Mental Wealth

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Why You Should Run Away from Your Problems

The research is in: Exercise works, better than anything else.

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While physicians and other mental health clinicians regularly recommend exercise to combat depression, we don’t always know how much or what kind will make a difference.

I tend to recommend that patients start out with gentle exercise—say, a 15-minute daily walk—to overcome the “getting started” hurdle. But it turns out that more rigorous exercise may be needed to really lift depression. Low-dose intensity exercise, and even merely stretching, was associated with some reduction in depressive symptoms, but the results were not nearly as robust.

Getting people to exercise rigorously, however, is another story.

How do you get someone to go for a run or partake in some other kind of serious cardio workout when they don’t even feel like getting out of bed? One way is to provide clear and convincing evidence that research has demonstrated that a particular “dose” is needed to make a substantial difference: The magic numbers equate to 3-5 days/week of rigorous exercise for 45-60 minutes (e.g. jogging or biking, or using a treadmill or stationary bike)—similar to current public-health recommendations.

Interestingly, in a recent study in which patients were assigned antidepressant medication, exercise, or a combination of both, the combination treatment did not appear to provide any additional benefit than exercise alone—which was equivalent to the effect of medication alone. In fact, when researchers looked at 6-month relapse rates, the exercise-only group did better than the combination group; only 9% had relapsed compared to 30% in both of the other groups.

There was some speculation that this finding may have been due to psychological factors, since one of the benefits of exercise is thought to be due to a sense of self-mastery that results in increased self-esteem. But I suspect it’s more than that. Perhaps the neurotransmitter (brain chemistry) normalization effect that exercise encourages is hampered or blunted by powerful medication effects, or perhaps blood flow changes are qualitatively or quantitatively different with a medication on board. Another factor to consider is whether perspiration—which may help to excrete toxins stored in fat—is altered by medication.

Regardless, the lower relapse rate in the exercise-alone group is an intriguing finding, and may serve as additional motivation to exercise for those patients who do not wish to take psychotropic medication or prefer a more natural approach to health. (As an aside, based on other research regarding the benefits of morning bright-light exposure on mood and sleep quality, an outdoor workout in the morning should augment exercise’s psychological effect even further.)

Think about how our ancestors lived: They ate natural foods, they were active all day long, and they had sunlight exposure in the morning along with a lack of light in the evenings. I doubt they were depressed very often, or for very long. If you feel lost regarding your own struggles with depression, try to emulate that lifestyle more closely. When it comes to health, Mother Nature often knows best.

 

References

Dunn, Andrea L., Madhukar H. Trivedi, James B. Kampert, Camillia G. Clark, and Heather O. Chambliss. “Exercise Treatment for Depression: Efficacy and Dose Response.” American Journal of Preventive Medicine 28, no. 1 (January 2005): 1–8. doi:10.1016/j.amepre.2004.09.003.

Dunckley, Victoria. “The Link Between Light-at-Night, Depression & Suicidality.” Psychology Today. Mental Wealth, March 30, 2014. http://www.psychologytoday.com/blog/mental-wealth/201403/the-link....

Ehrman, Jonathan, Paul Gordon, Paul Visich, and Steven Keteyian. “Exercise Effective Treatment for Depression.” In Clinical Exercise Physiology, 2nd Edition. Human Kinetics. Accessed July 26, 2014. http://www.humankinetics.com/excerpts/excerpts/exercise-effective-treatment-for-depression.

Kohyama, Jun. “Neurochemical and Neuropharmacological Aspects of Circadian Disruptions: An Introduction to Asynchronization.” Current Neuropharmacology 9, no. 2 (2011): 330.

Rethorst, Chad D., and Madhukar H. Trivedi. “Evidence-Based Recommendations for the Prescription of Exercise for Major Depressive Disorder.” Journal of Psychiatric Practice 19, no. 3 (May 2013): 204–12. doi:10.1097/01.pra.0000430504.16952.3e.

Victoria L. Dunckley, M.D., is a board-certified child and adolescent psychiatrist specializing in treating children with complex diagnoses and/or treatment-resistant conditions.

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