Exercise has a large and significant antidepressant effect in people with depression (including MDD).
Our data strongly support the claim that exercise is an evidence-based treatment for depression.
MDD I assume it means major depressive disorder
From personal experience, being (extremely) fit made me feel better about myself.
Just based on the fact that I can do a lot of things (sprint, hike, some cool gymnastic moves, solid flexibility, can run good distances) makes me feel better about myself.
Also, once you get in a good shape, it's really not difficult to stay in it. Contrary to what anyone says. But you have to do it "the right way": change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice. I recommend anyone struggling with "bad thoughts" to at least consider this - give it a couple of months, see how it plays out.
Eh, it's always hard to get in and stay in shape, just like it's always hard to create and maintain any habit. Not all of us ever get "used" to a pattern of behavior, so there's always a fight to maintain anything resembling a pattern.
Personally I just cycle everywhere. It's the fastest way to get around the city where I live (if you are willing to bend the traffic rules a bit). I am aware that it won't work for everyone, but I am surprised at how few people cycle.
There is a bit of a motivational hump to get over, but once you are over it (forcing yourself to cycle half an hour for as week maybe?) then it doesn't seem like a problem at all.
Could be a regional thing. Where I live, cycling is for many people the standard way to go around. But then, most people are students around this city.
There are quite a few cities in Belgium and the Netherlands that promote cycling though. :)
Only the northern part of Belgium though (Flanders). The rest of the country has quite poor infrastructure for cycling, especially when compared to the Netherlands.
I would love to cycle to work in Brussels but I do not feel comfortable doing so.
I don't know about Brussels specifically, but if you are worried about the volume of the traffic you can probably try cycling in off hours, mainly at night, and/or using the pavements liberally to build up the routine.
I'd not like to cycle in Brussels either.
Mostly cause of the (car) traffic there. Neither would I feel that comfortable at night in certain parts of Brussels :D
I have rather unpopular opinion about biking in most cities (it doesn't cover bike friendly places like Netherlands/Belgium/Denmark, but your usual place where bikers share roads and sidewalks with rest of us) - bikers often behave like assholes, especially but not only to pedestrians. Aggressive, arrogant, utterly ignoring red lights, zooming fast through crowds walking on pedestrian crossings. I had few near-hits myself when biker went maybe 10cm from me, doing 30+kmh, not even slowing down although he saw me.
Also have seen couple of incidents of biker hitting pedestrian hard only because biker was a total idiot and tried to get somewhere 5 seconds sooner. Fast bike hitting some old granny doesn't end well for her in any possible case. Fiancee who is a doctor had recently a case where biker hit pedestrian in same way, ignoring red light. Guy in his 40s was cca OK when brought to emergency room, but went into coma quickly due to internal bleeding in the brain. Dead within a week.
Maybe its this idiotic childish 'french' culture that I am exposed to here in Geneva (when you see them drive in France you know what I mean), but it really seems biking in the city brings out the worst out of people.
Biking elsewhere, in the nature, forests, unpaved roads, fields etc is something completely different, that I enjoy very much.
There is a clear difference between becoming fit and staying fit, no? Overweight depressed and no prior sports history to fit can easily take a year of hard work. Maintaining basic fitness (not big gym bill or 21k in 90 min fit, but regular happy fit) and a healthy BMI is really just adapting lifestyle and not even having to work out. Walk to the groceries, walk during lunch and f.e. when calling with friends. All true that these last examples are all adaptations of a healthy lifestyle, which I expect to be harder to adapt to for those with mental health issues.
In my experience that's not true with a general level of fitness. I would say that if you get into reasonable shape and have a habit of moving daily that after 3-6 months it becomes hard /not/ to move. ie; you feel antsy and sluggish if you haven't moved for a few days and feel in need of a long walk, etc. The default state of humans is not sedentary.
Getting 'fit' is very far away for a lot of people, MDD or not. That's not a reasonable aim for positive effects on depression. If we can get positive effects from regular exercise, it's great. If it requires patients to get 'fit', it's really not.
> Also, once you get in a good shape, it's really not difficult to stay in it. Contrary to what anyone says.
How old are you? This: "change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice" is one of the hardest things to do in life.
> That's not a reasonable aim for positive effects on depression. If we can get positive effects from regular exercise, it's great. If it requires patients to get 'fit', it's really not.
In my opinion, if you are not fit, then it won't have as good effect as it would otherwise. That might be.. jarring a little bit, but I don't think an obese person can workout 30 minutes and then call it a day, and believe he'll reap the benefits. Maybe I am wrong, but I don't think it is so.
So the goal should always be to get in great shape, the best you can get (in your circumstances, I mean; age/cardiovascular fitness/joint health etc.)
Our default mode should be being fit and everything else an abomination.
> This: "change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice" is one of the hardest things to do in life.
Sorry, I just fail to realize how can someone consciously think that this is one of the hardest thing in life. We have really way different view of life, then. To me, it takes some work, but it's not even hard. It's just something you do for couple of hours in your day, that's all.
And the best part? There's no downside for you. Better health, mental and physical, longevity, mood, etc..
> That might be.. jarring a little bit, but I don't think an obese person can workout 30 minutes and then call it a day, and believe he'll reap the benefits.
Then it's probably not helpful to treat depression though. At least not as a prescribed action. Send it back to "things everyone should do with rewards down the line".
> We have really way different view of life, then. To me, it takes some work, but it's not even hard. It's just something you do for couple of hours in your day, that's all.
Again. How old are you? This seems to just be a complete lack of experience being around depressed or unhealthy people, and a complete lack of understanding why anyone would find themselves in bad health. Weight issues and bad health are not only a result of people not wanting to put in effort.
Just try looking at long term weight loss success rates or something. Your ideas are not based in reality here.
Not to mention that being extremely fit or just trying to be means that your mind is being occupied by being busy, people will act more positively around you and you will also tend to sleep better.
Despite appearances we humans are much more animal than intellect, so that means the simple physical act will much more easily inform our mood and sentiment than just thinking alone.
Extra care should be taken with diet and rest to avoid lowering the immune system by over stressing the body too quickly. You don't want to catch a cold and interrupt your momentum.
In my opinion, motivational energy works a lot like financial investing.
It grows and shrinks exponentially. You have to spend energy, to get more energy (or even conserve it) but the return is uncertain. The optimal strategy is to invest an amount relative to the energy I have, to avoid draining my reserves.
To escape the effects of depression [alongside medical treatment] I have to invest my energy wisely, and ultimately I can (and have, in the past) achieve motivational abundance again. And I must adjust the investment strategy to my current capital. Exercise can be a very rewarding way of investing energy. But it can also be really hard at first.
Exercise is probably one of the most robust treatments we have for a lot of mental health issues. Personal experience: I dealt with recurrent MDD for over a decade, and chronic fatigue/pain issues for many many years as well. There were years were exercise was impossible (I'd literally pass out on the gym floor after trying to work out).
However, after I got well enough to move, regular movement helped wonders (I also think it helps get you into an embodied consciousness that contains less interpretation and more direct experience/awareness - esp somatic practices of moving meditation, yoga, contact improvisation)
Also, once I started getting /serious/ about exercise - like actual cardio and weightlifting 5 days a week - my energy levels skyrocketed after about 2-3 months, but it did take a bit.
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Slightly off topic, but I'm convinced we'll also eventually have a lot of robust data that shows that alcohol, even in minor but regular amounts (2-3 drinks most days of the week, say) has large negative effects on mood/energy that build up over time.
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I don't have any problems with psychoactive drugs, SSRIs never helped me, nor tricyclics, (stimulants help mood/energy a lot but have significant negative effects)- but if someone wants to try them, by all means do!
However, if someone came to me struggling with depression, I'd nearly 100% of the time encourage them to start exercising regularly, cut alcohol/eat better, and see a talk therapist or work through a self-help workbook and see where they are at in 3 months whether or not they also wanted to take anti-depressants.
In addition to all the mental health benefits, I like to point out that exercise important for body health and healing too because our lymphatic system doesn't have a pump!
Everywhere there are blood vessels there are lymph vessels, they carry away the interstitial fluid our cells are bathed in. That fluid contains some of the waste products from our cells. The lymphatic system is also an immune organ in its own right.
Often rest is the diametric opposite of what we need during convalescence or healing. Movement and exercise within our ability is vital.
> after I got well enough to move, regular movement helped wonders
Yeah, the "getting well enough to move" part is the crucial thing. Telling people with depression to just get off their asses and exercise will usually make things worse, not better. Even if you tell them they will feel better after. Even if they really believe that this is the case.
Exercise is great, but it's not the one magic thing that you can start with to treat depression. At least not for most people.
Probably telling anyone with that attitude anything will not go well. Telling an person struggling with addiction issues to just stop using, telling a person struggling with health-issues related to obesity to just eat less food, etc.
There is no one magic thing for depression usually...neither in a pill, nor in an ECT or ketamine treatment (though those last two can come close for some people), nor in exercise. But we don't need to approach exercise with the attitude of strict parent telling the lazy depressed person to get off their butt!
Instead, we can be examples of people that are living, embodied and active, and tell what it has done for us, and encourage them to think of movement as both a natural birthright and medicine.
>Slightly off topic, but I'm convinced we'll also eventually have a lot of robust data that shows that alcohol, even in minor but regular amounts (2-3 drinks most days of the week, say) has large negative effects on mood/energy that build up over time.
Do you remember any particular studies that show this? Would love to read more on this topic.
I think this one is going to be difficult to study, as often alcohol use is correlated to mental health issues - people self-medicate with alcohol in order to cope with their problems. There are also surely people who start drinking too much and then develop problems as a result, so it's a fairly classic correlation vs causation problem.
It's not getting in shape what lifts depression, it is physical activity in itself. You generally feel better after exercise.
It becomes much easier to hit the gym after realizing the reason to go is simply to feel better. Instead of thinking _I don't feel like going to the gym_ the correct cognition is _my medicine is there_.
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There's a variety of options to exercise. Don't stick to running if you don't enjoy it (but you keep doing it because you feel better). There's a large menu of activities, at first try what is convenient, deliberately try many things and find what is more fulfilling to you.
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With exercise nutrition follows quite naturally. It's difficult to navigate all the BS in nutrition, but in general eating fresh things closer to nature (leafs, fruit, veggies, nuts, lean meats) also has an impact on your wellbeing.
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Often there are more issues other than lack of exercise. If you are socially isolated, if you are under constant stress, if your home situation is dire, exercise will help you cope with it but it's not getting at the root cause. Identify and work on the cause too.
- Make sure you don't overtrain, as it can make you feel burned out, which can last a week or longer, and certainly will not help a depression. It also will not make your muscles grow faster. It's better to start slowly.
- If you can't do an exercise in a controlled manner, reduce the weight.
- Also don't target the same muscle-group more than once a week. Your muscles need time to recover.
- Muscles grow most if you load them (slowly) while they are being stretched.
- Find a training buddy.
- If you take supplements, be aware that they can have an effect on your mood. For example, L-glutamine and taurine (which are in many protein shakes) are known to affect neurotransmitters.
Untrained individuals really don't need to train very hard or frequently at all. Their bodies will respond to pretty much any kind of stimulus because it's so new.
Also, training a muscle once a week is bad advice. Protein synthesis for trained individuals drops to normal after 48 hours, and for untrained individuals/novices after 72 hours. Your muscles aren't growing after that.
The only reason to wait longer than that is if your workout incurred a lot of muscle damage. Muscle damage should be avoided at all cost. People used to believe that it was a trigger for muscle growth, but many studies later we know that that isn't the case.
Load a muscle twice a week if a novice or intermediate, up to three times a week if advanced. Use lower volume per workout to ensure you don't incur too much muscle damage.
I lifted weights 4 times per week for many years. It got me a lot of attention from the opposite sex, but never helped my depression or anxiety. Then I started running, and the effect was undeniable. It’s just one data point, but we evolved to run. I’m convinced it’s something about using your body to do what you were meant to do that helps alleviate anxiety and depression.
Not quite. That's a bit like saying we evolved to play football or it wouldn't work. Just because we can do it doesn't mean it was a fundamental part of our evolution with a survival mechanism behind it. We evolved to be able to pick things up, but we did not evolve to lift weights in the way one does in the gym. Running, however, was our main mode of taking down prey. The animals we hunted could run faster than us, but they could not sustain it. Humans evolved to be able to sustain running for long enough that the faster prey would eventually get tired and could no longer outpace their hunters. These hunts would take DAYS in many cases. This running endurance was central to our ability to survive, and as with all survival mechanisms, using that trait was and still is hugely rewarding, releasing a flood of dopamine even in modern humans.
That advice has a Michael Pollan (eat food, mostly plants, not too much) or Paleo Diet vibe to it. Perhaps a better term would be closer to what we would have encountered through most of the evolutionary history of our digestive system. In that time, nature hasn't generally been full of fatty meat. I don't know if that's actually true or if the theory of the diet is correct, but it is intuitive.
Now there's someone who has never been hunting or fishing. Animals don't tend to get real fat in nature; you need to raise them on a farm for that. People can actually die of "rabbit starvation" from eating lots of wild rabbit meat without enough grease and carbs from something else.
That depends a lot on the animals. Plenty of fat in a whale, for example, and societies that depend on whaling (or hunting other cetaceans) usually consume it in large quantities.
Conversely, rabbit is one of the most lean game animals out there.
> but in general eating fresh things closer to nature
I like to think in terms of "level 1" and "level 2" food.
* Level 1 is things that come from the ground/water (salt), grow from the ground/water (vegetables, etc.), or come from things eat things that grow from the ground/water (egg, fish, etc.).
> It's not getting in shape what lifts depression, it is physical activity in itself. You generally feel better after exercise.
Although being in shape can make the physical activity itself less miserable, and the sense of accomplishment is often deeply fulfilling to people.
> Often there are more issues other than lack of exercise. If you are socially isolated, if you are under constant stress, if your home situation is dire, exercise will help you cope with it but it's not getting at the root cause. Identify and work on the cause too.
It's a process. It's always a process. Tackling the simpler things (e.g. exercising, cleaning your room, getting up in the morning instead of throwing off your circadian rhythms, going to bed at night instead of throwing off your circadian rhythms, grooming yourself) makes you better at addressing these other problems. You need a foundation where you have at least some discipline and order and routine in your life to have the mental energy to cope with the harder parts of life.
Exercise is good for you. We've always known that. Also we know that eating properly is benificial, as your social situation and that you have a meaning in your life. Modern society rediscover this bit by bit.
My guess is that the last part, meaning, will be discovered and accepted lastly. To bad, cause that's in my opinion the most important thing.
If you believe in the evolution theory you can logically arrive at what is good for you.
one can logically arrive at what is good for one. What is right is what evolution has adapted us to. So the task then is to try to make as qualified a guess as possible and then try to match our lifestyle against it. Some things are obvious, others are more difficult.
Through evolutional history, what happend to individuals that didn't had any meaning, that did nothing that helped anyone, that was useless? Well, they died of.
my depression went away when I switched my diet from Standard German Diet to Keto, the anxiety went away when I made the switch to carnivore.
Observed changes in mood and thought after consumtion of starch/plant food (The occurence of these effects takes about 4 days):
Frozen non processed Spinach: Anxiety - Thoughts revolve around other people wanting to get me or steal from me or my friends.
About one tablespoon of mashed potato and sauerkraut: depression - Suicidal wishes, low energy Thoughts and self talk are going in the direction of "everything is my fault, I deserve this suffering, I should be dead"
A piece of apple without the skin every day for a week: Depression, laziness, don't want to get up, move, walk the dog, everything is too much, I'd rather just play games all day long.
These effects keep going for about two to three days and then vanish suddenly and I can do my work and routine, workouts, clean my place, etc.
> Frozen non processed Spinach: Anxiety - Thoughts revolve around other people wanting to get me or steal from me or my friends. About one tablespoon of mashed potato and sauerkraut: depression
The symptoms of histamine intolerance can be quite different. I am not aware of any test that really gives a definite answer. You can only keep a diet and look if the symptoms get better and then after some time try again food rich on histamines and look if the symptoms come back.
Personal experience is that high intensity exercise mixed with a comforting ritual was what broke me out of a couple bouts of severe depression. When the streak was broken by an event or travel, and several days missing out on exercise followed, I would fall back into the depressive mood.
The most recent depressive bout was probably the most extreme I've gone through, and required a couple close friends to jump in, but again, routine exercise with comfortable bits of a routine mixed in - like making a cup of tea, making sure I have a podcast queued up, a book to read, and a handful of songs I like - has seemed to help pull me from the brink.
Now that I have eclipsed thirty years and I still am over 300 lbs, and some of the recent depression-like feelings, I am making a more of a cognisant action to keep working at this and to journal how I feel before, during, and after the routine.
I look forward to seeing this kind of work being taken a little more seriously as a means to treat depression as opposed to only medication and therapy.
I was diagnosed as a teenager and prescribed Zoloft. I hated the medication because intrusive thoughts would spiral from “what if I jumped infront of this car” to “what if I locked the doors of this grocery store and set it ablaze”. So I stopped taking it and got fat.
As for high intensity, I’m sure that my use of the term isn’t correct, but I do something that raises my heart to 165+ for 30 seconds, keep my heart at 130, do something to spike it after 5 minutes and repeat until tired. I’ve been able to recently accomplish this reliably on an elliptical at the highest resistance level and maintain activity for 60 to 90 minutes.
After longer sessions I feel pretty good and sometimes a bit euphoric.
I only have to congratulate you for having "close friends" who "jump in". That is a great part of my keeping my mood stable lately (I have also a couple of friends who are not afraid to "jump in" and help me out).
It is quite difficult to "make friends". Real friends, who will "jump in", and not just mock you when you say one emotional thing like "I am sad". It is nearly impossible to make friends when you are starting to get older (like 40+)... I can not imagine what it is like if you are depressed and have no friends. How do those people get help?
I second this. What I expect from someone to help is : just listen and show compassion. Compassion in its literal sense means : "suffer with". I don't ask people to suffer, but just to be with me inside my suffering, ie, recognize that I suffer, recognize that this suffering is true, and that staying in that suffering for a while is ok. By not acting, one comfort the other in its own view of the world, make him at peace with it.
Once that bond has been made, then one can start to work on improving things.
Please don't do that. Very often depressed people are incredibly aware that they aren't being social and they're stuck in a rut. Just be a friend. Just based off wanting to help, you already seem like a good one. Check in on them from time to time. Just a simple text occasionally can mean a lot. Ask them how they are. Be prepared to not get non-answers. Be prepared to be walled out sometimes. If they ever want to talk, be there to listen. That will help a ton. Just be there for them.
Depression is a real bitch. It manifests itself differently in everyone. Perhaps coaxing someone to see a therapist, go out or whatever would actually help them. But that's not going to be true for everyone and the coaxing may do more damage than good if it's unprompted. If they express interest in anything (e:g; going to a movie, seeing a therapist, going to the gym), that can be a good time to give them a small nudge. I hope your friends find some light in their tunnels.
I've learned a tremendous amount about how to be a better friend by reading "Daring Greatly", "The Science of Trust", and "12 Rules for Life", as well as from how my friends and family have helped me when I'm down.
Verbally expressing your love and support for your friend, and helping them see the positive aspects of their self, their situation, and the world around them can go a long way. If you can get them to talk about their views, and help them see when they're stuck in unproductive negative self-talk, that can be truly eye opening. Help them love themselves. Encourage them to come on a walk or run or other exercise with you; don't force them or over pressure them, but say that you promise they'll feel better.
My understanding is that real clinical depression is not the kind of "feeling down" we all experience at some point or another. That's not something you fix by just having a drink, talk a bit, or go to a party.
It is more like the absence of feelings. Depressive people are more likely to take the least resistance path to everything you try to do. Want them to go out, they will follow you. Want them to talk, they will answer your questions. Leave them alone, they will stay where they are. In fact I know someone with severe depression who didn't even have physical feelings (like hunger, pain, cold, sleepiness, etc...).
Lack of exercise causes me a mixture of depression and anxiety. In a society in which we engineered physical challenge out of our lives, it's no wonder a segment of the population experiences depression.
My own experience attempting to use exercise to reverse moderate depression was that it correlated with me crashing into more serious depression.
It didn't make sense to me as I'd always heard that exercise was a solid remedy for mild depression.
It was when I read this 2005 article on Kuro5hin (RIP) called Demystifying Depression [1], that it made sense.
The section "The Role of Sports", with its explanation of the physiology behind the benefits and drawbacks of exercise for people with depression or burnout, is consistent with my own experience.
These days, having done a huge amount of work over 10+ years, including emotion-based treatments, diet/nutrition, and some pharmaceutical treatment, I can and do often undertake intensive exercise without negative effects.
But I still have to be careful - as the article says, listen to your body.
As a general comment about this document:
Anyone experiencing depression should seek professional help and should not make treatment decisions based on comments on internet discussion boards or online articles.
But as a lay-person's summary of the mechanics underpinning depression, I've not found anything better than this in the 14 years since it was first published.
If someone can recommend a better one, I'd be pleased to hear about it and will gladly start recommending it instead.
Ashwagandha works great. It is well studied too (check ksm-66). Prolonged use is safe and has no side effects. Depression is a result of hormonal imbalance which it corrects effectively along with aiding with deep sleep when taken at nights.
Exercise raises few hormones like endorphin, serotonin and reduces cortisol (depending on the kind of exercise, like long walks), but I am not convinced if someone says it balances them.
I've used that at times, and it's been somewhat beneficial some of the time.
But there's no silver bullet and no one-size-fits-all approach.
The causes are complex and different from one person to another, so a complete recovery will require multiple forms of treatment and a tailored approach.
Depression correlates with hormonal changes, but saying it's a result of it is reductionistic and inaccurate. Depression also highly correlates with changes in inflammatory markers called cytokines[1], but reducing it to a single biological factor never yields an accurate pathogenesis of the disease.
Robert Sapolskys Stanford Lecture gives a good overview of the interaction an relationship of the main risk factors causing depression[2].
It's not so much being wrong than just naming one piece of a more complex puzzle.
A wide range of things affect cytokines, nutrition and exercise are central, but also cognitive stress and sleep, and lifestyle factors like smoking, alcohol, certain drugs like amphetamines, to just name a few.
In general, expecting that the intake of some chemical will fix the multitude of factors contributing to this complex disease seems short sighted and may create false hopes in people suffering from it, so far no easy chemical fix has been found or it would instantly replace SSRIs in their lacking efficacy.
For me personally the only things that helped over long were radical mental discipline (daily mindfulness, cognitive behavior therapy), daily exercise, nutritional changes and a willingness to be comfortable being uncomfortable to make those changes.
Agree. I am a strong believer of treating things without medicines at all. Although I do take herbal supplements proven through centuries to be safe. One thing I can be sure is, there is no negative effect using ashwagandha.
> A wide range of things affect cytokines, nutrition and exercise are central, but also cognitive stress and sleep
If that is true, you get best sleep when using Ashwagandha and its effect on stress, like I said previously is well studied.
it is there for centuries and affects in a multitude of ways for a body to bring it into balance in every front. In ayurveda, if a practitioner or doctor was unable to diagnose a disease properly, they simply give them Ashwagandha, as it will work or fail to but never works adversely. I still strongly recommend trying it with any other interventions you mentioned like exercise, etc. I never discouraged any other interventions. It helped me personally, so I am inclined to suggest it to others who are hopeless at the moment. Like I said, zero harm. I never suggested it as a one shot solution. People with depression need more caring than any other.
I have to disagree with the false hopes part. Just went to find some reviews(in 100s) on aswagandha products who gave 5 star reviews who claim it helped them with their depression better than prescribed ones. I think we are getting lost in the loop again - "I won't take it until it is well studied" while rest of the people already befitting from it without any side effects reported. Problem is no one wants to do it for other medicines like "Metformin" which is proven to result in a person getting promoted to insulin injections later. Strangely no one till date knows how it works! Diabetes is similar too, it happens because of a multitude of factors, yet it all reduced to one single medicine "Metformin". Did you ever question that? Why?
It's nice that it works for you and others, it doesn't for me and most people around me. Selling it as a magic cure leaves me and those people excluded.
While science has its pitfalls I think we should try to be more scientific than giving out general recommendations based on (potentially faked) online reviews for a marketed product.
I can recommend checking out the Sapolsky lecture i linked above which should quickly make clear that a single chemical treatment approach is highly unlikely to ever become a general cure for all cases of depression.
The problem is it doesn’t address the underlying reason why your hormones are high or low.
It might be for some important reason to keep your body in homeostasis while dealing with a different problem.
Other literature I’ve read suggests that, for this very reason, prolonged use of adaptogens (including maca, rhodiola, ginseng) is inadvisable.
In my own case, I suspect it may have led to problems (e.g., caused HPA axis to slow down further) after a while, having shown benefits in the beginning.
From personal experience, having dealt with MDD/bipolar^, I can attest that exercise does help.
However, exercise alone is not always sufficient. Daily meditation sessions help tremendously. But the icing on the cake (pun intended) is, in the end, nutrition.
Our body (and thus our mind) works with what we put inside it. In fact, our body is made exclusively of what we, or our mother, ingested in the past. There is no escaping that fact, and most people seem to ignore it every single day.
Personally, switching to a zero-carb ketogenic diet has done wonders for my overall health and well-being, including mental health. I am of course very biased in affirming this, but I honestly think sugar and most other plant substances (except perhaps some fruits and their oils) are there to harm us. The phytotoxin defense hypothesis really resonates with my experience.
^: I have had recurrent depressive episodes throughout most of my life, and antidepressants make me manic, but I otherwise experience no "natural" mania, only a mild hypomania.
I wonder if all those anecdotes are placebo. The authors of this meta-analysis have links to rehabilitation and physiotherapy departments; so I'm not sure I see it as an exactly unbiased analysis. Unless it is clinical depression I find it hard to believe that someone can address their depression with mere physical movements without looking into the mental and emotional causes of it.
Personal anecdote: During a bad depressive time I saw a psychiatrist who enthusiastically prescribed serious antidepressant medications like they were M&M's. One to lift me up, one to help me sleep, one to take the edge off, one just in case an anxious episode occurred during the day, etc, etc. That kind of thing. And he said to me "There is still nothing I can prescribe you that is as effective as exercise."
I have a similar anecdote! Except mine ends with me becoming a marathon runner. I'm kinda glad none of the pills worked or else I might not have discovered the best natural anti-depressant.
The unfortunate thing is that often times when one is depressed, exercise is the the last thing on one's mind. And it also doesn't help that it can take a long time to have noticeable effects.
That's the most frustrating part of depression- You can have a nice protective mindset and habits carefully constructed and working great and then depression comes along and throws it all into darkness. You really have to work to keep pushing ahead and through it. I literally visualize putting one foot in front of the other to get through the hardest days.
I had a similar mindset change the last time I had a prolonged depressive episode. Usually, I would be either happy and productive and feel on top of the world, or I would feel like shit and do nothing.
My recent epiphany is a lot like "putting one foot in front of the other". It's mostly a change in values--instead of worrying so damn much about my own happiness, I just kind of thought, "I don't have to ENJOY being a high-functioning human being, but at least I can BE a high-functioning human being." Grim determination isn't really that much fun, but at least it breaks the part of the depressive spiral where you feel useless and your obligations continue to pile up.
The same happened to me, sort of. I never once had a psych say "You might try exercising to treat your depression." They would only prescribe medication. Then a few years ago my GP, who took over maintaining my prescriptions, asked me if I exercised regularly. I wasn't. So I started going 3 times a week, then 5-6, and I've been much less reliant on my medication to keep my spirits up. It's pretty shocking to me that this is neither a standard question psychs ask nor a suggested (additional) treatment modality.
Looking good naked cures all ills. I know that won't play well among the Rain Man comment section here, but the material you are woven out proves this to be true.
Among nearly all western countries there has been a decrease in testosterone levels, higher BMIs, and lower birthrates.
It's weird you felt you needed to make a nerdy straw man to rail against when the comments here mostly agree with your general thesis. Why the acidic tone?
Please don't post nasty swipes to HN. Dissing the community you're participating in is in bad taste, and breaks the site guideline against shallow dismissals.
For those of us who loathe excercise for the sake of excercise, may I suggest metalworking? You get the distraction of a project / learning to make cool things and it's a surprisingly physical process to inflict your will on such dense objects.
some other fun alternatives:
mountain biking is amazing and there may bw great places to do it in your town that you arent aware of yet. no cars to run you over and modern bikes let you go anywhere in comfort.
rock climbing in an indoor gym is safe and low impact and programmers often enjoy the mental aspect of it. it incentivizes you strongly to keep weight down as well.
climbing walls or being stuck in the wilderness with a bike don't sound like fun at all. pointless. I don't think your suggestion is helpful for people that have depression. The metal working suggestion from parent is far more helpful, as you are actually making something.
Rock climbing is like solving a puzzle with your body. You can't just go straight up. You have to analyze all of the differently shaped holds and walls and figure out how to position your body to maximize your grip while minimizing the amount of energy you need to expend. There's also a difficulty rating system, so you feel rewarded when you manage to finish a new level. But if you're not motivated by leveling or puzzle solving, it's probably not for you.
A lot of people in this thread giving their personal experience, but failing to realise they're doing exactly the same as people who promote crystal healing or homeopathy.
Depression is an umbrella term and it covers a wide range of experience. Some people will recover even if you do nothing to treat them; others will recover if you do anything (such as providing homeopathy) to treat them. Correcting for this is difficult, which is why respected organisations disagree about whether exercise works or not.
Felipe suggest that publication bias explains why other analyses don't show benefit of exercise as a treatment, but that doesn't make much sense. The only reason he sees such large effect sizes is because he includes huge amounts of low quality research.
When you restrict the analysis to good quality research the effect reduces and it's much harder to see any difference between no treatment and depression as treatment.
It's not particularly suprising that physiotherapists and sports therapists think what they do works. What is somewhat suprising is that HN routinely falls for it.
> they're doing exactly the same as people who promote crystal healing or homeopathy.
It's only exactly the same if you consider their formal argument in a vacuum, neglecting everything you know and reasonably believe about the world.
An intervention with a plausible mechanism has a greater chance of being effective than an intervention with no conceivable scientific mechanism (healing crystals; homeopathy). Anecdotal evidence isn't high-quality scientific evidence, but it does work as a decision support method to think about what to study more carefully -- or what to stick with because it works for some reason and you don't have the resources to scientifically validate the effect.
Furthermore, and this does overlap with the placebo effect as well as fraudulent medicine: if a specific person tests a mood-elevating intervention on themselves and perceives a benefit, nobody can contradict them. Not to defend ardent believers of nonsensical cures, but if it's stupid and it works, it's not stupid.
this is a reasonable point. we know exercise does lots of things. we don't know that about homeopathy. hence it is more reasonable to suspect that exercise has an effect on depression than it would be for crystals and homeopathy.
Sure, but we have the research and the only research that shows significant effect size for exercise would, if were done on homeopathy, show similar effect sizes.
Since we know homeopathy is bullshit we can conclude that these low quality trials should be removed from our meta analysis.
And when you do that the effect for exercise as a treatment for depression almost disappears.
People say that but the drops and pills make zero difference.
Sun sure does feel good, but the vitamin additives does not have the same effects. Based on that one could make the conclusion that it is not vitamin d but something else with sunlight that is beneficial.
Yes, recent studies have shown that Vitamin D is the marker that's associated with whatever process sun exposure induces. It's not the vitamin itself causing the benefits. Get some sun, just not too much.
During a depressive episode after the suicide of a friend I compiled a check list of very basic things that I noticed had helped in everyday life. I wrote it down when I noticed that I couldn't remember the items reliably (or when it didn't occur to me to think of them). I carried it in my pocket for some while.
It contained very basic things, like questions if I had eaten enough, slept enough, whether I spent time outdoors (fresh air/sun), had met friends recently or exercised recently and corrective actions for each item (and yes, "eat something" was on it). Some items were accompanied by comments like "exercise will only help for the next day or two, do not skip for longer than that".
Another thing that helped surprisingly well was having a shower, shaving and dressing up. Basically the opposite of letting oneself go.
And in really bad moments, jamming/DoS-ing my brain by some sort of meaningless meditation (sitting, breathing and counting so that no other thoughts appeared anymore) helped as well.
The best thing is that I haven't had to use the list in a long time now and hopefully never will have to again.
I agree with the dressing up. A lot of times, I've found my depression helped simply by dressing nicely and going out, even if it's just to eat. It's a confidence boost and you do get some human interaction which can really help.
Otherwise, your mention of the mood implications of dressing up reminded me of the many times I've noticed that, after waking up in the morning feeling depressed and shitty, sometimes just pushing through and eating breakfast/getting showered/dressed makes me feel significantly better. Something about getting that last shoe on and standing up and suddenly my brain flips a 180.
That exercise (especially endurance sports) is as effective as your typical SSRI is known for decades. The problem is getting a depressed person to exercise five days a week and holding up to that schedule for months and years.
I guess one of the nice things about the modern world is that there's lots of different activities one can choose. Like basketball? Play basketball! Like Crossfit? Do some Crossfit. Like running? Go for a -
OK - no one really likes running...
All these activities have casual social groups attached to them you can join. If you miss a meetup, someone's gonna check in with ya.
The initial bump to make it habit is hard, and it could take a few tries, but that's true for any positive habit.
You don't have to exercise for 5 days a week though - that's an arbitrary choice. I've been going to the gym 3-4 times / week for 1-3 hours at a time for years and it's absolutely helped my mood. There's no magic to 5 days a week.
Absolutely. As I commented elsewhere here, I suffered from a depressive episode after a close friend committed suicide.
The lack of energy is extraordinary and what I experienced must have been mild compared to what others with severe depression suffer from.
Anecdote: a sliding door slipped from its rail because there was no stopper at the end of the rail and it had to be moved back in place. It is neither heavy nor difficult to do it.
I gave up after the first attempt to fix it.
Depression is nothing that I would ever wish on anyone, no matter how much I might hate that person.
Any sort of excercise has never made me feel anything other than shit. High intensity? I feel like shit instantly. Just miles of walking? I feel like shit throughout the entire process. I don't get any sort of "high" after doing it - everything aches, and I am tired, and I feel like shit. If a doctor told me to get more excercise, I would tell them to fuck off.
I have had the exact opposite experience. Prior to 2012 I was in college and was overweight/out of shape and always felt like crap. I decided to get into shape: did intense cardio and HIIT workouts, lifted weights, and got into excellent shape within a year. I lost 50 lbs, went from being able to do 0 pull ups to over 20, I ran a few Tough Mudders (12 mile obstacle course races), etc.
I still run, lift weights, and keep my body fat % low, and if I can help it, I'll never go back. If I go days without exercise I start to feel terrible, foggy headed, lethargic. One 5 mile run will immediately make me feel great for the rest of the day.
Aerobic exercise has always been like that for me. I get exactly none of the "euphoria" or whatever people talk about with it. The result of any serious amount, even back when I was pretty damn in shape and made myself do it somewhat frequently, is that I feel like I'm ill for a good long while after. I also happen to find it boring as hell, though put me in an aerobic sport and I'll run myself around to vomiting and love every second of it.
Lifting weights feels pretty good though. Doesn't constantly leave me with injured-feeling levels of joint or muscle pain like running and friends do. Just the good kind of aches.
Does exercise treat depression effectively? Yes, of course! The only problem is when you're too depressed to work out. This is where SSRI's and other first-line treatments can be valuable: they can lift you up just enough to go get the rest of your life squared away.
There's a quote I like from Jordan Peterson (yes, I know he's a mixed bag) that goes something like: If you come to me to get help with serious depression, the first thing I will do is prescribe an anti-depressant. Not because it's the long-term solution to the problem, but because they work, and I can't treat you if you're dead.
Jordan Peterson is very outspoken about lifestyle-centered treatments, i.e. the whole "clean your room"/"sort yourself out" stuff, but you definitely need to start somewhere and an anti-depressant can help.
* Strength training tends to be a long term benefit. It can be really draining if you put in a difficult workout every session. Copious logging matters to lock in the sweet spot of difficulty, and maximizing recovery rate matters just as much - I found that increasing vitamin D intake did the trick here. But I find that the strength isn't the beginning and end - it helps to have it as a barometer of progress, but it's only one thing.
* Cardio-intensive activity helps my mood throughout the day. Last year I trained judo, which rewards all-around athleticism(though my desire to compete is limited) and it pushed me to take cardio more seriously. I got gifted a Fitbit last Christmas, and took up a jogging routine first thing out of bed by way of pleasing the hourly activity monitor. By focusing mostly on the technique and habit instead of pace, I've improved my form quite a bit, gotten my sleep schedule under control and also hit on another supplement that seems to get my anxiety down(magnesium citrate). However, this led me to something else which I'm still working on:
* I would tend to finish my jog with a cup of coffee and I finally realized last week that I had been letting my caffeine consumption creep up, and this was throwing off a lot of other stuff. My gym numbers were still coming in, but my concentration was mostly shot, and finally at an event Thursday I had one of the free diet sodas and soon after found that I was unusually anxious and had developed an eye twitch. This is too much, I told myself. I had gone through phases of overconsuming and cutting back before, but I was tired of the cycle.
So I decided later that night that I would cold turkey caffeined drinks. I'm still consuming a little bit of chocolate, but it's been an eye-opener. I started having bottled water instead of coffee so as to keep my other habits in the same place. Day one was the most difficult, but my sleep improved immediately and my focus already started getting better on the second day. By the third I realized that I was smiling and engaging with activities better than I had in a long time. My depressive spells never quite went away with the other things, but they seem to be gone after dropping the caffeine(although I'm still getting the eye twitch).
So, yes, it's a lot of things. Sobering up from coffee is something that's helped by getting all my other habits together. If you're starting from a "sodas every day/no exercise/no gym experience" standpoint, this is roughly the path I've recommended to friends:
* Get some resistance bands and start a program with those. They're some of the simplest and most accessible strength training around. Focus on developing some technique and logging your progress.
* Get a fitness tracker and try to hit some of the goals. I like the hourly goals(even though they do not measure when I get up and do housework), others like daily steps.
* Switch either from sugar + caffeine to just sugar or just caffeine. I shifted away from soda about a year into my first job(by - surprise surprise - overconsuming until I felt ill). Then work your way down from there by getting bottled water more often.
* Research supplements. This is not easy with so many options, but there are usually common ones that come up with respect to certain sports and activities.
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[ 6.4 ms ] story [ 248 ms ] threadExercise has a large and significant antidepressant effect in people with depression (including MDD). Our data strongly support the claim that exercise is an evidence-based treatment for depression.
MDD I assume it means major depressive disorder
From personal experience, being (extremely) fit made me feel better about myself.
Just based on the fact that I can do a lot of things (sprint, hike, some cool gymnastic moves, solid flexibility, can run good distances) makes me feel better about myself.
Also, once you get in a good shape, it's really not difficult to stay in it. Contrary to what anyone says. But you have to do it "the right way": change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice. I recommend anyone struggling with "bad thoughts" to at least consider this - give it a couple of months, see how it plays out.
There is a bit of a motivational hump to get over, but once you are over it (forcing yourself to cycle half an hour for as week maybe?) then it doesn't seem like a problem at all.
There are quite a few cities in Belgium and the Netherlands that promote cycling though. :)
I would love to cycle to work in Brussels but I do not feel comfortable doing so.
Also have seen couple of incidents of biker hitting pedestrian hard only because biker was a total idiot and tried to get somewhere 5 seconds sooner. Fast bike hitting some old granny doesn't end well for her in any possible case. Fiancee who is a doctor had recently a case where biker hit pedestrian in same way, ignoring red light. Guy in his 40s was cca OK when brought to emergency room, but went into coma quickly due to internal bleeding in the brain. Dead within a week.
Maybe its this idiotic childish 'french' culture that I am exposed to here in Geneva (when you see them drive in France you know what I mean), but it really seems biking in the city brings out the worst out of people.
Biking elsewhere, in the nature, forests, unpaved roads, fields etc is something completely different, that I enjoy very much.
> Also, once you get in a good shape, it's really not difficult to stay in it. Contrary to what anyone says.
How old are you? This: "change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice" is one of the hardest things to do in life.
In my opinion, if you are not fit, then it won't have as good effect as it would otherwise. That might be.. jarring a little bit, but I don't think an obese person can workout 30 minutes and then call it a day, and believe he'll reap the benefits. Maybe I am wrong, but I don't think it is so.
So the goal should always be to get in great shape, the best you can get (in your circumstances, I mean; age/cardiovascular fitness/joint health etc.)
Our default mode should be being fit and everything else an abomination.
> This: "change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice" is one of the hardest things to do in life.
Sorry, I just fail to realize how can someone consciously think that this is one of the hardest thing in life. We have really way different view of life, then. To me, it takes some work, but it's not even hard. It's just something you do for couple of hours in your day, that's all.
And the best part? There's no downside for you. Better health, mental and physical, longevity, mood, etc..
Then it's probably not helpful to treat depression though. At least not as a prescribed action. Send it back to "things everyone should do with rewards down the line".
> We have really way different view of life, then. To me, it takes some work, but it's not even hard. It's just something you do for couple of hours in your day, that's all.
Again. How old are you? This seems to just be a complete lack of experience being around depressed or unhealthy people, and a complete lack of understanding why anyone would find themselves in bad health. Weight issues and bad health are not only a result of people not wanting to put in effort.
Just try looking at long term weight loss success rates or something. Your ideas are not based in reality here.
Regarding 'the right way', thinking in systems/implementations/solutions rather than goals/KPIs might help (at least it does for me):
https://blog.dilbert.com/2013/11/18/goals-vs-systems/
Despite appearances we humans are much more animal than intellect, so that means the simple physical act will much more easily inform our mood and sentiment than just thinking alone.
Extra care should be taken with diet and rest to avoid lowering the immune system by over stressing the body too quickly. You don't want to catch a cold and interrupt your momentum.
It grows and shrinks exponentially. You have to spend energy, to get more energy (or even conserve it) but the return is uncertain. The optimal strategy is to invest an amount relative to the energy I have, to avoid draining my reserves.
To escape the effects of depression [alongside medical treatment] I have to invest my energy wisely, and ultimately I can (and have, in the past) achieve motivational abundance again. And I must adjust the investment strategy to my current capital. Exercise can be a very rewarding way of investing energy. But it can also be really hard at first.
However, after I got well enough to move, regular movement helped wonders (I also think it helps get you into an embodied consciousness that contains less interpretation and more direct experience/awareness - esp somatic practices of moving meditation, yoga, contact improvisation)
Also, once I started getting /serious/ about exercise - like actual cardio and weightlifting 5 days a week - my energy levels skyrocketed after about 2-3 months, but it did take a bit.
--
Slightly off topic, but I'm convinced we'll also eventually have a lot of robust data that shows that alcohol, even in minor but regular amounts (2-3 drinks most days of the week, say) has large negative effects on mood/energy that build up over time.
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I don't have any problems with psychoactive drugs, SSRIs never helped me, nor tricyclics, (stimulants help mood/energy a lot but have significant negative effects)- but if someone wants to try them, by all means do!
However, if someone came to me struggling with depression, I'd nearly 100% of the time encourage them to start exercising regularly, cut alcohol/eat better, and see a talk therapist or work through a self-help workbook and see where they are at in 3 months whether or not they also wanted to take anti-depressants.
Everywhere there are blood vessels there are lymph vessels, they carry away the interstitial fluid our cells are bathed in. That fluid contains some of the waste products from our cells. The lymphatic system is also an immune organ in its own right.
Often rest is the diametric opposite of what we need during convalescence or healing. Movement and exercise within our ability is vital.
Yeah, the "getting well enough to move" part is the crucial thing. Telling people with depression to just get off their asses and exercise will usually make things worse, not better. Even if you tell them they will feel better after. Even if they really believe that this is the case.
Exercise is great, but it's not the one magic thing that you can start with to treat depression. At least not for most people.
There is no one magic thing for depression usually...neither in a pill, nor in an ECT or ketamine treatment (though those last two can come close for some people), nor in exercise. But we don't need to approach exercise with the attitude of strict parent telling the lazy depressed person to get off their butt!
Instead, we can be examples of people that are living, embodied and active, and tell what it has done for us, and encourage them to think of movement as both a natural birthright and medicine.
Do you remember any particular studies that show this? Would love to read more on this topic.
*
It's not getting in shape what lifts depression, it is physical activity in itself. You generally feel better after exercise.
It becomes much easier to hit the gym after realizing the reason to go is simply to feel better. Instead of thinking _I don't feel like going to the gym_ the correct cognition is _my medicine is there_.
*
There's a variety of options to exercise. Don't stick to running if you don't enjoy it (but you keep doing it because you feel better). There's a large menu of activities, at first try what is convenient, deliberately try many things and find what is more fulfilling to you.
*
With exercise nutrition follows quite naturally. It's difficult to navigate all the BS in nutrition, but in general eating fresh things closer to nature (leafs, fruit, veggies, nuts, lean meats) also has an impact on your wellbeing.
*
Often there are more issues other than lack of exercise. If you are socially isolated, if you are under constant stress, if your home situation is dire, exercise will help you cope with it but it's not getting at the root cause. Identify and work on the cause too.
You can tell anything you want to a 200 pound loaded barbell, over and over again...
- Make sure you don't overtrain, as it can make you feel burned out, which can last a week or longer, and certainly will not help a depression. It also will not make your muscles grow faster. It's better to start slowly.
- If you can't do an exercise in a controlled manner, reduce the weight.
- Also don't target the same muscle-group more than once a week. Your muscles need time to recover.
- Muscles grow most if you load them (slowly) while they are being stretched.
- Find a training buddy.
- If you take supplements, be aware that they can have an effect on your mood. For example, L-glutamine and taurine (which are in many protein shakes) are known to affect neurotransmitters.
Also, training a muscle once a week is bad advice. Protein synthesis for trained individuals drops to normal after 48 hours, and for untrained individuals/novices after 72 hours. Your muscles aren't growing after that.
The only reason to wait longer than that is if your workout incurred a lot of muscle damage. Muscle damage should be avoided at all cost. People used to believe that it was a trigger for muscle growth, but many studies later we know that that isn't the case.
Load a muscle twice a week if a novice or intermediate, up to three times a week if advanced. Use lower volume per workout to ensure you don't incur too much muscle damage.
Conversely, rabbit is one of the most lean game animals out there.
I like to think in terms of "level 1" and "level 2" food.
* Level 1 is things that come from the ground/water (salt), grow from the ground/water (vegetables, etc.), or come from things eat things that grow from the ground/water (egg, fish, etc.).
* Level 2 is recipes made from level 1 stuff.
Although being in shape can make the physical activity itself less miserable, and the sense of accomplishment is often deeply fulfilling to people.
> Often there are more issues other than lack of exercise. If you are socially isolated, if you are under constant stress, if your home situation is dire, exercise will help you cope with it but it's not getting at the root cause. Identify and work on the cause too.
It's a process. It's always a process. Tackling the simpler things (e.g. exercising, cleaning your room, getting up in the morning instead of throwing off your circadian rhythms, going to bed at night instead of throwing off your circadian rhythms, grooming yourself) makes you better at addressing these other problems. You need a foundation where you have at least some discipline and order and routine in your life to have the mental energy to cope with the harder parts of life.
My guess is that the last part, meaning, will be discovered and accepted lastly. To bad, cause that's in my opinion the most important thing.
If you believe in the evolution theory you can logically arrive at what is good for you. one can logically arrive at what is good for one. What is right is what evolution has adapted us to. So the task then is to try to make as qualified a guess as possible and then try to match our lifestyle against it. Some things are obvious, others are more difficult.
Through evolutional history, what happend to individuals that didn't had any meaning, that did nothing that helped anyone, that was useless? Well, they died of.
These effects keep going for about two to three days and then vanish suddenly and I can do my work and routine, workouts, clean my place, etc.
I did depression comics/art when I was trying to fix it with meds, therapy and excercise, I'd be happy to cooperate if someone would like to help me market the stuff https://www.deviantart.com/aszantu/gallery/52706431/key-proj...
Have you thought about histamine intolerance?
The most recent depressive bout was probably the most extreme I've gone through, and required a couple close friends to jump in, but again, routine exercise with comfortable bits of a routine mixed in - like making a cup of tea, making sure I have a podcast queued up, a book to read, and a handful of songs I like - has seemed to help pull me from the brink.
Now that I have eclipsed thirty years and I still am over 300 lbs, and some of the recent depression-like feelings, I am making a more of a cognisant action to keep working at this and to journal how I feel before, during, and after the routine.
I look forward to seeing this kind of work being taken a little more seriously as a means to treat depression as opposed to only medication and therapy.
Were you diagnosed by a professional psychiatrist ?
As for high intensity, I’m sure that my use of the term isn’t correct, but I do something that raises my heart to 165+ for 30 seconds, keep my heart at 130, do something to spike it after 5 minutes and repeat until tired. I’ve been able to recently accomplish this reliably on an elliptical at the highest resistance level and maintain activity for 60 to 90 minutes.
After longer sessions I feel pretty good and sometimes a bit euphoric.
Hope you keep them and keep safe!
Sitting alone behind a computer screen every night and weekend is asking for problems.
I assume it means continuing to be social, helping out, and encouraging the person in question to "get out of their bubble", so to speak.
I haven't had personal experience with the harsher side of depression, so I'm not sure what is effective (on my part).
Interestingly, it's often exactly the opposite that's needed: just be there and listen.
Once that bond has been made, then one can start to work on improving things.
All of this requires time and a lot of energy.
Depression is a real bitch. It manifests itself differently in everyone. Perhaps coaxing someone to see a therapist, go out or whatever would actually help them. But that's not going to be true for everyone and the coaxing may do more damage than good if it's unprompted. If they express interest in anything (e:g; going to a movie, seeing a therapist, going to the gym), that can be a good time to give them a small nudge. I hope your friends find some light in their tunnels.
Verbally expressing your love and support for your friend, and helping them see the positive aspects of their self, their situation, and the world around them can go a long way. If you can get them to talk about their views, and help them see when they're stuck in unproductive negative self-talk, that can be truly eye opening. Help them love themselves. Encourage them to come on a walk or run or other exercise with you; don't force them or over pressure them, but say that you promise they'll feel better.
My understanding is that real clinical depression is not the kind of "feeling down" we all experience at some point or another. That's not something you fix by just having a drink, talk a bit, or go to a party.
It is more like the absence of feelings. Depressive people are more likely to take the least resistance path to everything you try to do. Want them to go out, they will follow you. Want them to talk, they will answer your questions. Leave them alone, they will stay where they are. In fact I know someone with severe depression who didn't even have physical feelings (like hunger, pain, cold, sleepiness, etc...).
It didn't make sense to me as I'd always heard that exercise was a solid remedy for mild depression.
It was when I read this 2005 article on Kuro5hin (RIP) called Demystifying Depression [1], that it made sense.
The section "The Role of Sports", with its explanation of the physiology behind the benefits and drawbacks of exercise for people with depression or burnout, is consistent with my own experience.
These days, having done a huge amount of work over 10+ years, including emotion-based treatments, diet/nutrition, and some pharmaceutical treatment, I can and do often undertake intensive exercise without negative effects.
But I still have to be careful - as the article says, listen to your body.
As a general comment about this document:
Anyone experiencing depression should seek professional help and should not make treatment decisions based on comments on internet discussion boards or online articles.
But as a lay-person's summary of the mechanics underpinning depression, I've not found anything better than this in the 14 years since it was first published.
If someone can recommend a better one, I'd be pleased to hear about it and will gladly start recommending it instead.
[1] https://en.wikibooks.org/wiki/Demystifying_Depression/Print_...
Exercise raises few hormones like endorphin, serotonin and reduces cortisol (depending on the kind of exercise, like long walks), but I am not convinced if someone says it balances them.
I've used that at times, and it's been somewhat beneficial some of the time.
But there's no silver bullet and no one-size-fits-all approach.
The causes are complex and different from one person to another, so a complete recovery will require multiple forms of treatment and a tailored approach.
[1] https://scholar.google.com/scholar?q=depression+cytokines+me...
[2] https://www.youtube.com/watch?v=NOAgplgTxfc [Robert Sapolsky On Depression]
https://www.spandidos-publications.com/ijmm/42/1/425
I think its use for stress & anxiety reduction is studied too,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/
In general, expecting that the intake of some chemical will fix the multitude of factors contributing to this complex disease seems short sighted and may create false hopes in people suffering from it, so far no easy chemical fix has been found or it would instantly replace SSRIs in their lacking efficacy. For me personally the only things that helped over long were radical mental discipline (daily mindfulness, cognitive behavior therapy), daily exercise, nutritional changes and a willingness to be comfortable being uncomfortable to make those changes.
> A wide range of things affect cytokines, nutrition and exercise are central, but also cognitive stress and sleep
If that is true, you get best sleep when using Ashwagandha and its effect on stress, like I said previously is well studied.
https://examine.com/supplements/ashwagandha/
it is there for centuries and affects in a multitude of ways for a body to bring it into balance in every front. In ayurveda, if a practitioner or doctor was unable to diagnose a disease properly, they simply give them Ashwagandha, as it will work or fail to but never works adversely. I still strongly recommend trying it with any other interventions you mentioned like exercise, etc. I never discouraged any other interventions. It helped me personally, so I am inclined to suggest it to others who are hopeless at the moment. Like I said, zero harm. I never suggested it as a one shot solution. People with depression need more caring than any other.
I've used it occasionally before bed and it did seem to reduce stress, but I'm not sure how much it was placebo.
It might be for some important reason to keep your body in homeostasis while dealing with a different problem.
Other literature I’ve read suggests that, for this very reason, prolonged use of adaptogens (including maca, rhodiola, ginseng) is inadvisable.
In my own case, I suspect it may have led to problems (e.g., caused HPA axis to slow down further) after a while, having shown benefits in the beginning.
Long story short: the body always fights back.
However, exercise alone is not always sufficient. Daily meditation sessions help tremendously. But the icing on the cake (pun intended) is, in the end, nutrition.
Our body (and thus our mind) works with what we put inside it. In fact, our body is made exclusively of what we, or our mother, ingested in the past. There is no escaping that fact, and most people seem to ignore it every single day.
Personally, switching to a zero-carb ketogenic diet has done wonders for my overall health and well-being, including mental health. I am of course very biased in affirming this, but I honestly think sugar and most other plant substances (except perhaps some fruits and their oils) are there to harm us. The phytotoxin defense hypothesis really resonates with my experience.
^: I have had recurrent depressive episodes throughout most of my life, and antidepressants make me manic, but I otherwise experience no "natural" mania, only a mild hypomania.
(Anecdotally, your 15km a week is only going to get you 428km in 200 days.)
Specifically, heavy weights.
The unfortunate thing is that often times when one is depressed, exercise is the the last thing on one's mind. And it also doesn't help that it can take a long time to have noticeable effects.
My recent epiphany is a lot like "putting one foot in front of the other". It's mostly a change in values--instead of worrying so damn much about my own happiness, I just kind of thought, "I don't have to ENJOY being a high-functioning human being, but at least I can BE a high-functioning human being." Grim determination isn't really that much fun, but at least it breaks the part of the depressive spiral where you feel useless and your obligations continue to pile up.
Among nearly all western countries there has been a decrease in testosterone levels, higher BMIs, and lower birthrates.
Go read Chateau Heartiste.
https://news.ycombinator.com/newsguidelines.html
rock climbing in an indoor gym is safe and low impact and programmers often enjoy the mental aspect of it. it incentivizes you strongly to keep weight down as well.
* There's a point--learning how to use your body/leverage.
* It's social. There will be fellows to motivate you to train consistently. You might even make a few friends.
* There's progression. Whether belts, tournaments, or just being about to beat your training partners improvement is pretty noticeable.
A gym membership is ~$100-200/mo. There are bad gyms. Make sure not to commit too early and try others if you don't like the environment.
Depression is an umbrella term and it covers a wide range of experience. Some people will recover even if you do nothing to treat them; others will recover if you do anything (such as providing homeopathy) to treat them. Correcting for this is difficult, which is why respected organisations disagree about whether exercise works or not.
Felipe suggest that publication bias explains why other analyses don't show benefit of exercise as a treatment, but that doesn't make much sense. The only reason he sees such large effect sizes is because he includes huge amounts of low quality research.
When you restrict the analysis to good quality research the effect reduces and it's much harder to see any difference between no treatment and depression as treatment.
It's not particularly suprising that physiotherapists and sports therapists think what they do works. What is somewhat suprising is that HN routinely falls for it.
It's only exactly the same if you consider their formal argument in a vacuum, neglecting everything you know and reasonably believe about the world.
An intervention with a plausible mechanism has a greater chance of being effective than an intervention with no conceivable scientific mechanism (healing crystals; homeopathy). Anecdotal evidence isn't high-quality scientific evidence, but it does work as a decision support method to think about what to study more carefully -- or what to stick with because it works for some reason and you don't have the resources to scientifically validate the effect.
Furthermore, and this does overlap with the placebo effect as well as fraudulent medicine: if a specific person tests a mood-elevating intervention on themselves and perceives a benefit, nobody can contradict them. Not to defend ardent believers of nonsensical cures, but if it's stupid and it works, it's not stupid.
Since we know homeopathy is bullshit we can conclude that these low quality trials should be removed from our meta analysis.
And when you do that the effect for exercise as a treatment for depression almost disappears.
Many of us work inside office with hardly any sunlight coming in. Going out under sun in the morning for 30 minutes will be helpful.
It contained very basic things, like questions if I had eaten enough, slept enough, whether I spent time outdoors (fresh air/sun), had met friends recently or exercised recently and corrective actions for each item (and yes, "eat something" was on it). Some items were accompanied by comments like "exercise will only help for the next day or two, do not skip for longer than that".
Another thing that helped surprisingly well was having a shower, shaving and dressing up. Basically the opposite of letting oneself go.
And in really bad moments, jamming/DoS-ing my brain by some sort of meaningless meditation (sitting, breathing and counting so that no other thoughts appeared anymore) helped as well.
The best thing is that I haven't had to use the list in a long time now and hopefully never will have to again.
Otherwise, your mention of the mood implications of dressing up reminded me of the many times I've noticed that, after waking up in the morning feeling depressed and shitty, sometimes just pushing through and eating breakfast/getting showered/dressed makes me feel significantly better. Something about getting that last shoe on and standing up and suddenly my brain flips a 180.
OK - no one really likes running...
All these activities have casual social groups attached to them you can join. If you miss a meetup, someone's gonna check in with ya.
The initial bump to make it habit is hard, and it could take a few tries, but that's true for any positive habit.
The lack of energy is extraordinary and what I experienced must have been mild compared to what others with severe depression suffer from.
Anecdote: a sliding door slipped from its rail because there was no stopper at the end of the rail and it had to be moved back in place. It is neither heavy nor difficult to do it.
I gave up after the first attempt to fix it.
Depression is nothing that I would ever wish on anyone, no matter how much I might hate that person.
I still run, lift weights, and keep my body fat % low, and if I can help it, I'll never go back. If I go days without exercise I start to feel terrible, foggy headed, lethargic. One 5 mile run will immediately make me feel great for the rest of the day.
Also, if I was overweight I simply wouldn't bother with excercise for losing it - it's so inefficient. I'd just skip a day of eating every other day.
Lifting weights feels pretty good though. Doesn't constantly leave me with injured-feeling levels of joint or muscle pain like running and friends do. Just the good kind of aches.
* Strength training tends to be a long term benefit. It can be really draining if you put in a difficult workout every session. Copious logging matters to lock in the sweet spot of difficulty, and maximizing recovery rate matters just as much - I found that increasing vitamin D intake did the trick here. But I find that the strength isn't the beginning and end - it helps to have it as a barometer of progress, but it's only one thing.
* Cardio-intensive activity helps my mood throughout the day. Last year I trained judo, which rewards all-around athleticism(though my desire to compete is limited) and it pushed me to take cardio more seriously. I got gifted a Fitbit last Christmas, and took up a jogging routine first thing out of bed by way of pleasing the hourly activity monitor. By focusing mostly on the technique and habit instead of pace, I've improved my form quite a bit, gotten my sleep schedule under control and also hit on another supplement that seems to get my anxiety down(magnesium citrate). However, this led me to something else which I'm still working on:
* I would tend to finish my jog with a cup of coffee and I finally realized last week that I had been letting my caffeine consumption creep up, and this was throwing off a lot of other stuff. My gym numbers were still coming in, but my concentration was mostly shot, and finally at an event Thursday I had one of the free diet sodas and soon after found that I was unusually anxious and had developed an eye twitch. This is too much, I told myself. I had gone through phases of overconsuming and cutting back before, but I was tired of the cycle.
So I decided later that night that I would cold turkey caffeined drinks. I'm still consuming a little bit of chocolate, but it's been an eye-opener. I started having bottled water instead of coffee so as to keep my other habits in the same place. Day one was the most difficult, but my sleep improved immediately and my focus already started getting better on the second day. By the third I realized that I was smiling and engaging with activities better than I had in a long time. My depressive spells never quite went away with the other things, but they seem to be gone after dropping the caffeine(although I'm still getting the eye twitch).
So, yes, it's a lot of things. Sobering up from coffee is something that's helped by getting all my other habits together. If you're starting from a "sodas every day/no exercise/no gym experience" standpoint, this is roughly the path I've recommended to friends:
* Get some resistance bands and start a program with those. They're some of the simplest and most accessible strength training around. Focus on developing some technique and logging your progress.
* Get a fitness tracker and try to hit some of the goals. I like the hourly goals(even though they do not measure when I get up and do housework), others like daily steps.
* Switch either from sugar + caffeine to just sugar or just caffeine. I shifted away from soda about a year into my first job(by - surprise surprise - overconsuming until I felt ill). Then work your way down from there by getting bottled water more often.
* Research supplements. This is not easy with so many options, but there are usually common ones that come up with respect to certain sports and activities.