exercise as a treatment for depression

[lordofthemark]

http://www.theatlantic.com/health/archive/2014/03/for-depression-prescribing-exercise-before-medication/284587/

a longish (for AC) piece on exercise as a substitute for, and complement/multiplier for, antidepressants. Interesting.

I think biking is even more effective. In addition to the organic effects all exercise has, cycling, at least on roads and on heavily travel MUTs, requires a high level of focus (“nothing concentrates a man’s mind like the prospect of being doored/sideswiped”) – plus the focus needed (at least for the less experienced of us) to shift properly. It forces one to break away from obsessive and negative thoughts – add to that the joy of the outdoors (well in some places at least) and the sense of accomplishment when you go faster/further/stronger than you did before.

[PotomacCyclist]

Look at running forums. There are a lot of people who talk about using running as a way to deal with depression. Sometimes it seems like a third or a half of the people who post. (Keep in mind that most runners probably don’t frequent running forums or post that much.) Many of them say that they were able to get off the over-prescribed drugs by running on a regular basis.

Either running or cycling could probably work. The main difference is that it’s a bit simpler to get started with running. Less equipment to bother with than with cycling, unless you use Capital Bikeshare for cycling. (Fortunately, that’s an option for many people in the DC metro area.)

[rcannon100]

”All endurance athletes are running away from something inside themselves”

– The Profit Lance Armstrong

[Henry]

@rcannon100 80387 wrote:

”All endurance athletes are running away from something inside themselves”

– The Profit Lance Armstrong

One of the few times he spoke the truth.

[PotomacCyclist]

I don’t know if that applies to everyone. I started triathlon and cycling after watching the 2008 Summer Olympics, especially Michael Phelps and the Olympic marathons. I got so fired up that I wanted to train for some sort of race (although at the non-elite level).

[cvcalhoun]

This is, alas, a subject on which I have had occasion to devote way too much thought. My view is that exercise undoubtedly helps with depression, but that it is truly impossible to compare the effectiveness of exercise with the effectiveness of antidepressants. If you look at their chart, you can see one reason for my skepticism. The chart indicates that exercise alone is somewhat effective, and that antidepressants alone are somewhat effective, but that the combination of exercise and antidepressants is less effective than exercise alone. It is hard to think of a reason why antidepressants would be somewhat effective alone, but would lessen the beneficial effects of exercise.

I think the issue is self-selection. If you are so depressed that you are struggling to get out of bed, and even the simplest tasks feel herculean, it is more likely that you will never start an exercise program, or that if you do, you will quit after a short time. If you are so depressed that you are in danger of losing your job, you will probably spend more hours at your job instead of spending that time exercising. So the people who are able to continue with an exercise program for six months tend to be the ones who had less severe depression to begin with and are facing less stress during that six-month period. Conversely, antidepressants have enough side effects that people with less serious depression to begin with often decide that the cure is worse than the disease. Because antidepressants do not require time or energy to take, they are attractive to those who are so stressed out by just trying to keep up with work that they can’t manage the time for exercise, therapy, or more sleep. So the ones who continue medications for six months tend to be the ones who had more severe depression to begin with, and who have more stresses to deal with.

And a trial of exercise is not like a drug trial, in which a control group can be given a placebo. It’s kind of hard to figure out what a placebo for exercise would consist of.

My own view is that anyone who is depressed should be exercising. However, the approach varies depending on the situation:

1. If you are too depressed to be able to exercise (for example, if you need to spend extra hours at work to counter the concentration issues generated by depression, and you are sleeping most of the time you are not at work due to the extra sleep requirements generated by depression), antidepressants can help you get to the point that you can exercise.
2. If you are able to exercise, and your depression is mild enough so that immediate resolution is not critical (e.g., if you are not in danger of losing your job or your marriage), you can try exercise alone or in combination with therapy to see if it is enough.
3. If immediate resolution is critical, you’re probably best off starting antidepressants and therapy and simultaneously exercising as much as you can manage.

Once the depression is under control, you can experiment with gradually reducing medication while continuing exercise. (After all, exercise has many health benefits aside from control of depression, while medications are a total pain!) However, if your tendency toward depression is enough, you may find that while exercise diminishes the amount of medication you need or makes your medication more effective, it will not be a substitute for medication. In that event, you’re best off ignoring the part of the chart that suggests that exercise alone is more effective than exercise combined with medication.

[lordofthemark]

thanks for that thoughtful post.

When I last needed an alternative to SSRI’s, I don’t think anyone suggested biking (though exercise was suggested and I didn’t do all that much). I have used it in the last couple of years as a way to deal with life stresses.

[brendan]

@rcannon100 80387 wrote:

– The Profit Lance Armstrong

The “Profit”, indeed.

[Author]

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