I would imagine you'd get this advice from other non-neurotypical people too. My son is neurodivergant, and strict routine like what is being described is about the only thing that keeps him able to handle most daily life tasks regularly. But plenty of other advice he constantly gets frustrates him similarly to the frustration you seem to be describing. We call it "you've just never had it cooked right" advice. So I feel your exasperation.

Just a shout out here for medication. ADHD meds are rated effective in the 70-90% range, which is just incredibly good compared to medication effectiveness for just about anything else.

I have ADHD, and hate the feeling of being a victim. "I have this, so I can't do that. It's just the way it is." No! Not for this. Not when there are so many treatment options.

I accept that things may be harder for me than a typical person, that I may have to put in more work than other people to get the same results, that this is something that's very real that I have to deal with and manage at all times. That there will be times when I will fail and my stupid monkey brain will win the moment. But I won't let it define me, I won't let it dictate who I am and what I can and cannot do.

EDIT: Also, I mean to agree with you here: there's a point where no amount of discipline will work, and the advice to "just try harder" sounds like an alien telling you to just grow wings and fly. If you find yourself at that point, medicine can and will help. It also helps you be able to get in a routine of actually doing exercise, which in turn helps even more, and it becomes a sweet positive feedback loop.

It really doesn’t remove that for everyone. Glad if it works for you.

What makes this “neurotypical?” I don’t necessarily consider myself as such, but I’ve made it a point to have some routine in my life. In fact, I think being highly regimented and sticking to a routine can be very neuroatypical. I would never go so far as to say I’m autistic, but there are markers on that spectrum, like becoming upset when a routine is disrupted. I certainly am perturbed when I’ve set some routine for myself and something interrupts it.

I'm not claiming this works for everyone but what sometimes work for me to form a routine is to do the thing but without committing effort to it. I.e. go to the gym but you only promise yourself to go there, not actually spend effort there. Any actual exercise you then do is a bonus, not a "payment on your promise".

I think it can be generalized as:

Find the thing to do that doesn't require much effort but puts you in the context of doing the effortful thing. Do that thing. See if you "want" to do the effortful thing. Otherwise go home.

Cleaning? Put the vacuum in your hands and see if something happens.

At least I think that's how it works for me.

The points when it's hardest to make it work is when there's lots of distractions. Like when you try to get into a routine of doing work at a computer.

The parent comment's point is that you can reduce the amount of executive function required to do the correct thing. Doing something at the same time every day will indeed make it more automatic, requiring less willpower to do it again tomorrow. This effect applies whether you're neurotypical or not and is grounded in behavioral research.

There are better examples in my opinion than just doing something at 18:00 every day. There's a technique called habit stacking where you identify all the habits you already have at a given time (like when you first wake up), and then you add one more at the end. It's easier to introduce a new habit this way, and it becomes ingrained more quickly, resulting in less need to use executive function.

There are still more techniques. An example from my personal life: in my whole adult life, I've never gone to the gym... unless I sign up for a gym that's right across the street from my workplace. Then it happens like clockwork. If all I need to do is walk across the street, I end up in the gym, and inevitably, I work out. If I need to drive 20 minutes though, well my willpower just ain't that great, so it basically never happens.

The best book I've read on this topic is Atomic Habits by James Clear. He goes deep down the rabbit hole of these techniques you can employ and touches on the research it's all based on. The brain's not a computer so I mean it's not all just going to come together automatically, but in my experience this stuff does work.

Willpower is what you use when you’re allowed choice and know you should make the good choice but actually feel like choosing the bad choice. The trick to good discipline is to never allow it to be a choice. There are no excuses. There is no negotiation. It just is the same way the sun rises or the tax man comes. Good discipline is a skill you develop and it is far easier than trying to live via something as temperamental as willpower.

You need some level of willpower to get your legs to take you to another place. Certainly if it involves getting in a car and parking.

If you don't have that, the skill needed to develop it is the skill to get someone to prescribe you amphetamines.

You say "when you're allowed choice" like there are some times when you aren't allowed choice, and I think this is where you lose me. Everything is a choice. Always. It's not a matter of "allowed/not allowed." It's just a reality of existence for me. I'm not sure if I can explain this, but I can try.

You seem to have a kind of "decision persistence" that I don't have, where having decided it once makes it still true in the actual moment of taking the action. It doesn't matter how many times I choose things in advance, in the hypothetical, for the future--and the future is always in the hypothetical. I still have to choose every moment, day in and day out, what I'm doing. Even now, it's not quite a foregone conclusion that I'm going to finish typing this and click the "reply" button. Probably will, but I won't know that for SURE until I've done it. I might decide it isn't worth it after all.

My brain simply does not consider past decisions binding on present activity. I might still decide to do the same thing I thought I would do at this time when I thought about this earlier, but I have to decide it again, because it hasn't happened yet. Every moment is a "deciding again," which means every moment needs willpower. Putting on one shoe doesn't guarantee the other shoe comes next. After a shit, pulling up my underpants doesn't guarantee the pants come next. Maybe I step out of the pants and am halfway through lunch before I realize I never pulled my pants up after the toilet and have been walking around my house without pants for 45 minutes.

"It just is" is not an experience I have. They're not excuses. The next thing just goes, right out of my head. I don't talk myself out of doing what I previously decided to do next or into something else. But there is no mechanism that makes something happen just because I decided it should earlier.

There always has to be another choice, in each moment, about what to do, and whether to keep doing it. Every one of these choices requires willpower, and there's only so much in the jar. But it's not like the jar fills up once, overnight, and I just draw from the jar until it's empty and then it's gone for the day. The jar arbitrarily loses and gains willpower ad hoc throughout the day. So I can always reach into the jar, and sometimes there's some willpower in there and I can do the thing that Planning Smeej thought would be a good idea yesterday, but sometimes there's not, and nobody knows what's going to happen until maybe there is again later.

I don't know if I've made that make any sense. I just know that you're describing a reality fundamentally different than the one I experience.

I have utterly horrible executive function. Diagnosed and everything. Sitting here on HN right now avoiding boring spreadsheet work to finish my day out.

It’s not easy for anyone to develop these style of habits and routines. It’s just hard mode and takes much more effort for folks with executive dysfunction.

The first rule is choose one thing and stick to it. With realistic goals. Mine was: I am going to walk at least 6,000 steps a day. No matter what. Zero excuses.

Since schedules are insanely difficult for me I set none. If I remembered I still needed to walk and I could do it in the moment I simply prioritized it. It’s surprisingly easy to fit in 10 minutes of walk in throughout your day, even when working a desk job. It could simply mean pacing while on conference calls.

Another rule was “if I fail to achieve it one day, I must achieve it the next” to avoid the “all or nothing” mental trap.

This was to the level of getting into bed, checking step counter, and if I was under target literally getting out of bed, putting clothes back on, and walking until I hit it. I had all sorts of technical widgets to enforce this and help remind me.

It totally sucked for the first couple months. Then it started to just become a thing. Then I ramped it up to 12k/day until I hit a weight goal.

It’s the best thing I ever did for my mental health since it started a snowball in other areas of my life. I was able to swap out a few days of steps for an hour workout (beginning with a personal trainer to force me to show up 2 days a week minimum). I was and still am constantly 10 minutes late to my session but no matter what I show up to them.

The weeks I miss them due to schedule conflicts or travel I feel much worse mentally. And it’s easy to give into the anxiety and panic over not having enough time in the day to fit it in after procrastinating on other items. You also start to realize that those other items are probably not as important as you thought.

I find routine and habits over schedule and calendaring are hyper-important for my dysfunction and have leaned into that. It’s more of a “this thing before that thing” sort of deal vs “at 3pm I do the thing” since the latter would go off the rails immediately.

It’s possible. Just the hardest thing I’ve maybe ever accomplished in life so far.

Gonna be different for everyone and you probably need that one moment of clarity to get the initial motivation. The motivation will go away, but the habits and discipline will probably stick around.

Been using this same method to build habits and routine into other areas of my life now as well.

> I find routine and habits over schedule and calendaring

I find the same. To keep myself honest, I built a simple habit tracking sheet (grid paper; 1 page/month; x axis list items; y axis list days). Keep it simple to reduce friction, no more than a handful of items, and try to stack habits and routines. Focus on anchor points of the day like sleep/work/exercise/nutrition/meal prep/tidy house. I’ll also track non-action items like coffee/alcohol/anxiety/video games/book reading, etc. Include the process as part of end of day wind down and reflection.

Your daily reminder that neurotypical people do not exist.

I found this to be true, and that it perfectly dovetailed with TFA.

When I was at my absolute depth (so far…) back in 2013, I would see my counsellor at 1130 on a Saturday. I’d be able to recount the darkness of the previous 7 days in stark vivid detail, yet cheerfully and not feeling at all depressed in the moment. The counsellor asked what I did on Saturday morning except the session and my answer was, well I do Parkrun[0] of course. I always do Parkrun. It’s in my calendar, it’s not really negotiable. It might have been the only time I managed to get out of bed all week, but, I mean, how can I possibly skip Parkrun?

I never actually linked the exercise to the boost in my mental health until I had it pointed out to me at that moment. I go for a run and I feel better because of the run. I would spend the whole 5km stewing and ruminating and maybe in tears but half hour after getting home I could function! it’s stuck with me ever since, and I’ve never (yet) been so down again.

Tomorrow will be my 429th Parkrun :)

[0] https://www.parkrun.com/

That's amazing! I'm so glad for you that you found something that works and which can keep you going!

This reads like an ad. Why would you capitalize it like a product name and then even link to the website?

I still have no idea what it really is. From the name I'd think you're going for a run at a local park. The website calls it a "5k and 2k community event", what that's supposed to mean I have no clue. It insists you either "join" or "volunteer", all while being as non-specific as possible why I should even care

2/5k what? people? distance? currency? number of events? It almost reads like in-group speak of a cult I don't partake in.

-- Rant over --

I’m advocating not advertising.

I capitalise it out of muscle memory. That’s all. FWIW Wikipedia capitalises it as well.

I called it out with a link because I expect many folk to be unfamiliar with it, but the nature of parkrun itself — rather than simply going for a 5k[m] run — is intrinsic to the point I was trying to make.

5k is perfectly well understood to be a distance, especially in context, in British English and I’m a Brit. My bad I guess for not adding “m” for (some of) the HN readership. [EDIT: actually, I said 5km! Not my fault if parkrun says 5k, but they are a British organisation)

Regardless of that, you were correct that parkrun is indeed a run around a park. I won’t explain any further nor link anywhere lest it be misconstrued as advertising (something that’s proudly free, mind you). Besides which I need to get to and get my running kit on.

5k is a common distance for runs. 2k would be a shorter run/walk event, it's more common when you have kids participating. It's not confusing, just normal language. No cults involved unless you think running is a cult. The "k" is for "kilometer" in case you're still confused.

5k is not a distance. 5km, 5 thousand feet or yards are. I've never heard of this weird and unnecessary "abbreviation"

HN would be a depressing place if we all had to have a rant every time someone posted about something I had never heard of!

> saturdays from 16 to 18 is house cleaning time.

> Routine can be used for bad things but also for good things.

So your willpower causes such routines to work. Not everyone works that way. And not everyone not working that way has depression. I don't think one can generalise this to "routines will fix your depression".

> but after some repetitions your mind (and body) begin to get used

I also don't buy into that. A good counter-example is tobacco smokers. Some manage to quit the moment they decide they want to quit, with no substitutes. Others try with substitute and interestingly for many who try, that also works, but for some it does not. And some can barely ever quit smoking. And a lot of this has to do with how their brain works.

Matthew Perry spoke about that with regard to his alcohol addiction. People are different. I personally never started with smoking, for instance, because I never trusted myself to be able to (want to) quit again - so at the least I was consistent in this regard (plus also, because in our youth, so many others started to smoke suddenly, and I always felt it was a very stupid reason to smoke merely because others would do so, even at an early age. Their rationales would not be mine and I failed to see the point in adopting their positions and make them my position).

I bet simply having a dog needing walking tips the scales into an exercise routine at some level.

It did for me. You have to be truly heartless to see a dog being sad about not going outside. So you take it for a walk, then another and another. Soon enough you're researching hiking trails in your region and getting healthier.

Dogs are the best.

agreed, with an addendum : we have rescue cats too, and they too are like "nope, off the computer, time to play".

And perhaps because we have both, they all will play games together (and with us humans): the cats are like dogs who can do gymnastics.

the cats will walk outside on leashes but look annoyed and embarrassed. however our feral ancestry dog is like having Richard Simmons on meth...and makes me amused at people who are like "a border collie is a handful". i'm like tell it to her paw.

God yeah. So much healthier and happier in my forties than my thirties, and it's all down to my executive assistant.

yes and then dog dies so you go back into a depression :(

and then you realize shelters/rescues are full of super healthy dogs yearning for a home, and same for cats, and then you go adopt at least one, and realize you've honored what your previous pet would want for you.

(speaking from experience, 5 rescues here now, lots of activity for lots of fun...thankful for WFH flexibility)

not ready for that yet but i look forward to that future

yep, understood, and your future looks bright!

> Motivation is fleeting but routine persists.

Ahnold Schwarzenegger said that the gains in an exercise program happen when you really don't want to do it, but do it anyway.

>Motivation is fleeting but routine persists. When there is something that you want to do regularly (exercise, doing the final boring part of some sideproject, cleaning the house...) you remove willpower from the equation and set a day and a time.

Absolutely!! Don't wait to Feel Like It, or Be Motivated... and especially do not depend on another person/trainer/weather to motivate you!

Fitness is a to-do, like laundry or grocery shopping or going to work. Now where the nuance comes in is finding what you enjoy. But a nuance of this nuance is, you don't know what you like until you have done it for a while, at least one month. Don't do boot camps or hacky gimmicky things people try to trick themselves into doing.

For a while I was deep into photography and writing. In both, I read and listened to people who were experts - successful writers and photographers. I learned this - they don't wait for inspiration. They commit X time per day to doing their craft, as habit.

I write this after coming from the gym, on a chilly night, after a relatively annoying day, and I feel 80 percent better.

Now the joint soreness and constant tightness are a problem, cuz I'm getting older. But it must be done.

An easier routine for me to manage house cleaning is to set up a calendar with one little chore each day.

List out what needs to be done every week, every month, every season, and set them up to repeat.

Every day you do your little two minute task (clean the bathroom mirrors; vacuum a single room), so you get a little win. And they’re each so small that it never feels like you need to switch into a long “cleaning binge” that you need to dread.

The key I found was to avoid self flagellation.

Try your hardest to do each session, but if you miss a session don't try to make it up. Just get on and do a normal session the next time it falls due. You're in it for the long term, so long term it doesn't matter if you were intermittent when building the habit, or the occasional session gets missed for a reason.

I’m on this journey myself; learning to become more emotionally well-regulated, and kinder to myself. For years I had depression, and I used self-flagellation and self-loathing as drivers to motivate myself to do better. In work, hobbies, fitness, relationships…everything. I would unfairly criticize, disdain, and lash out in anger at myself, in ways I would never treat another person. My baseline emotional state skewed negative, and I’ve realized I was suppressing or dissociating from emotions entirely. It took a while to realize I wasn’t coping well. I made improvements over many years time, but sometimes still fall back into old default patterns. I finally hired a therapist to work through stuff and develop better emotional health and cognitive strategies. Started with just checking-in and recognizing emotions, and being more fair and kind to myself, which in turn helps to respond to everyday circumstances more objectively. It has helped immensely, and I don’t think I could have made the same progress without a neutral third party. I highly encourage anyone in a similar place to hire a therapist; it can be hard to find someone you meld with, but it’s worth it.

This, plus start small. Just do those 5 or 10 minutes of karate exercises per day, at a fixed time, or 5 new flashcards per day.

I agree. If you're in it for the long term, it doesn't matter if you start low or increment slowly. You will eventually get to an equilibrium that has an effect.

thats right. a year ago i decided, fuck this going to the gym randomly and not having a plan and only kind of committing. im going to do it. so i got a trainer, committed to 4 days a week, and so far ive kept that up for a year. and now, if i find myself running out of time in the day i make time for the gym. it is such a part of my routine that i simply do it without much questioning. because i know if i dont go i will no longer be able to do the things in the gym the way i do them today. i enjoy that feeling and wish to continue. i think the point of life, at least partially, is to figure out things that you enjoy that don't take from you and do them consistently.

It is really easy to have a routine when you are single and healthy in your 20s. It stops working so well later on. If you have friends, partner, kids, parents, pets, work, health issues etc. the routine is going to be challenged. If that only happens once every few months no big deal, but now that I am in my late 30s with a partner, kid, 3 pets and elderly parents. I literally have something derail my day almost every single day. Carefully planning my week would be a recipe for misery.

I think really successful people are ones that just don't give a shit, like full on narcissism. Like my dream is X, I need to do Y today. The dog is sick? My kid needs a ride? My parents need help? Not my problem I am doing Y full stop.

I’m in the same situation as you as well many other people who still workout. The trick is to remove as much friction as possible for working out and adding friction to activities that aren’t good for you. For example, if you don’t have time for the gym, make it easier to workout at home, make working out the very first thing you do when you wake up, etc…

Routines tend to get more and more derailed as the day goes on. Wake up early and get the important stuff done first.

As for narcissism, the optimal amount is not zero. If you want to continue being of value to your family over the long term then sometimes you have to take care of yourself first. Unless it's a life-or-death emergency, others can wait a bit for help.

I subscribe to Arnold Schwarzenegger’s newsletter, which has a surprising amount of great, well researched content.

Right after New Year’s Day, he said pretty much what you said. Discipline beats Herculean effort that’s sporadic.

Scott Adams said it a different way - systems over goals.

> Motivation is fleeting but routine persists.

That makes me think of a philosophical comic on quitting smoking. [0] Rather than cerebral willpower, a lot of value comes from indirectly shaping what your animal-brain does or doesn't encounter/expect every day.

[0] https://existentialcomics.com/comic/13

I'm not even back from work at 18-19 every day, or even most days. It varies by hours. By the time I have had dinner I'm thinking about settling down to settle my mind so that I might sleep that night. I'm also mentally exhausted after a day in my job. How do I create a habit without a time gap?

The same routine for good things can turn into being a bad thing. Brcause it can make you inflexible. So there's a trade off there.

For me, it was when I was in a situation where I had to work 80 hours a week to keep my job. I had to get rid of my routine for 8 months and I am happy I did it otherwise I would he poor today.

Being inflexible is only a problem for other people! :P

Glad that works for you, but please know if you are giving advice to individuals, that not everyone can work this way. In fact, for some people, this sort of artificial structure actually makes it harder to get the stuff done, and just makes things worse.

As someone that is unable to keep any sort of routine, I have objections here. :D Without some sort of obligating circumstance, it is incredibly easy to forego what would have otherwise been today's routine.

This 100x. I go to work because I don't want to have a long uncomfortable conversation with my boss, and because I hate interviewing, and not having income is even worse. Even at work, I often find reasons (like HN) to do actually DO work.

I've had routines at times in my life for months. And they disappear in a matter of days when I get stressed or my schedule changes or whatever.

It is funny, as this extends to stuff like watching TV. I have never, in my life, managed to watch more than a few episodes of a show. It isn't that I don't like shows. I just don't have the habit of getting ready to watch a show.

If you don't run your life others will do it for you.

Nothing in this life is a must.

What worked for me was a thing I started with one of my best friends, where we're accountability buddies for each other. We both pick topics/habits we wanna foster and then talk once a week about how that went the last week. In my case I chose exercise (going a certain number of times per week), and there were quite a few moments already, where I'm sure I would've just skipped if I didn't have this construct. It basically created this social obligation to keep the habit. I can really really recommend it if you wanna try it out with someone.

> Motivation is fleeting but routine persists.

This is tautological: if the action doesnt persist, it isn’t routine.

This is a great quote

>> Motivation is fleeting but routine persists.

>Motivation is fleeting but routine persists

Dude, not when we are talking about mental health problems. A semi serious mental health problem can take you out of the routine of showering, eating and brushing yoir teeth.

>There is no question if I want to do it, it is set at that time and I have to do it, period.

Again we talk about mental health here. Getting out of bed before dinner can be an impossible task. There is no "I have to do it, period". That period can cease to exist, and all you are left with is "i have to do it" over and over again without the ability to actually do it.

We have a certain amount of "willpower" that can overcome motivational barriers. This willpower is limited, though. It's very helpful to have clear guidance on where to allocate this very limited resources, especially in situations where people are otherwise struggling.

All of which is to say -- these exhortations can play a useful role. :)

It's also worth noting that willpower in general is constantly being whittled down by how stressful and, for lack of better term, fucking annoying modern life is. I'm reminded of a quote from my favorite article from Ed Zitron:

> In plain terms, everybody is being fucked with constantly in tiny little ways by most apps and services, and I believe that billions of people being fucked with at once in all of these ways has profound psychological and social consequences that we’re not meaningfully discussing.

And I think one of those psycho-social consequences we're not discussing is everyone is just... fucking annoyed now, constantly, about shit that it doesn't feel right to really complain about. Like, you plus or minus live on your phone, and I'm very much including myself in that statement. Every time you get logged out of an app you use every day to, for example, board your morning train, or park your car, or have to reset a password to pay your power bill, just like, all of that? Every time your day is interrupted with stupid bullshit from Modern Life takes a tiny bit of that energy, and I dunno about everyone reading this, I have a quite well managed and streamlined life, and I still have just... dozens of these. Every single day. I can't fathom being one of the folks who ISN'T as well versed in tech as I am, existing for them must be utter HELL.

And that's the essentials, that's not even going into how most tech products now are constantly begging for your attention, for your engagement, trying to pluck the strings of your psyche into making you angry, or horny, or whatever. Engage with platforms, buy these products, watch 9 TV shows so you're not out of the loop, you've been added to an SMS spam group, and everyone is replying to it saying they're not interested, on and on and on.

Sorry this turned into more of a rant than I really envisioned but yeah. I can easily comprehend a day where I try and go to my gym, and the fucking app doesn't work right and I can't get in, and I just quit because I've already solved 20 fucking captchas today and I simply lack the energy to do another, to help train some goddamned AI, for a company I don't know, you know?

> existing for them must be utter HELL.

You've certainly hit upon why they use the same password for every single thing.

I just got a new phone which meant I had to read-login and set up every app and account.

It was an intense deluge of SMS codes, flipping back and forth to the Authenticator, dismissing welcome popup modals, security email notifications.

I was frazzled by the multitasking and can only imagine how hard it would have been for some senior citizen that was badgered into updating their device.

Which phone? Upgrading recent Samsung phones is pretty smooth and low stress, everything just transfers over.

AIUI, the whole "certain amount of willpower" was a misunderstanding / exaggeration / bullshit claim that's not really held to be true anymore.

Source? I'd love to learn more about this!

Yup, which is why diets fail. People who are fat generally do not have enough available willpower to lose weight.

I wouldn’t phrase it that way. Relying on willpower is a recipe for failure. Humans generally don’t have enough willpower, it goes for most things, even when you don’t have strong physiological forces involved. The key to getting a diet to work is in figuring out how to not require willpower, which means thinking about it differently, forming new habits. Stress and social environment also need attention or they will steamroll your goals.

> figuring out how to not require willpower

This goes for coping with a lot of executive function problems and disorders.

Part of how I have to manage my rather severe ADHD is specifically crafting an environment that's as ADHD friendly as possible, much to my wife's dismay.

That means nothing can ever be hidden away or out of sight, otherwise I will immediately forget it exists. It means every bill must be on autopay, or it will not get paid. It also means living as minimally as possible, for me. Even something as "simple" to a neurotypical like washing dishes or doing laundry is a seemingly impossible mountain for me to climb. I solve that by owning as little as possible, and I also remove choices by, for example, just owning multiples of the same exact outfit.

The moment any sort of friction or context switching is involved in a task, I am going to fail, so I have to architect my life in a way that reduces friction as much as possible.

I also have ADHD and i also find living as minimally as possible very helpful. Could you elaborate on more of those tactics that work for you? I am also curious how you apply this to your work life

Basically things that eliminate friction. I wear only slip on shoes because having to tie & untie is friction. I replaced our kitchen cupboards with those glass window ones so I can see whats inside every cabinet without opening it. I have multiple laundry bins, so I actually don't put clothes away in a dresser when done. I just leave them in the bin, pull out what I'm going to wear, and then have separate bin(s) for dirty. Eliminates a huge friction point (folding & hanging) when it comes to doing laundry.

For work, that's mostly just luck. I'm a solo sysadmin for a non-tech company, and I work from home so I have a great deal of freedom. Outside of interruptions for help desk level tickets/emails (which suck and do throw off my flow), no one really oversees what I do and I set my own deadlines for the most part so I can work when and however it suits me to take advantage of days where I have good flow state.

This has more to do with hunger requiring a tremendous amount of willpower to ignore rather than fat people having less willpower than people of average weight.

If you eat poorly, those foods will not satiate and the "hunger" (it's not the hunger of a body starved of calories) persists. Eat for sustenance and the hunger you may feel will be different.

I also know that if I overeat, I have a strong urge to keep feeding (more chips, more pizza, more chipsahoy). Whereas when I eat a proper meal, I'm fine when the eating of that meal ends.

I hope you realize that what works for you and your body doesn’t work for everyone. Your experience is not universal. Your body chemistry and genetics are not universal.

When it comes to the most basic instincts, it is universal and genetic. We do not differ in that.

We can argue about whether or not punching yourself in the face will hurt, universally and for all, or we can acknowledge that arguing about this is picking the wrong level of information with which to take issue.

Kids often still need to learn that punching yourself in the face hurts.

Curiously, if I'm busy I don't get hungry. I don't eat before going out dirt biking, and don't feel hungry at all until after the riding is done and the bikes loaded on the trailer and turning on to the road home.

Boredom snacking durring the work day kills me, maybe even slowly litteraly.

It feels very different. Depressed people lack the motivation/energy to start exercise, fat people seem more in line with addiction in not being inclined to overcome short term craving for more feed.

While at a certain level of abstraction you can reduce both to A -> !B -> C, that generalization seems to obfuscate specific important differences that impact pathways to treatment. Craving is not the same as lacking energy. Craving, while subversive, energizes, depression does not.

It takes a tremendous amount the first 3-7 times. After that it is a learned skill.

The entirety of this thread is people thinking life is easy. Kill yourself or get over it, and I mean in a sentimental way.. (Not literally)

The only thing that helped my depression, apathy and executive dysfunction was realizing I was going to rot anyways, I was never going to be happy, so I may as well start the startup, go on runs, and succeed.

Let go of the expectation you will want to/be in the mood or feel good from it

Life is not chocolate malts and gummy bears

My suspicion as someone with lifelong weight struggles and having tried GLP-1 medication: overweight people require more willpower to lose or maintain weight relative to those of normal weight.

So the advise or admonishment of the normally weighted that losing weight "just requires willpower" is true but facile.

If we were to medically induce a constant feeling of hunger and insatiability into a person of normal weight, I'm sure they could keep the weight off, but would find that their willpower is highly depleted.

There are medications that cause increased appetite and weight gain (ex: some bipolar depression medications, prednisolone). This effect is so pronounced, that if a doctor sees the patient not gaining weight, they will suspect non-compliance and have to rule it out. Of course, some patients use extreme diet and exercise (willpower) to avoid these effects, but a normal person accustomed to expending a normal amount of willpower to maintain weight will find themselves gaining.

Over-eating is not strictly a choice. Corporations spend billions on manipulating the public because it works. Regulation is needed, not willpower.

I don't believe regulation is the answer. As I get older, I've become increasingly skeptical of any information coming from the government.

But somehow information from corporations is good and we should let me do whatever?

Overeating is often a coping mechanism. It’s really hard to displace unless your life is going fantastic. Even with GLPs.

To solve digestive problems, I managed to eat the exact same meal every single meal for 20 straight months. And it didn't help me lose weight.

So I dispute this statement with some enthusiasm.

I seriously dispute this. I spent weeks not being able to eat enough. I hardly lost weight despite being close to the optimal calorie range to do so.

You should try out for the "Alone" game show:

https://www.history.com/shows/alone

...not losing weight on a limited diet would be a huge advantage over the other players.

That may be true if you're severely depressed, but I think it can save you if you're starting to get depressed. That's what happened to me at one point, and an online comment saved me.

I was like 60% depressed but on my way there. I just took my first computer science class in college but I was overly ambitious when I participated in an undergrad CS research. The stress and imposter syndrome was shoving me to the downward spiral.

I posted some gloomy thoughts on an online forum. It was long ago, but I remember the post contained how I could kind of relate to the villain while watching the movie The Dark Knight Rises.

Some online person advised me "lift weights". I had never tried seriously lifting weights, but I was living in a student apartment 10 minutes away from the student gym, so I decided to give it a try. I can't forget the sensation when I did a set of bench press. After a period of amassing so much stress, each rep felt like I was reaching my hand into my brain, directly scooping out the waste and tossing it away.

I became much more active after that, and successfully finished the research and the degree.

It's like how homelessness is more reversible for people who became homeless less than a year ago, and why organizations focus on those groups.

If psychiatrists could mind control their depressive patients into doing 2-3 weeks of heavy compound lifts, I'm certain more than half would be cured.

I also question the universality of it. No amount of exercise changed my depression or made life any less miserable. Anti-depressants finally helped me get past the trauma I was unable to properly process otherwise.

I don’t think depression is a universal root-cause diagnosis so I’m inclined to agree.

I’ve been diagnosed clinically several times in life with depression and the pills never did anything for me. Sometimes exercise worked, sometimes it was of little or no use.

With retrospect, all of my episodes of depression were a function of environment. As a child, growing up in a broken home situation and bad school environment, of course there is going to be depression. Life sucks. Further, no pill or weight lifting schedule is going to fix that either. Only breaking out of that situation will.

As an adult, I’ve absolutely had and broken out of a long episode of depression with exercise. Bad breakup, startup failure, then introduce chronic drinking and subsequent weight gain. Guess what, cutting back on drinking, bicycling to work 30 minutes each way, doing martial arts in the evenings, it was a great fix. It enhanced self image, added a new community of positive people, and broke a cycle of depression.

I definitely agree, there are two fundamental forms of "depression"--internal and a reaction to a bad external situation. Very different causes, what works for one doesn't work for the other. And I don't even like the "depression" label for bad situations--as with the previous post about willpower. We have a limited ability to cope with bad, when it's exceeded (or our efforts are misapplied resulting in the same end) we get "depression". No, we get reality! That's why things like forcing rehab does nothing about addiction--it doesn't remove what drove the person to the drugs in the first place.

And I'm the counter anecdotal case of your anecdotal case.

I have a page long list of failed psychiatric regimens that included drugs alone and drugs combined with talk therapy. None of them effective.

I won't say that I'm cured of depression now or will ever be. But a strict and persistent exercise routine lessened it to the point where I can function day to day. This was never achieved with presrciption drugs or therapy (of which I have developed a dim opinion).

And you think the effects of drugs is universal?

Exercise is a side effect free treatment that works for some people so it’s worth a shot because it sometimes works.

The poster you responded to didn't claim that drugs were universally helpful. I think the main point is that there is no universal that works for everyone. For some exercise works, for some drugs, for others therapy. And "works" isn't a yes/no, one might work a little for you, one might work super great.

The poster questioned the universality of exercise. And the went on to say that drugs worked for them in the next sentence. Clearly the two statements are related.

Anecdotal data isn't sufficient to infer a universal rule. The point of my comment wasn't to argue for drugs. It was to push back against the idea that drugs like anti-depressants are unnecessary and bad, which I see all the time when this topic comes up. A common take is "why use or prescribe drugs when apparently exercise works fine against depression?"

I'd argue that depression kills and optimal therapy is: anti-depressants, exercise AND talking therapy and the time to start is NOW.

I wouldn't knock the effectiveness of any of them with the caveats that: (1) you can get anti-depressants from you primary care doc, the best practice is to start on something, ramp up your dose and try something different if it is not working or you don't like the sides. I really thought Vanlafaxine was a comfortable ride but it raised my blood pressure to the "go to the ER" range. Call on the phone and lean in about adjusting your meds. (2) Getting an appointment for talk therapy can take a while these days. (3) In a hard case you can get a more complex medication cocktail from a psychiatrist but the wait could be worse than the talk therapy. (4) People in the military do insane amounts of cardio because it helps dealing with insane amounts of stress. 2 hours a day of cardio helped me deal with a business development process that went on for years before ultimately failing.

> People in the military do insane amounts of cardio because it helps dealing with insane amounts of stress.

This is giving the military way too much credit for organized stress management. If military people give the impression of doing "insane amounts of cardio" it's because that's what the physical fitness tests are biased towards.

And we also won't talk about the fact that getting a psych diagnosis, especially in fields like aviation, can end your career, while managing stress via alcohol gets a wink and a nod as long as you don't have an alcohol-related incident.

Or avoid medication for anything but treatment resistant depression.

SSRIs are not well understood. Their side effects are not great. Getting off them is miserable. I had them. I felt dead inside. Mission accomplished. Depression was gone, so was my desire to eat, have sex, or do anything else. I wasn’t depressed, I was a zombie. 8 adjustments and medications later I got off them and realized they’re yet another pill to fix a problem 98% of people can fix other ways if they tried.

I do not understand this intense desire to be medicated. Exercise, go outside, talk to people. Get good sleep. Once the rest of your life is squared away get some meds if necessary. Psychiatrists and psychologist walk the razors edge of quackery every single day. Talk therapy is a program to take tremendous amount of money from people and funnel it into their account. It’s absolutely nuts the average talk therapist bills at over 300 dollars an Hour. There is no reproducibility in mental health. in their “science”. Therefore, there’s no reason to believe their magical pills will fix problems they barely understand at a biological level.

As a final note people in the military do a ton of cardio because running and rucking is hard work you train for. It is certainly not to “stay sane”.

100% I have found the same, SSRI's definitely make things worse and I stay away from them, and regular exercise has offered the biggest consistent/persistent improvement in mood.

Medication is the fastest way to make some positive progress before you completely spiral and majorly fuck up your life.

Would you rather take a pill and keep working while you sort things out or would you try to rebuild everything after you burn it all down? Talk therapy and exercise may be just as effective or more so long term, but may not be effective enough in the short term.

Dunno why you are being downvoted, probably cope. It is well known by now that antidepressants are only marginally effective on average [1-2]. You're right they should probably only be prescribed for quite severe or treatment-resistant depression. Although the treatment-by-severity effect has been somewhat disputed [3-4], it has rough support [5], and makes sense since it is dubious that we should be giving ineffective medication with serious costs and side-effects to people with moderate depression.

[1] https://ebm.bmj.com/content/27/2/69.abstract

[2] https://ebm.bmj.com/content/25/4/130.abstract

[3] https://link.springer.com/article/10.1186/1744-859X-12-26

[4] https://doi.org/10.1192/bjp.bp.116.187773

[5] https://jamanetwork.com/journals/jama/article-abstract/18515...

My take is pessimsitic estimates of AD effectiveness assume you get one Rx and don't follow up and adjust dose and medication choice. I was lucky when I took ADs to have a good primary care doc who had a psychiatric nurse practitioner working at his office and being a good self-advocate.

yeah... i did forget to add meaningful community and spiritual activities to that list but people can have just as strong objections to them as they do to the other things on my list!

[flagged]

We've asked you to stop posting like this to HN. I understand that the topic is sensitive and personal, but being this aggressive in HN comments is not ok and we ban accounts that do it.

You've been a good contributor to HN for a long time and most of your comments aren't like this, but there is also a long history of us asking you to stop posting personal attacks:

https://news.ycombinator.com/item?id=46012112 (Nov 2025)

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Moreover, your account has continued to be in the habit of posting aggressive comments recently, including personal attacks (e.g. https://news.ycombinator.com/item?id=46478121, https://news.ycombinator.com/item?id=46463522). This is not cool.

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The military does insane cardio because when the enemy knows where you are sometimes you have to run hard and fast in hopes you can get to safety before they can kill you. I've known people who likely would have died in Afghanistan without that insane cardio.

it might help with stress too, but that isn't as clear

i think they are merely saying what worked for them. it is working for me too, despite my misgivings about “just taking a pill”. YMMV.

Depression isn't monocausal so it'd be far too simple for it to have a single solution.

But in general, humans just work better when we're regularly putting our bodies under reasonable physical load.

I'm a non-competitive athlete, and yes exercise can help depression, but no, it will not be sufficient for anything but your mild to average case of it.

Exercise is a crucial part of dealing with it, but it is not a panacea.

Depression is an umbrella term that covers lots of underlying biological conditions.

Exercise forms the foundation of a biologically healthy brain which is required for all conditions. For some conditions it’s all you need for others it’s not enough

True. I ran my but off in 2025 but it was mainly holding my anxiety over finding a job at bay.

>> I'm a non-competitive athlete

Honest question, but what do you mean by this?

I've played competitive team sports my whole life and have a very competitive drive. If its not team sports, its rock climbing where I feel like I'm competing against myself or my brain trying to solve a route. If I'm hiking, I'm competing against the clock or how far I can go. If I'm lifting weights, its about how many sets I can do and what weight in order to push myself.

So even in what most people deem "non-competitive" activities I'm still competing against a clock, or my body, or my brain.

I'm just curious what you meant is all.

EDIT: Typical HN. Ask a question and get downvoted. Logging off the day - thanks.

I'm not competing against anyone but myself, I'm not trying to meet any specific weight/size/etc cutoff for competition, the point is exercise and improvement and not any official or unofficial competition.

Someone might train for marathons, body building, etc. I don't.

Yeah, any of these studies that show “X works better than Y” are inevitably operating on averages. Not everyone will respond the same way. Not to mention that the very existence of the structure and human interaction required for these studies makes a huge difference in their outcomes.

I hesitate to ask but what is your gender? I think there may be very gender specific effects in this comparison. I would also be very curious the type and intensity of exercise and whether you had comorbidities that impact ability to train (obesity, low testosterone, etc).

I'm male. I've done everything from cycling to 5-10k running to heavy weightlifting. The only other thing I have is ADHD, no other comorbidities.

Thanks for the response and the useful (to me at least) data point. Glad the AD helped and sorry to hear you didn’t find all that exertion useful. Goes to show how individual we all are in terms of mental health.

> I also question the universality of it.

The article doesn't claim exercise is a universally effective treatment, so whose statements are you questioning?

There's no universality on anything linked to mental health.

I think the real exhortation is to develop a multi-pronged strategy for managing depression. I didn't feel like my depressed life got durably better until I had both exercise and therapy, and there are still times where things aren't going well with no clear discernible reason. I suspect that adding a low dose of medication on top would help.

Every additional coping mechanism you add, that works well for you, provides defense in depth.

Well... sure. I've had trouble with anxiety and it's actually an incredibly anxiety provoking thing for me to go to therapy. But I read enough information telling me that therapy is good for anxiety so I finally went. I think there's people out there who need to know that exercise is helpful for depression, even if the depression makes it difficult.

Much like the sibling comment I started walking around the local park before spending more time hiking. I live semi rurally though and wouldn't want to walk in an urban environment.

I normally feel much better after walking and cycling. Also I think doing something repetitive like walking allows you to think, tune out of other things.

Everyone is different, so I say this not to tell you how to feel but just to offer a different perspective:

Walking in urban environments can be its own sort of joy. Cities (well, good ones anyway) are full of life and energy and humanity, have unexpected nooks and crannies, and a rich sense of dynamism and excitement. Even late at night (as long as you're safe), a quiet city can be a source of serenity and melancholic beauty. Writers like Baudelaire and Benjamin described at great lengths the pleasures of flânerie.

Nature is wonderful too, of course! I love a good hike through the forests and mountains...but I also love a good stroll downtown.

No. Urban environments suck to walk around. What you wrote is utter drivel.

If one needs to justify it by quoting authors, that suggests it isn't self evident and they are just trying to justify something that they know isn't good.

What an unnecessarily hostile comment. "Utter drivel"? I was talking about how I personally feel. Am I just imagining enjoying the things that I enjoy?

Writers have, obviously, written about how walking in nature is nice. Does me saying that now mean that walking in nature is awful?

Maybe you're doing other people a favour by staying away from them, sheesh.

> What an unnecessarily hostile comment. "Utter drivel"? I was talking about how I personally feel. Am I just imagining enjoying the things that I enjoy?

No it isn't. Anytime you make an fairly straight forward statement on any website you get some unnecessary contrarian response.

There are a bunch of downsides to doing any sort of outdoor activity in an urban environment. That is just a fact. It is noisier, often there it nothing to look at, repetitive (in a bad way) etc. etc.

Therefore I would not recommend walking as a form of exercise in that environment as the vast majority of people wouldn't enjoy it.

Whimsical writings by 19th century French poets aren't relevant to those facts.

> Maybe you're doing other people a favour by staying away from them, sheesh.

What an unnecessary comment to make. I never said anything about what you are like.

What a bizarre response.

Not at all. It was a contrarian response.

Walking in an urban environment is generally not very pleasant. It is often repetitive (in the bad way), noisy and there is little to look at. It the reason they often carve out space for parks and commons.

It doesn't have to take deep discipline. I started my routine by just going for short walk after dinner everyday and it built up from there. It's intimidating to have to start at gym for 60 minutes 3x/week. Just do whatever little you like - a few pushups, a walk, a dance and stop when its not enjoyable. It tends to naturally build up.

This is 100% true, and what I'm about to describe isn't an attempt to falsify it: took me 11 years and 3 cities to figure it out.

You don't have to exercise so much as get moving.

I'm the best I've been in 37 years, and it's because in August I started forcing myself to just keep walking whenever I went out to have a cigarette. I was in Boston, and would end up ~nowhere and exhausted.

Then started doing random stuff: "might as well walk to Harvard Square instead of the bike path again" "might as well go to a bookstore instead of somewhere random" "I should use the skate park, I don't fit in*, but I miss rollerblading from middle school"

Then my dog died, 2 days later I severely sprained my ankle at the skate park and couldn't walk anywhere substantive for a couple weeks. By the time I'm able to do a sustained 10m+ walk it's winter.

Went to visit California as a not-tech-employee for the first time, so I saw San Luis Obispo and Los Angeles for the first time. And the same habit kicked in, in SLO I ended up hiking for the first time on what I find out later was not a real trail, end up hiking every day that week.

Get to LA and it's nothing like I would have thought. Egalitarian, tons of stuff to do, and Waymo is a godsend. Whenever I get antsy there's somewhere to go and a way to get there.

2 weeks later, I got an apartment in LA, moving away from Northeast for the first time in my life. I could see me just spending another 4 months decaying in Boston until its barely warm enough out to take a 30m walk, and I'm tired of that cycle..

All that to say, I'm fit, I had a great career in high school sports, I played basketball occasionally, but couldn't really get active consistently. Treadmill was never stimulating enough to keep my attention on anything other than being bored. In retrospect, I really wish I heard this old saw ~all of us know and heard it as "moving around" instead of exercise.

(n.b. this was all under active mental health care x medications spanning a decade+. It's not that the mental health care was useless, I don't think I could have done what I did without it. But it couldn't "fix" me on it's lonesome, only enable me to get moving.)

* in retrospect this was wrong, plenty of newbies, and one of the most welcoming social environments I've been in. just people out there all trying to do the same thing and supporting each other.

That's a great way to think about it. "Get moving" is a lot less intimidating and feels more achievable than "exercise" which conjures images of marathons and four-plate squats.

get moving is the key.

Some of my best friends are personal trainers and they say the same thing. When you tell people just moving essentially gives you what they refer to as "free exercise". The kind that doesn't make people feel like they have to get up off the couch, change their clothes, go to the gym, get on the treadmill, lift their weights, etc.

Just walking around the block. Just walking up a few flights of stairs. Just doing something that doesn't feel like you have to have a huge investment is sometimes the best way to start - then transition into more structured stuff like wight lifting or running or anything else. And you still get the benefits for almost nothing. Walk a few flights of stairs and your legs start to burn, your lungs open up, you increase your blood flow, and you release endorphins. And it didn't cost anything if you can just include it in your day-to-day activities.

Not sure how many times I make extra trips to my basement just to get in a few more stairs. lol

Getting moving *is* exercise.

No way could I do a gym and these days most things in a gym would be just begging for joint pain. But the wilderness is a great gym (assuming you know what you're doing safety-wise, I see too many idiots out there.)

> Getting moving *is* exercise.

There's a difference between what something is and what something is perceived as. For whatever reasons they may have, many people have a strong negative emotional reaction to the idea of exercising, ask them to go for a two mile walk around the neighborhood with you and they'll balk. But then you take them to a city like Rome and they'll walk 20 miles in a day without even realizing it.

(context: gp poster) It's extremely funny to contemplate what my resumé would say about my intelligence vs. it taking 11 years of really worrying about my mental state consistently, occasionally trying to precisely define "exercise" via my mental health professionals and get in the weight room, when I knew the whole time about that phenomenon. i.e. I'd play pickup basketball for 3 hours post-high school but wouldn't run for 10 minutes. (not saying you're wrong, the opposite, it is the fundamental core lesson. intellectual error was forgetting to expand "exercise" to include walking to places I wanted to be)

Also the bad times can be a great time to build good habits. I’ve tried and failed to develop an exercise routine many times, but it wasn’t until I was laid off for 6 months that it finally stuck. I had a friend who went to the gym every day in the middle of the day so I didn’t really have a reason not to go. 6 months was long enough for the habit to stick and fast forward years later and I still have the habit. It’s been so good that I regularly think about how good it was that I had the opportunity to be laid off.

You can also have a "deeply-disciplined routine" and get thrown out of it and hit depression because exactly by that one impact.

Source: Myself.

I’m not sure if you need to hear this but in case you do: There’s only one way to get back to it and the sooner you do it, the easier it is. First week is hardest, then the positive feedback loop starts kicking in. Do not to think about it, just get it done.

What most people without this "experience" never understand:

you just _cant_

If you've seen a distinct "low bar", its nearly impossible to get straight up above this bar

reread what you replied to

Fun fact, people suffering from loss of quality of life issues don't lack motivation. Lots of these people are in great pain, constantly, every day. My mother had a hip issue where the pain could instantly shoot up so bad she couldn't move (from just the normal, constant, almost in tears pain). She couldn't risk going somewhere to exercise, she would be stuck. She couldn't risk exercising on days where she needed to work the next day. Some days she would break down crying going to the grocery store because she had gotten stuck there the previous time she went.

A LOT of quiet unassuming people are INSPIRINGLY motivated to push through INCREDIBLE pain and obstacles, every day. Many that prevent them from 'just exercising until life gets better'. It is bullshit to say they lack motivation/character/willpower.

Nail on the head. I know that exercise will make me feel better, but during a period of depression/grief I could not even get out the house.

To my surprise, it has been my experience that this turns out to be pulmonary. It was always the chicken-and-egg of... breathing.

Seems like this has been my story:

Severe prolonged stress floored me. Turns out that the autonomous control of bronchoconstriction and dilation had gone out of wack, into dysregulation. My lungs were basically clamped shut. (Muscular tension and sundry dysregulation from severe prolonged stress makes sense, right? Applies to the lungs too!)

Exercise worked when I could get myself to do it... because exercise forces lungs to open.

And the nervous system and brain, well it requires lots of oxygen. In order to learn. And unlearn.

—

edit: Also interesting: Ketamine therapy worked. And... ketamine is a bronchodilator!

That's interesting. I've noticed when I go for a long-enough run and my body warms up to an optimal state, breathing feels easy and effective. I wish I could breathe like that all the time.

> Exhortation to develop those good habits in the good times, I suppose.

This is what medication for more severe cases of things like depression is supposed to offer: an opportunity to learn, usually through therapy, to cope with the condition in a healthy way.

Yup!

Same thing for ADHD.

Medication helps having willpower/focus to develop better habits and realize you are not a useless dumb human. It's just that your brain is a little finicky to get going sometimes.

In fact the few diagnosed ADHD people I know are wicked smart. It's just that their brain overclocks to unproductive levels without medication.

its amazing that we haven't found anyone dualwielding the skill of therapist and personal trainer. we already have things like sex surrogacy (https://www.webmd.com/sex/what-is-sexual-surrogacy) so its not like it would be that weird by comparison.

True, but the same is true for therapy. Finding a good therapist isn't easy, and having depression certainly doesn't make it easier.

One thing that worked well for me is I switched my transportation to almost exclusively bicycle. Do I always want to exercise? Do I always want to get on my bike when it's below zero in active weather? No, not always. But if I want to get where I'm going that's my option and I get the exercise in the process (and save a buttload of money too)

I think we also approach exercise the wrong way. And IMO this is true with sleep too (which also impacts depression). We're using the wrong metrics.

The most important thing to get started with working out is just to start doing some exercise. You can start on one push up a day or something. It's all about creating momentum and habit.

Once you do it, then you can increase the time and the intensity and optimize exercise and all. But doing sport should be about doing one push up a day and thats it. About starting as slow as you can.

Sleep is the same in that we try to sleep as much as we can, and get as much REM and deep sleep, and these are not the right metrics for most people. The most important is just to go to bed and wake up at the same time everyday. That's it.

People are obsessed with trying to go to sleep at some point in time. Don't. Go to sleep when you're tired, wake up sleep deprived at the right time, the next evening it'll be easier to sleep at the right time

My two cents on this topic is to create short term, superficial incentives to help create the practices that yield the long term incentives. For me this is paying extra for a gym with a hot tub, sauna, and cold plunge. Now I derive relaxation from the workout, but before that I also received a lot of support from the knowledge that the amenities afterwards were waiting for me.

I'm not a big believer in discipline.

“Action precedes motivation.” ― Robert McKain

This seems to work for me at least. If I start trying to reason with myself why I should get out of bed at 5am to go to the gym rather than excuse XYZ, I will talk myself out of it.

If I simply start "moving" and start doing "stuff" without engaging my brain, things happen and within a short space of time, I'm pumping iron and feeling great.

That is true. And motivation is not a fixed variable. It is possible to get increased motivation by a better plan, resulting in increased self efficacy.

From studies like this, maybe more awareness and perhaps funding to solutions providing smaller steps

Shameless plug, I am building one: Low friction mini games, social, squats/situps/pushups. Feelgoodcrew.com

Once exercise becomes a habit, it's very easy to do even on days when your mood is terrible. A strict routine (initially) is the trick to making things easier forever.

You definitely want to build that habit when you're at your best.

i think what is missing from this narrative is not whether or not people have a routine, it is that exercise elevates your mood away from the depressed state, therapy encourages you to question your thoughts and decisions through out your day that might lead you away from a depressed state. to put it a different way, whats the point of exercising every day if you continue the thoughts and habits that are less than satisfactory to you without any self awareness?

I always wondered if this kind of research was just finding that depressed people motivated to exercise are already in a recovery mindset

Motivation generally follows action, not the other way around.

I hear ice swimming also works.

If you are or you know some that is depressed one of the best things you can do is start exercising with someone.

I really like this advice. When I'm sad I don't want to leave the house, and certainly won't have the motivation to do much exercise on my own. But having friends peer-pressure me into making good choices would (and has) helped a lot.

This is only talking about therapy and not medication. The original study is a bit light on details https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

> For the 57 trials (2189 participants) comparing exercise with no treatment or a control intervention, the pooled SMD for depressive symptoms at the end of treatment was −0.67 (95% confidence interval (CI) −0.82 to −0.52; low‐certainty evidence), showing that exercise may result in a reduction in depressive symptoms. When we included only the seven trials (447 participants) with adequate allocation concealment, intention‐to‐treat analysis and blinded outcome assessment, the pooled SMD was smaller (SMD −0.46, 95% CI −0.88 to −0.04). Pooled data from the nine trials (405 participants) with long‐term follow‐up provided very uncertain evidence about the effect of exercise on depressive symptoms (SMD −0.53, 95% CI −1.11 to 0.06; very low certainty evidence).

Like, what does -0.67 really mean in this context. I read the study and it is not really explained. Maybe I'm too dumb to get it, though.

Other metas show exercise is more effective than both therapy and drugs.

ssri don’t fix any underlying condition and barely work long term, that if they really work at all.

What if medication helps people being able to exercise?

It's a standardized mean difference, which I believe can roughly be interpreted as: "treated groups had 0.67 stddev lower depression score than control groups."

That's a pretty substantial improvement - consider someone who's more depressed than 75% of the population becoming completely average. (Because the 75th percentile is about 0.67stddev above the median.)

You cannot say if this is a substantial change or not, because you need to know by how much the groups actually differ on average, i.e. you need the unstandardized effect size, expressed as a mean difference in the scale sum scores, or as an actual percentage of symptoms reduced, or etc. In general, there are monstrous issues with standardized mean differences, even setting aside the interpretability issues [1-3].

See also my response to GP.

[1] https://journals.plos.org/mentalhealth/article?id=10.1371/jo...

[2] https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1348/0...).

[3] https://www.tandfonline.com/doi/abs/10.1080/00031305.2018.15...

Good point. Would it be roughly accurate to say: "consider someone who's more depressed than 75% of the *study treated* population becoming completely average *among the study treated population*"?

Nope, you can't say how many people return to average from standardized effect sizes. I wish we had a standardized effect size that was more useful and actually meant something. Cohen actually proposed something called a U3 statistic that told us the percent overlap of two distributions, but that still doesn't tell us anything meaningful about practical significance.

You can't make decisions / determine clinical value from standardized effect sizes sadly, so when I see studies like this, my assumption is unfortunately that the researchers care only about publishing, and not about making their findings useful :(

It means nothing, standardized effect sizes have no clinical meaning here, they are purely statistical. To measure if these kinds of changes matter, you need to determine the Minimal (Clinically) Important Difference [1-2]. I.e. can clinicians (or patients) even notice the observed statistical difference.

In practice, this is a change of about 3-5 points on most 20+ item rating scales, or a relative reduction of 20-30% of the total (sum) score of the scale [1-2]. Unfortunately, anti-depressants are under or just barely reach this threshold [3-4], and so should be widely to be considered ineffective or only borderline effective, on average. Of course this is complicated by the fact that some people get worse on these treatments, and some people experience dramatic improvements, but, still, the point is, depression is extremely hard to treat.

Unfortunately, this also means that if exercise is only nearly as effective as therapy for depression, it may mean that the benefits of exercise are not actually really clinically observable, if measured properly and not just based on arbitrary statistical significance.

EDIT: There is less data on MCIDs for therapy, but at least one review suggests therapy effects can be in the 10+ point range [5]. But the way the exercise study is presented, with standardized effect sizes, we have no idea if the results matter at all [6].

[1] Button, et al. (2015). Minimal clinically important difference on the Beck Depression Inventory - II according to the patient’s perspective. Psychological Medicine, 45(15), 3269–3279. https://doi.org/10.1017/S0033291715001270 [https://www.cambridge.org/core/journals/psychological-medici...]

[2] Masson, S. C., & Tejani, A. M. (2013). Minimum clinically important differences identified for commonly used depression rating scales. Journal of clinical epidemiology, 66(7), 805-807. [https://www.jclinepi.com/article/S0895-4356(13)00056-5/fullt...]

[3] Hengartner, M. P., & Plöderl, M. (2022). Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evidence-Based Medicine, 27(2), 69-73. https://doi.org/10.1136/bmjebm-2020-111600 [https://ebm.bmj.com/content/27/2/69.abstract]

[4] Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should antidepressants be used for major depressive disorder?. BMJ evidence-based medicine, 25(4), 130-130. https://doi.org/10.1136/bmjebm-2019-111238 [https://ebm.bmj.com/content/25/4/130.abstract]

[5] Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of affective disorders, 159, 118–126. https://doi.org/10.1016/j.jad.2014.02.026 [https://pubmed.ncbi.nlm.nih.gov/24679399/]

[6] Pogrow, S. (2019). How Effect Size (Practical Significance) Misleads Clinical Practice: The Case for Switching to Practical Benefit to Assess Applied Research Findings. The American Statistician, 73(sup1), 223–234. https://doi.org/10.1080/00031305.2018.1549101

Exercise is great, just make sure to take sometime to evaluate where you are at mentally. I was running about 40 miles and doing 5 hours of lifting per week to try and stay a head of my depression, and when I finally burnt out everything came crashing down all at once.

Exercise is great for addressing feelings related to being physically inactive. It won’t address other mental health issues, such as learning to control your emotions & fostering healthy relationships.

There's a deeper level to the way you calibrate your mental operation. If you're under a lot of mental stress, your body is evolved to prime you for physical effort, beyond the fight or flight responses. By engaging in exercise, you're resetting your physical condition, and that can put you in a much better position to mentally cope with whatever is happening.

This is something that has very deep evolutionary roots. A looming project deadline, a relationship crisis, feeling burned out, general malaise about your place in life - all of those stressors can bring about different neurochemical and hormonal changes that are in whole or in part dealt with in a healthy way by engaging in strenuous physical activities.

That puts you in a position to gain perspective without the immediacy of the negative emotion, so you don't have to feel anxious, or have subtle negative threat framing around everything.

You can abuse that, like anything else, and mask real negative factors in your life, or it can be a phenomenal and healthy way to deal with the negative framing of otherwise neutral or even positive circumstances in your life.

The problem is when the exercise is excessive and/or the depression is caused by stress/overload. In that case the exercise can lead to burnout/CFS/overtraining, resulting in worse depression as well as debilitating physical symptoms.

> Exercise is great for addressing feelings related to being physically inactive.

That definition is probably too narrow.

https://en.wikipedia.org/wiki/Neurobiological_effects_of_phy...

I think one of the tricky things about depression is how unique each person's experience with it can be. I can only speak from my own history. For me, medication was indispensable in getting me to a point where lifestyle changes could occur.

That being said, I do believe that exercising, eating right, maintaining a healthy sleep schedule, etc., all the boring lifestyle things have been key to preventing myself from slipping back into that depressed state, years after stopping medication.

If it helps anyone I take antidepressants and have had a positive experience with them. Depression can be caused by a chemical imbalance and no amount of exercise or talking about it will fix it.

One of the most frustrating things when your really low is people giving advice like do exercise to feel better - please don’t do this.

> Depression can be caused by a chemical imbalance and no amount of exercise or talking about it will fix it.

This is a debatable. As far as I understand things: 'chemical imbalance' has no tests to confirm that's actually true, That's just a story they tell to relax people.

Which is orthogonal to the point that antidepressants can work for some people.

We don't know how depression works. It very well may be many little things dressed in a trench coat.

https://www.sciencedirect.com/science/article/pii/S266656032...

https://www.nature.com/articles/s41380-022-01661-0

https://www.neurocaregroup.com/news-insights/the-death-of-ch...

Jim Carey had the best way to think about this: “I believe depression is legitimate. But I also believe that if you don’t exercise, eat nutritious food, get sunlight, get enough sleep, consume positive material, surround yourself with support, then you aren’t giving yourself a fighting chance.”

I wonder what his thoughts are on post natal depression? Of course those things help but there can be factors outside of people’s control that can lead them down this path…

Another quote from Jim Carey:

  People talk about depression all the time.

  The difference between depression and sadness is sadness is just, you know, from happen stance. Whatever happened or didn't happen for you...

  ... and depression is your body saying fuck you, I don't want to be this character anymore, I don't want to hold up this avatar that you've created in the world. It's too much for me.

  So, a friend of mine who's a spiritual teacher has a really good take. His name is Jeff Foster, and his take on it is that they should change [how we think of] the word "depressed" as "deep rest"

  deep rest - your body needs to be depressed, It needs deep rest from the character that you've been trying to play.

Link: https://youtube.com/shorts/lMQJ2bHeP4c?si=UPRHV8DVWZ77nXCM

If you say that to a depressed person, they are going to sink deeper into despair. Most people (even those who are not depressed), are not meeting that bar.

Always remember, being true is not the same as being helpful.

Id rather we start with some variant of that rather than to default to dope so we don't offend people with the truth.

Exercising can help. It's not bad advice or inappropriate to suggest it. People shouldn't suggest it as if it's a cure all and certainly shouldn't suggest you just need to buck up, but the study is showing it can really help.

Context: I'm "using" SSRIs, talk therapy, psychotherapy, strength training and endurance training -- all in parallel right now.

It can be inappropriate depending on where the person is, when I was diagnosed I could barely get out of bed. Feels a bit like telling an anorexic person to eat something.

"Chemical imbalance" theories of depression (e.g. "serotonin hypothesis") have been scientifically discredited for well over a decade now.

EDIT: For a recent overview, see https://www.nature.com/articles/s41380-022-01661-0

I support people taking antidepressants if it helps them.

But I have to say the "chemical imbalance" theory either means no more than "depression responds to an antidepressant (sometimes)" or it is false/meaningless. Neither neurologists nor psychologists have a sufficiently detailed understanding of the workings of the brain to make such a claim.

Again, I'm glad drugs work for you. I would note that there three ways drugs can go for people; working with few problems, not working, working but with significant physical and/or psychological side-effects. Especially, taking any substance daily for the rest of one's life can stress the organs responsible for digesting/processing regardless of whether than substance is otherwise a great fix.

So I think we need to look beyond a glib "this fixes it for everyone" rhetoric even if this fixes it for you (and yeah, some of my friends should at least drugs, I'll admit).

Yes, exactly. I have exercised daily (either weight training or cardio) for nearly 20 years. I've also had anxiety and depression for that entire stretch of time.

Exercise was how I stayed mildly sane for a good majority of those years, but when I started taking medication it was like the entire world changed. I wish I had started earlier in life. It helped me to become a lot more introspective as well, being able to better examine why I was feeling the way I did.

There are some things that no amount of exercise or "healthy living" can fix, that's unfortunately just the human condition. It's nothing to be ashamed of.

> Depression can be caused by a chemical imbalance

And yet many other times, it can be caused or exacerbated by situational and psychological factors, including "being stuck at home all day".

> One of the most frustrating things when your really low is people giving advice like do exercise to feel better - please don’t do this.

Worse, antidepressants actually cause significant harm to many people who take them, often without even improving their depressive symptoms. This is very bad, and I would say significantly worse than giving general advice that might be inapplicable to some people.

There's no one-size-fits-all solution, and some people probably are legitimately just in need of more motivation to go running or biking or whatever else will get them the exercise they need.

Usual antidepressants (reuptake inhibitors) have specific chemical and clinical effects. Some forms of depression, mostly with stress, respond heavily, others, like refractory and bipolar, show no effect. It's like saying a knife cannot cut an arbitrary material. It depends. Studies of ADs must start to differentiate at least a few subtypes of depression.

The hypothesis of chemical imbalance causing depression is mostly discredited.

https://www.ucl.ac.uk/news/2022/jul/analysis-depression-prob...

Some times its almost like telling a person in the middle of a heart attack that they ought to change their diet and start exercising more.

that $5K deductible though...

Apologies - one of the very few great things left in UK is the NHS and my diagnosis was free and my prescription is £9/month.

I take sertraline (Zoloft in the US I think) and that is cheap - $20/30 month.

You would pay less than £9 in the USA for 1 month of sertraline.

Maybe so, but I also cut m finger quite badly on NYD, I went to an urgent care centre had it looked at, x rayed and dressed and some antibiotics. The next day I had an appointment with a consultant and then went in to surgery to have it inspected to see if I had cut the nerves or tendon (thankfully I had not), had it swen up dressed, and a follow up appointment to have the dressings removed and final check. All at no cost.

The £9 is for the administration of the prescription - if th drugs are super expensive heart medication or whatever, it would still be £9 (or free).

I stand by NHS being the only great thing we have left.

I'm not even talking medication, talking about cost of therapy it's like $200 per session sometimes but yeah all depends

I had to pay $3K for an MRI in cash one time, which yeah you get what you pay for but my buddy pays $2.8K/mo in insurance for his family, like that's a big chunk of his monthly pay

Oh I want to be clear no snark towards you this is the cliche topic of healthcare in US

Regarding the topic at hand though, yeah I lift 5 days a week and do a half hour of maximum inclined walk for those days as well. Mental health but also I want to be ripped. Helps my job has a gym and I'm the only one in there in the mornings. We also walk like 2 miles at work, in circles around the parking lot, talking to co-workers 4 days a week.

My main problem is anxiety, like I wish I could walk downtown in a city and do street photography but I fear that someone will ask me for money or get robbed. The funny thing is I'm a big guy, like 6', I bench almost 300 lbs. I'm not like a stick. I have a fear of crowds too I can do shopping but sometimes in like a WalMart that's a lot of people and of course I'm terrible with women, the fear even if I have the bod. I'm just scared of eye contact and low self-esteem even having a six-fig job my self-determined value is whether a woman will say yes to me or not, it's funny. I don't have a fear of speed I can drive 160mph+ on the highway, helps to have a good car.

But for the moment I'm working towards freeing myself from debt and then being able to live a life where I'm not in fear of losing my job. I'm a privileged person, this is brought on by myself eg. dropping $1.2K a night at a strip club or $600 Venmoing a band to play song requests. I'm complaining about therapy cost lmao.

> my diagnosis was free

As long as you don't factor in your taxes.

Do you think they're stupid and just don't realize that they pay for it with taxes?

You're not factoring in the most critical piece of financing - the mental burden. You don't want to be stuck figuring out how to get enough money to pay for mental health services when you need them the most. That's when your earning potential is at its lowest, and every minor obstacle to getting help gets magnified ten fold.

That may as well be a death sentence unless you're privileged enough to be able to easily pay for it with savings. Realizing that you need help, figuring out how to access it, and actually following through is hard enough as it is without any added financial burden.

For me I think the quality and type of care is different when there’s no profit centre - it’s just people looking after people.

I take this to mean therapy for depression (particularly for men) is barely effective at all and exercise is not quite as barely effective at all.

If therapy for depression were a pill, I'm not sure it'd demonstrate enough efficacy to get approved.

Anecdotal obviously, but from my experiences and those in my friend-group, therapy seems actively harmful in many circumstances. Therapy can be an enabler of bad behavior, helping to build a new fancy framework of excuses just as easily as it can help you land somewhere better. How long has it been since you've seen something bad (maybe it was just slightly selfish, maybe it was something worse and chronic) waved away as "self-care"? Or if you've lost faith in people or communication generally, then you're not going to feel better by going through many rounds of therapist mismatch and at some point you've aggravated problems rather than fixing them. Fortunately for the industry, measuring the harm is just as difficult as measuring the benefits. The advice to "just exercise more" may not help, but at least it really can't hurt.

> Therapy can be an enabler of bad behavior

Be aware that a lot of therapists are aware of this and actively try not to do this.

Unfortunately, services like BetterHealth allow clients to select their therapists in ways which results in people doctor shopping to get what they want. Doctors want to get paid so they'll say/do whatever to keep clients.

It's like the antibiotic issue with internal medicine. People will see a bunch of doctors until they get what they want.

That's one of the interesting paradoxes to me: everyone I know who's had therapy says you need to "shop around" and find the right fit.

On the one hand, I feel this is right. With dentists and doctors, second opinions are important because we all know people who have had years of their lives or physical health ruined due to quick doctor's visits where the doctor was light on time, patience, and information.

At the same time, it seems like it can be like that episode of It's Always Sunny in Philadelphia where they just keep firing their arbitrators until they find one that isn't concerned with ethicality.

Yes but isn't this pretty fundamental to the process? You could look for more qualified/expensive people, but even if it were free and everyone was extremely qualified then there's still customer-satisfaction metrics to try and game.

To bring it back towards exercise, it's fair to say that it literally cannot hurt and might help, which is more than you can say about therapy. And at least it is very, very telling whether a therapist is working questions about sleep/exercise into the very first interactions. Anyone who does not is definitely a quack.

The problem is that the same is true for many medications and other treatments, but if you're in the "lucky" minority (a pretty large one) for whom there's some relief... it's worth the try. It's not like choosing bleeding and emetics instead of chemotherapy for cancer, it's just the best we have right now to treat a complex system that we barely have the earliest understanding of.

Adding to this, the molecular mechanisms of psychiatric disorders such as depression, bipolar disorder, and schizophrenia are not well understood. People prefer their brains and skulls intact so taking brain samples for study is not possible.

Diagnosis and grading is fuzzy - a cluster behavioral symptoms observed and reported by patients, family members, and clinicians.

Based on some of the genetic evidence, which can also be fraught, it is likely that something like depression is in fact a grouping of a bunch of separate underlying disorders / causes that all result in the same (easily) observable symptoms. Hence why some treatments work on a subset of patients, but are ineffective in others.

Psychotherapy is similar to pharmacotherapy in effect size but longer lasting after discontinuation. Given that the latter has been approved, it's safe to assume psychotherapy would be approved if it were a pill.

I think the major problem we have is we are lumping depression and anxiety into the same category.

Some people probably do have issues quickly resolved by SSRIs. Others are magically fixed by bupropion while it spikes anxiety in others. Others have major trauma that they have to work through and many therapies (like internal family systems therapy, as one example) are great at handling that. Others are stuck in cognitive distortions and merely learning about them and handling them (through cognitive behavioral therapy) can be life changing.

But if you have major trauma in your past, exercise is probably not going to do much. If you are heavily overwhelmed and your body is stuck in perpetual flight or fight) exercise and meditation might be a giant help.

But right now the practitioners are aware of this, but it's really hard to double blind test these divisions until people can do the analysis first. And at that point, you've basically already started therapy.

I don’t think that conclusion follows. These results don’t mean “barely effective.” They mean that, on average, people who get therapy or exercise end up noticeably better off than people who don’t. When researchers translate the results into intuitive terms, therapy typically moves the average person from the middle of the pack to around the top 30 percent, and exercise to roughly the top 35 percent. That’s the same general magnitude of benefit seen with many approved medications, including antidepressants themselves. Depression trials have large placebo effects, which makes the numbers look smaller, but that doesn’t mean the treatments are doing almost nothing.

I can see how therapy can be helpful for some people. But I find it to be a big scam from my own personal experience.

What incentive do they have to give you immediate and durable results? Why do most only take cash?

I did some ML work with an addiction psychiatrist at the peak of the opioid crisis. He said,”To pay my bills, I have to treat rich people.”

I find taking long walks and speaking candidly about how I’m feeling is always the most effective way to deal with tough emotions.

You are assuming everyone has someone to take long walks with and speak their innermost vulnerable thoughts/feelings with. A therapist is a paid person to achieve this same outcome.

No I’m not. Please read the first sentence of my post.

I agree, it’s tough to be honest when you’re vulnerable. Expressing vulnerability exposes how people really feel about you.

You’re right I missed that. We’re in agreement then

and people wonder why i call psychiatrists legal drug dealers - what incentive does a psychiatrist have to fix someone , when they could make 10x more money keeping that person dependant forever

Any psychotherapist, and mainly psychiatrists, tries to create a heavy dependence to their patents, not so chemical but behavioral and psychological, which they call patient bonding. They don't want to instruct the patient and make them independent. It's shown that this causes a consistent improvement and simultaneously establishes their dominance long-term.

> Any psychotherapist ... tries to create a heavy dependence to their patents, not so chemical but behavioral and psychological, which they call patient bonding.

This world view is extreme, not true, and directly harmful to your mental health.

You should consider talking to a psychotherapist about why you feel that way :^)

In all seriousness, the world is a much more pleasant place when you discard extremist views and accept the good with the bad.

it is a choice to take the red or blue pill

If we had effective treatment, then psychiatrists that are effective would quickly displace ones that keep you hooked on non-effective ones.

theres definitely a few counter arguments that are valid ... on a personal level i am far too biased to consider changing my mind , after multiple times witnessing psychiatrists increase drug dosages upon being informed that symptoms were improving ... thats what a drug dealer does not a doctor ... oh shit that sounds like an llm hahaha

I decided to go unmedicated from SSRIs/mood stabilizers in 2024 and it changed my life for the better. Prior to stopping, I thought I was physically unhealthy until I found out excessive overheating & exhaustion was a common side effect of Zoloft. Since then, I've lost around 40 pounds and have been able to regularly exercise without issues. My mental health also improved with forcing myself to get vitamin D outside. It can be the simplest of things to improve your life, but it can be easy to forget (especially WFH).

Did you get the "brain zaps" when coming off the SSRIs? How long did it take?

Definitely. It wasn’t too bad, but it took roughly a month for the brain zaps to completely stop with Zoloft & Wellbutrin. I had worse brain zaps in the past from Lexapro, that was bad enough I’d lose focus on whatever task I was doing.

I've had many exercise regimens throughout my life but never has it ever helped me with mental health in any way.

Exercise has always been a mental drain for me. A day when I go to the gym is a day when I give up mental capacity that could have been used for something else. I'll be less effective at work and less organized at home. It's like my IQ's dropped by double digits.

I drink enough water and electrolytes, in case anybody's wondering.

Sorry if I'm stating something obvious for some, but, exercise doesn't HAVE to be something pushed by the industry like running or going to the gym.

I got great success converting friends and coworkers to... walking.

Not going on a multi-hours hike on the weekend, but just walking around the block or in a park for half an hour at mid-day, and going through the same routes so you don't have to think about finding your way.

By doing so, not only you are physically active, which is a big positive overall for most of office workers, but it requires so little of focus to achieve it that your mind is now free to wander as it please.

During this free period, you can come up with a solution to an issue you've been stuck on during the morning or for days, or you'll think about plans for the future, or you'll just get back to work with a clear mind, ready to tackle the issues of the afternoon.

> I give up mental capacity that could have been used for something else

That's the beauty of _just walking_, it requires no mental capacity, it frees it actually. Don't overthink things, like where should I walk, when, do I have the right gear... Just get outside, put the appropriate clothing depending on the weather and, enjoy your free mind compute credits!

Once you see how it works, it feels like cheating.

Afterwards you'll feel better physically and mentally.

All the gym/running/zone 2 stuff is something different altogether that could come up once you're converted to the light exercise/big effects of _just walking_.

I took meds for depression a few years ago. I don't know that they did anything other than signal to myself that I wasn't ready to give up. They may have served as a kind of "dumbo's feather" that helped me get through a rough patch. Exercise might be similar. People who choose to exercise make the statement to themselves that they are worth doing something positive for. Some mental health problems resolve with time and without medication, and in those cases, exercise might be a great way to address them. But if you're struggling, call your doctor and make and appointment. Medication is sometimes the answer.

There is a tri-lateral(?) relationship between exercise, sleep, diet, and how the three impact mental health.

A waste product of exercise is Adenosine. Adenosine build-up leads to increased sleep pressure, and improved Neural Function of Sleep, not just "being unconscious".

This is where things get a bit interesting when we look at depression. For many people, depression results in decreased Neural Function of Sleep (specifically slow-wave activity) even though sleep time often increases.

However there is also some evidence that restricting slow-wave activity can act as a "reset" button. The researchers I have spoken to about this are either in the "too dangerous to do the research" camp, or "distrupting slow-waves for a very short period, then increase slow-wave activity".

Of course, sleep and exercise would only be a single pathway to improving depression outcomes. Exercise alone, and the dopamine, oxygenation, and many other outcomes are also likely to come into play.

Comparing this to pharmaceutical or behavioural therapies, I can see why they'd be as effective. You're treating the entire system, not just trying to change a single chemical in the brain, specifically when we aren't even measuring the chemical before or after treatment.

I found this to be contradictory with my mental health period even after losing nearly 100 pounds, and going from zero to walking 8 to 10 miles a day, my mental health did not improve. It felt good to accomplish goals, two life-changing goals, really, but my overall disposition and deep depression did not change. I have no explanation for this.

It may be worth looking into childhood trauma if that's something that may be applicable. I had a similar experience, after losing 35kg over 3 years I felt and looked great on the onsite, even having to overcome back surgery during that period as well, felt like I'd conquerered the world. I thought I'd "done enough work", but as I found out, sometimes there is work to be done on the inside as well.

I exercised for years. I’m talking multiple hours a day. It was a part time job. It never improved my mood.

Some people don’t suffer from chemical imbalances, unhealthy habits ruining their mood, or whatever your snake oil will magically cure. There’s a term called Shit Life Syndrome and some people just have that as their long term situation.

For a long time I used to be able to manage my exercise with depression. Eventually, it stopped working. I literally climbed a mountain, got to the top and felt nothing.

What got me out of that place was improv comedy lessons. Highly recommend to anyone. Improv schools and theatres should be as ubiquitous as gyms.

Did you mean manage your depression with exercise?

I've found out that running outside just for 10 minutes with quite high intensity is really effective for anxiety / depression with instant effect. Also, specifically lactic acid producing exercises, such as doing free squats quickly works too. It might have something to do with how the brain uses lactic acid for some functions, but this is just my guess.

Found out that there's some research on this: https://www.biotechniques.com/biochemistry/exercise-lactate-...

This kind of makes sense. Most forms of depression have to do with not wanting to do something or lacking motivation to do so. Whereas in sports, people get busy usually, they do something, even if it may just be soccer playing. Exercise is also usually good for one's physical well-being, blood circulation increases, muscles may improve, pain may go away (depends on the exercise, but usually say, two days after some heavy work out, most people may feel better than before, unless it was some extreme exercise that caused injury).

I don't think this works for all type of depression though.

I wonder if there’s some survivorship bias. E.g. did they only study people who started and maintained a routine vs. everyone who started a routine but couldn’t stick with it due to depression symptoms

Observation bias. Those who succeed to drive themselves to do an effort, are already out of the depression. Try doing 7hrs sports a week and falling into depression: You won’t have the energy. It’s not sports that gets you out of depression, but sure it’s a stage on the way back and you gotta constantly give it a chance.

This is spot on. "To stop being sick you just have to do all the stuff healthy people do, and not do the stuff sick people do! I have never seen a healthy person being sick, so it must work!".

I will speak from my experience. I have diabetes and I try to manage it well, with workout. But sometimes when the sugars are high for a while, I can feel it, the sadness, the hopelessness. It took me a while to understand that is high sugar levels and a mild form of depression. Now I will do some workout when I feel that and after a little workout, I can see how my mind also start to feel better. This is not a solution for everyone who is experiencing depression probably but might help some who are experiencing because of high sugar levels.

hey friend, I'm glad to hear you found a way to improve things. It's not easy.

I also notice my mind better after workouts.

I tried intensive workout

It's unhelpful because I got tired, and then I stopped workout entirely

Now I just do fast walking and it's nice

Have you tried lifting weights (different pace than HIT)?

You sound like a couch potato, like me.

Try HIIT 1 minute walking, 1 minute running

stimulating for the brain, safe, fun and an easy way to ease into running.

I would assume that "doing something" is the key here? Successfully doing exercise probably has add on benefits that you can more successfully do other things afterward. But successfully reading a book can help me get out of depression. Successfully cleaning the kitchen. Really, just successfully doing anything is a huge cure against depression.

I'm not sure this is the type of depression being talked about here. It's unfortunate that we have conflated periods of being sad / down with clinical depression. I have no doubt that reading a book or cleaning the kitchen or accomplishing a goal can help with feeling down or general sadness, but clinical depression is a whole separate beast without such easy a fix.

Who said these were "easy" fixes, though? I am emphatically not claiming that "just doing something" will work. Though, fair that what I put there can seem that way.

I am more trying to claim that "just doing something" has an annoying track record of looking like "it" is what worked. I would fully believe that, in reality, the thing that worked was already at play before the success started happening. That is, fully depressed people don't succeed at any of these things.

No, it’s more specific - doing something physical.

Cleaning dishes yes, reading a book no

My point in including both is that both can be surprisingly effective and turning my mood around. Despite them being very different. Included the dishes because that is physical and a chore that most people actively dislike.

Edit: Just to be clear, per my other post sibling to this, I should say that they can both seem to be very effective at turning my mood around. I do not, necessarily, think either is causal on their own.

Its also a huge sign you are already on your way out of the depression.

Physical exercise, like diet, and mood are complicated bio-psycho-social functions that are depended on dozens of overlapping factors in each person. Most meta-analyses and their underlying studies ignore most of these dimensions and come to a binary yes-no conclusion based on a mere p-value. Huge confounding effects persist that the studies should heavily take into account. At least examining such popular functions provide large samples cheaply.

May rampant depression everywhere be caused by not the lack of exercise, but because of life becoming overly sedentary?

30 years ago moving your body wasn't going to the gym, it was part of everyday life. Staying 2 hours nonstop in front on the screen was to watch a movie, and maybe done a couple times a week, tops.

Now we just deliver 3 tomatoes to our doorstep to avoid going out.

This leads to a fairly obvious conjecture :

That since for 100,000 years humans were roaming the landscape gathering or hunting, and for 10,000 years engaged in heavy agricultural work, is the modern day rise in depression not just correlated but caused by the modern day reduction in daily heavy exercise?

It’s such an obvious idea I am wondering if folks know of any research / studies on it?

Don't underestimate the meaning and relationships people had in those times, hunting together to feed your family, farming with your community and interacting with animals etc.

I think physical activity, even just going on walks makes one feel change is possible. If something sucks and I sit home all day on YouTube, then it continues to suck. If I can change my environment, do things outside, see new people and find myself if different situations, then the thing that sucks starts feeling like maybe it also could change.

For example I doubt exercising in a basement just by yourself on 1 machine is likely to materially help with depression. At least not as much as going out doing a variety of things, or playing a game of basketball at the local gym/community center.

Yeah. I think the communitarian point is valid, and valuable. Also, even if you only do that 1 machine thing in the basement, you can regard it as an achievement that's worth something. At least I did that thing. It makes me feel kinda ok too, or just better.

>is the modern day rise in depression

I think it was quite hard to get an appointment for a depression diagnosis 100,000 years ago.

The audiobook Spark by Dr. John Ratey, psychiatrist is a great listen with a bunch more evidence based arguments to support that exercise is better then drugs for depression.

I highly recommend the audiobook as it is read by him and he is very enthusiastic about his research.

The one quote I remember from the book is that he stopped prescribing Prozac and started prescribing treadmills...

I did a summary here: https://www.chestergrant.com/highlights-from-spark-how-exerc...

It's in my top 15 books that changed my worldview.

Some key highlights:

1. In 2001 fit kids scored twice as well on academic tests as their unfit peers.

2. German researchers found that people learn vocabulary words 20 percent faster following exercise than they did before exercise, and that the rate of learning correlated directly with levels of BDNF.

3.Specifically, every fifty minutes of weekly exercise correlated to a 50 percent drop in the odds of being depressed.

Nothing has solved sadness for me as well as lifting weights, long fast bike rides, and team sports. Nothing.

I’m here ti add my own anecdotal two cents:

2024 has been a rough year. I didn’t begin any real recover until around march-may 2025… when i started going yo the gym and lifting weights. Yeah sure i’m doing therapy and all that jazz but the real improvements started with weight lifting.

I'm sure the result is in some sense valid, but it's like saying that radiation therapy can be nearly as effective as antibiotics for a sore throat. The conditions under which it works, the method of action, and what is accomplished are all different.

It’s also fantastic for anxiety, or at least it has been for me. Though I’ve heard anxiety and depression are often linked so I wonder if there’s some common underlying mechanism by which it helps either both.

Therapy carries a huge risk, so maybe if you compare average outcomes exercise is only nearly as effective, but if you consider the 2 overall exercise comes out way, way ahead imho.

Is the huge risk being involuntarily committed?

If so, that is a risk that is very dependent on local laws. I would be much more cautious about seeking mental health care in Florida, where the Baker Act makes it very easy, than in Connecticut [0]. The risk of being involuntarily committed also, of course, has to be balanced against the risk of forgoing mental health care when you need it and then injuring or killing yourself.

[0] https://psychiatryonline.org/doi/10.1176/appi.ps.201900477

That seems like a minor concern. Therapeutic malpractice is a thing, misdiagnosis, iatrogenic treatments and so forth; not uncommon. Was a time when gay was in the dsm, the pendulum has swung back and forth on transgender children.

Extremely disappointing analysis in the article and also the cited paper's abstract [0]. The only way this data could possibly hold any value is if they found a way to control for how depression might influence an individual's likelihood of choosing to participate in the trial in the first place, as well as trial completion rates.

Even an amateur could read the headline and instantly understand this critical point the experiment's design, and yet it's not even acknowledged under the "Risk of bias" section.

[0] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

Unfortunately, if exercise is only nearly as effective as therapy for depression, it may mean that the benefits of exercise are not actually really clinically observable, if measured properly and not just based on arbitrary statistical significance.

Standardized effect sizes like the ones reported here have no clinical meaning, they are purely statistical. To measure if these kinds of changes matter, you need to determine the Minimal (Clinically) Important Difference [1-2]. I.e. can clinicians (or patients) even notice the observed statistical difference.

EDIT: There is less data on MCIDs for therapy, but at least one review suggests therapy effects can be in the 10+ point range [5]. But the way the exercise study is presented, with a standardized effect size, we can have no idea if the results matter at all [6].

Nearly as effective? It’s significantly more effective!

This is complete bullshit. Exercise has been show to be more effective than therapy and drugs.

Exercise improves the biological health of the brain which can be fixing the underlying condition.

If you are depressed because your brain is biologically unhealthy, therapy isn’t going to do anything

It's almost as if humans were optimized to constantly move around all day by evolution. Huh. Who would have thought.

I read the title as "Exorcise". I'll show myself out.

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