[HN Gopher] Exercise can be nearly as effective as therapy for d...
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Exercise can be nearly as effective as therapy for depression
Author : mustaphah
Score : 223 points
Date : 2026-01-09 18:29 UTC (4 hours ago)
(HTM) web link (www.sciencedaily.com)
(TXT) w3m dump (www.sciencedaily.com)
| cheald wrote:
| This is a finding that keeps coming up, and I've certainly found
| it true in my life, but there's a significant chicken-and-egg
| problem in that depression frequently precludes the motivation to
| exercise, and if you don't already have a deeply-disciplined
| routine to overcome the lack of motivation, people won't do it.
|
| Exhortation to develop those good habits in the good times, I
| suppose.
| zaptheimpaler wrote:
| It doesn't have to take deep discipline. I started my routine
| by just going for short walk after dinner everyday and it built
| up from there. It's intimidating to have to start at gym for 60
| minutes 3x/week. Just do whatever little you like - a few
| pushups, a walk, a dance and stop when its not enjoyable. It
| tends to naturally build up.
| WackyFighter wrote:
| Much like the sibling comment I started walking around the
| local park before spending more time hiking. I live semi
| rurally though and wouldn't want to walk in an urban
| environment.
|
| I normally feel much better after walking and cycling. Also I
| think doing something repetitive like walking allows you to
| think, tune out of other things.
| wk_end wrote:
| Everyone is different, so I say this not to tell you how to
| feel but just to offer a different perspective:
|
| Walking in urban environments can be its own sort of joy.
| Cities (well, good ones anyway are full of life and energy
| and humanity, have unexpected nooks and crannies, and a rich
| sense of dynamism and excitement. Even late at night (as long
| as you're safe), a quiet city can be a source of serenity and
| melancholic beauty. Writers like Baudelaire and Benjamin
| described at great lengths the pleasures of flanerie.
|
| Nature is wonderful too, of course! I love a good hike
| through the forests and mountains...but I also love a good
| stroll downtown.
| HauntingPin wrote:
| I also question the universality of it. No amount of exercise
| changed my depression or made life any less miserable. Anti-
| depressants finally helped me get past the trauma I was unable
| to properly process otherwise.
| 2muchcoffeeman wrote:
| And you think the effects of drugs is universal?
|
| Exercise is a side effect free treatment that works for some
| people so it's worth a shot because it sometimes works.
| PaulHoule wrote:
| I'd argue that depression kills and optimal therapy is:
| anti-depressants, exercise AND talking therapy and the time
| to start is NOW.
|
| I wouldn't knock the effectiveness of any of them with the
| caveats that: (1) you can get anti-depressants from you
| primary care doc, the best practice is to start on
| something, ramp up your dose and try something different if
| it is not working or you don't like the sides. I really
| thought Vanlafaxine was a comfortable ride but it raised my
| blood pressure to the "go to the ER" range. Call on the
| phone and lean in about adjusting your meds. (2) Getting an
| appointment for talk therapy can take a while these days.
| (3) In a hard case you can get a more complex medication
| cocktail from a psychiatrist but the wait could be worse
| than the talk therapy. (4) People in the military do insane
| amounts of cardio because it helps dealing with insane
| amounts of stress. 2 hours a day of cardio helped me deal
| with a business development process that went on for years
| before ultimately failing.
| stuffn wrote:
| Or avoid medication for anything but treatment resistant
| depression.
|
| SSRIs are not well understood. Their side effects are not
| great. Getting off them is miserable. I had them. I felt
| dead inside. Mission accomplished. Depression was gone,
| so was my desire to eat, have sex, or do anything else. I
| wasn't depressed, I was a zombie. 8 adjustments and
| medications later I got off them and realized they're yet
| another pill to fix a problem 98% of people can fix other
| ways if they tried.
|
| I do not understand this intense desire to be medicated.
| Exercise, go outside, talk to people. Get good sleep.
| Once the rest of your life is squared away get some meds
| if necessary. Psychiatrists and psychologist walk the
| razors edge of quackery every single day. Talk therapy is
| a program to take tremendous amount of money from people
| and funnel it into their account. It's absolutely nuts
| the average talk therapist bills at over 300 dollars an
| Hour. There is no reproducibility in mental health. in
| their "science". Therefore, there's no reason to believe
| their magical pills will fix problems they barely
| understand at a biological level.
|
| As a final note people in the military do a ton of cardio
| because running and rucking is hard work you train for.
| It is certainly not to "stay sane".
| PaulHoule wrote:
| yeah... i did forget to add meaningful community and
| spiritual activities to that list but people can have
| just as strong objections to them as they do to the other
| things on my list!
| nineteen999 wrote:
| 100% I have found the same, SSRI's definitely make things
| worse and I stay away from them, and regular exercise has
| offered the biggest consistent/persistent improvement in
| mood.
| wombatpm wrote:
| Medication is the fastest way to make some positive
| progress before you completely spiral and majorly fuck up
| your life.
|
| Would you rather take a pill and keep working while you
| sort things out or would you try to rebuild everything
| after you burn it all down? Talk therapy and exercise may
| be just as effective or more so long term, but may not be
| effective enough in the short term.
| stuffn wrote:
| You clearly are completely and totally incapable of
| reading.
| skywhopper wrote:
| Your experience is not the same as other people. No one
| cares if you don't understand their own life and choices.
| Get off your high horse and stop assuming that "those
| dumb depressed fat people just need to sleep better, eat
| better, and exercise and obviously it's just that easy".
| If you had success with whatever method, that's great.
| We're thrilled for you. But what works for you is not a
| universal solution.
| stuffn wrote:
| Thanks for the strawman.
|
| I won't argue against you. It's clear you would've been
| in complete support of the lobotomy craze. Exercise,
| diet, sleep, and good company are the most universal cure
| for the average form of depression. I specifically called
| out treatment resistant depression as requiring
| medication. Surely your basic bitch depression caused by
| being overworked, underfed, and slammed with bills can't
| be fixed with anything but a simple pill.
|
| You missed the greater point that medicines are
| overprescribed and OP all but made a Pfizer ad out of
| their post. HNers lack contextual reading ability, and
| life experience. It's a shame really. The over
| prescription of drugs is a tremendous problem in the
| west.
|
| My "high horse" is supported by actual medical science.
| Unlike the entire field of mental health.
| psunavy03 wrote:
| > People in the military do insane amounts of cardio
| because it helps dealing with insane amounts of stress.
|
| This is giving the military way too much credit for
| organized stress management. If military people give the
| impression of doing "insane amounts of cardio" it's
| because that's what the physical fitness tests are biased
| towards.
|
| And we also won't talk about the fact that getting a
| psych diagnosis, especially in fields like aviation, can
| end your career, while managing stress via alcohol gets a
| wink and a nod as long as you don't have an alcohol-
| related incident.
| bluGill wrote:
| The military does insane cardio because when the enemy
| knows where you are sometimes you have to run hard and
| fast in hopes you can get to safety before they can kill
| you. I've known people who likely would have died in
| Afghanistan without that insane cardio.
|
| it might help with stress too, but that isn't as clear
| mrgoldenbrown wrote:
| The poster you responded to didn't claim that drugs were
| universally helpful. I think the main point is that there
| is no universal that works for everyone. For some exercise
| works, for some drugs, for others therapy. And "works"
| isn't a yes/no, one might work a little for you, one might
| work super great.
| 2muchcoffeeman wrote:
| The poster questioned the universality of exercise. And
| the went on to say that drugs worked for them in the next
| sentence. Clearly the two statements are related.
| HauntingPin wrote:
| Anecdotal data isn't sufficient to infer a universal
| rule. The point of my comment wasn't to argue for drugs.
| It was to push back against the idea that drugs like
| anti-depressants are unnecessary and bad, which I see all
| the time when this topic comes up. A common take is "why
| use or prescribe drugs when apparently exercise works
| fine against depression?"
| keeganpoppen wrote:
| i think they are merely saying what worked for them. it is
| working for me too, despite my misgivings about "just
| taking a pill". YMMV.
| abraxas wrote:
| And I'm the counter anecdotal case of your anecdotal case.
|
| I have a page long list of failed psychiatric regimens that
| included drugs alone and drugs combined with talk therapy.
| None of them effective.
|
| I won't say that I'm cured of depression now or will ever be.
| But a strict and persistent exercise routine lessened it to
| the point where I can function day to day. This was never
| achieved with presrciption drugs or therapy (of which I have
| developed a dim opinion).
| Jtsummers wrote:
| > I also question the universality of it.
|
| The article doesn't claim exercise is a universally effective
| treatment, so whose statements are you questioning?
| antonymoose wrote:
| I don't think depression is a universal root-cause diagnosis
| so I'm inclined to agree.
|
| I've been diagnosed clinically several times in life with
| depression and the pills never did anything for me. Sometimes
| exercise worked, sometimes it was of little or no use.
|
| With retrospect, all of my episodes of depression were a
| function of environment. As a child, growing up in a broken
| home situation and bad school environment, of course there is
| going to be depression. Life sucks. Further, no pill or
| weight lifting schedule is going to fix that either. Only
| breaking out of that situation will.
|
| As an adult, I've absolutely had and broken out of a long
| episode of depression with exercise. Bad breakup, startup
| failure, then introduce chronic drinking and subsequent
| weight gain. Guess what, cutting back on drinking, bicycling
| to work 30 minutes each way, doing martial arts in the
| evenings, it was a great fix. It enhanced self image, added a
| new community of positive people, and broke a cycle of
| depression.
| LorenPechtel wrote:
| I definitely agree, there are two fundamental forms of
| "depression"--internal and a reaction to a bad external
| situation. Very different causes, what works for one
| doesn't work for the other. And I don't even like the
| "depression" label for bad situations--as with the previous
| post about willpower. We have a limited ability to cope
| with bad, when it's exceeded (or our efforts are misapplied
| resulting in the same end) we get "depression". No, we get
| reality! That's why things like forcing rehab does nothing
| about addiction--it doesn't remove what drove the person to
| the drugs in the first place.
| marcosdumay wrote:
| There's no universality on anything linked to mental health.
| cheald wrote:
| Depression isn't monocausal so it'd be far too simple for it
| to have a single solution.
|
| But in general, humans just work better when we're regularly
| putting our bodies under reasonable physical load.
| heavyset_go wrote:
| I'm a non-competitive athlete, and yes exercise can help
| depression, but no, it will not be sufficient for anything
| but your mild to average case of it.
|
| Exercise is a crucial part of dealing with it, but it is not
| a panacea.
| burningChrome wrote:
| >> I'm a non-competitive athlete
|
| Honest question, but what do you mean by this?
|
| I've played competitive team sports my whole life and have
| a very competitive drive. If its not team sports, its rock
| climbing where I feel like I'm competing against myself or
| my brain trying to solve a route. If I'm hiking, I'm
| competing against the clock or how far I can go. If I'm
| lifting weights, its about how many sets I can do and what
| weight in order to push myself.
|
| So even in what most people deem "non-competitive"
| activities I'm still competing against a clock, or my body,
| or my brain.
|
| I'm just curious what you meant is all.
|
| EDIT: Typical HN. Ask a question and get downvoted. Logging
| off the day - thanks.
| heavyset_go wrote:
| I'm not competing against anyone but myself, I'm not
| trying to meet any specific weight/size/etc cutoff for
| competition, the point is exercise and improvement and
| not any official or unofficial competition.
|
| Someone might train for marathons, body building, etc. I
| don't.
| resumenext wrote:
| I hesitate to ask but what is your gender? I think there may
| be very gender specific effects in this comparison. I would
| also be very curious the type and intensity of exercise and
| whether you had comorbidities that impact ability to train
| (obesity, low testosterone, etc).
| HauntingPin wrote:
| I'm male. I've done everything from cycling to 5-10k
| running to heavy weightlifting. The only other thing I have
| is ADHD, no other comorbidities.
| skywhopper wrote:
| Yeah, any of these studies that show "X works better than Y"
| are inevitably operating on averages. Not everyone will
| respond the same way. Not to mention that the very existence
| of the structure and human interaction required for these
| studies makes a huge difference in their outcomes.
| 4fterd4rk wrote:
| Well... sure. I've had trouble with anxiety and it's actually
| an incredibly anxiety provoking thing for me to go to therapy.
| But I read enough information telling me that therapy is good
| for anxiety so I finally went. I think there's people out there
| who need to know that exercise is helpful for depression, even
| if the depression makes it difficult.
| boplicity wrote:
| We have a certain amount of "willpower" that can overcome
| motivational barriers. This willpower _is_ limited, though. It
| 's _very_ helpful to have clear guidance on where to allocate
| this very limited resources, especially in situations where
| people are otherwise struggling.
|
| All of which is to say -- these exhortations can play a useful
| role. :)
| LorenPechtel wrote:
| Yup, which is why diets fail. People who are fat generally do
| not have enough available willpower to lose weight.
| CrossVR wrote:
| This has more to do with hunger requiring a tremendous
| amount of willpower to ignore rather than fat people having
| less willpower than people of average weight.
| PeterStuer wrote:
| It feels _very_ different. Depressed people lack the
| motivation /energy to start exercise, fat people seem
| more in line with addiction in not being inclined to
| overcome short term craving for more feed.
|
| While at a certain level of abstraction you can reduce
| both to A -> !B -> C, that generalization seems to
| obfuscate specific important differences that impact
| pathways to treatment. Craving is not the same as lacking
| energy. Craving, while subversive, energizes, depression
| does not.
| browningstreet wrote:
| If you eat poorly, those foods will not satiate and the
| "hunger" (it's not the hunger of a body starved of
| calories) persists. Eat for sustenance and the hunger you
| may feel will be different.
|
| I also know that if I overeat, I have a strong urge to
| keep feeding (more chips, more pizza, more chipsahoy).
| Whereas when I eat a proper meal, I'm fine when the
| eating of that meal ends.
| skywhopper wrote:
| I hope you realize that what works for you and your body
| doesn't work for everyone. Your experience is not
| universal. Your body chemistry and genetics are not
| universal.
| carlosjobim wrote:
| When it comes to the most basic instincts, it is
| universal and genetic. We do not differ in that.
| carlosjobim wrote:
| It takes a tremendous amount the first 3-7 times. After
| that it is a learned skill.
| WalterBright wrote:
| Curiously, if I'm busy I don't get hungry. I don't eat
| before going out dirt biking, and don't feel hungry at
| all until after the riding is done and the bikes loaded
| on the trailer and turning on to the road home.
| 46Bit wrote:
| Overeating is often a coping mechanism. It's really hard to
| displace unless your life is going fantastic. Even with
| GLPs.
| avidiax wrote:
| My suspicion as someone with lifelong weight struggles and
| having tried GLP-1 medication: overweight people require
| more willpower to lose or maintain weight relative to those
| of normal weight.
|
| So the advise or admonishment of the normally weighted that
| losing weight "just requires willpower" is true but facile.
|
| If we were to medically induce a constant feeling of hunger
| and insatiability into a person of normal weight, I'm sure
| they could keep the weight off, but would find that their
| willpower is highly depleted.
|
| There are medications that cause increased appetite and
| weight gain (ex: some bipolar depression medications,
| prednisolone). This effect is so pronounced, that if a
| doctor sees the patient not gaining weight, they will
| suspect non-compliance and have to rule it out. Of course,
| some patients use extreme diet and exercise (willpower) to
| avoid these effects, but a normal person accustomed to
| expending a normal amount of willpower to maintain weight
| will find themselves gaining.
| azkalam wrote:
| Over-eating is not strictly a choice. Corporations spend
| billions on manipulating the public because it works.
| Regulation is needed, not willpower.
| WalterBright wrote:
| I don't believe regulation is the answer. As I get older,
| I've become increasingly skeptical of any information
| coming from the government.
| dahart wrote:
| I wouldn't phrase it that way. Relying on willpower is a
| recipe for failure. Humans generally don't have enough
| willpower, it goes for most things, even when you don't
| have strong physiological forces involved. The key to
| getting a diet to work is in figuring out how to not
| require willpower, which means thinking about it
| differently, forming new habits. Stress and social
| environment also need attention or they will steamroll your
| goals.
| thewebguyd wrote:
| > figuring out how to not require willpower
|
| This goes for coping with a lot of executive function
| problems and disorders.
|
| Part of how I have to manage my rather severe ADHD is
| specifically crafting an environment that's as ADHD
| friendly as possible, much to my wife's dismay.
|
| That means nothing can ever be hidden away or out of
| sight, otherwise I will immediately forget it exists. It
| means every bill must be on autopay, or it will not get
| paid. It also means living as minimally as possible, for
| me. Even something as "simple" to a neurotypical like
| washing dishes or doing laundry is a seemingly impossible
| mountain for me to climb. I solve that by owning as
| little as possible, and I also remove choices by, for
| example, just owning multiples of the same exact outfit.
|
| The moment any sort of friction or context switching is
| involved in a task, I am going to fail, so I have to
| architect my life in a way that reduces friction as much
| as possible.
| smeej wrote:
| To solve digestive problems, I managed to eat the exact
| same meal every single meal for 20 straight months. And it
| didn't help me lose weight.
|
| So I dispute this statement with some enthusiasm.
| kayodelycaon wrote:
| I seriously dispute this. I spent weeks not being able to
| eat enough. I hardly lost weight despite being close to the
| optimal calorie range to do so.
| ToucanLoucan wrote:
| It's also worth noting that willpower in general is
| constantly being whittled down by how stressful and, for lack
| of better term, fucking annoying modern life is. I'm reminded
| of a quote from my favorite article from Ed Zitron:
|
| > In plain terms, everybody is being fucked with constantly
| in tiny little ways by most apps and services, and I believe
| that billions of people being fucked with at once in all of
| these ways has profound psychological and social consequences
| that we're not meaningfully discussing.
|
| And I think one of those psycho-social consequences we're not
| discussing is everyone is just... fucking annoyed now,
| constantly, about shit that it doesn't feel right to really
| complain about. Like, you plus or minus live on your phone,
| and I'm very much including myself in that statement. Every
| time you get logged out of an app you use every day to, for
| example, board your morning train, or park your car, or have
| to reset a password to pay your power bill, just like, all of
| that? Every time your day is interrupted with stupid bullshit
| from Modern Life takes a tiny bit of that energy, and I dunno
| about everyone reading this, I have a quite well managed and
| streamlined life, and I still have just... dozens of these.
| Every single day. I can't fathom being one of the folks who
| ISN'T as well versed in tech as I am, existing for them must
| be utter HELL.
|
| And that's the essentials, that's not even going into how
| most tech products now are constantly begging for your
| attention, for your engagement, trying to pluck the strings
| of your psyche into making you angry, or horny, or whatever.
| Engage with platforms, buy these products, watch 9 TV shows
| so you're not out of the loop, you've been added to an SMS
| spam group, and everyone is replying to it saying they're not
| interested, on and on and on.
|
| Sorry this turned into more of a rant than I really
| envisioned but yeah. I can easily comprehend a day where I
| try and go to my gym, and the fucking app doesn't work right
| and I can't get in, and I just quit because I've already
| solved 20 fucking captchas today and I simply lack the energy
| to do another, to help train some goddamned AI, for a company
| I don't know, you know?
| smeej wrote:
| > existing for them must be utter HELL.
|
| You've certainly hit upon why they use the same password
| for every single thing.
| parpfish wrote:
| I just got a new phone which meant I had to read-login and
| set up every app and account.
|
| It was an intense deluge of SMS codes, flipping back and
| forth to the Authenticator, dismissing welcome popup
| modals, security email notifications.
|
| I was frazzled by the multitasking and can only imagine how
| hard it would have been for some senior citizen that was
| badgered into updating their device.
| refulgentis wrote:
| This is 100% true, and what I'm about to describe isn't an
| attempt to _falsify_ it: took me 11 years and 3 cities to
| figure it out.
|
| You don't have to _exercise_ so much as _get moving_.
|
| I'm the best I've been in 37 years, and it's because in August
| I started forcing myself to _just keep walking_ whenever I went
| out to have a cigarette. I was in Boston, and would end up
| ~nowhere and exhausted.
|
| Then started doing random stuff: "might as well walk to Harvard
| Square instead of the bike path again" "might as well go to a
| bookstore instead of somewhere random" "I should use the skate
| park, I don't fit in*, but I miss rollerblading from middle
| school"
|
| Then my dog died, 2 days later I severely sprained my ankle at
| the skate park and couldn't walk anywhere substantive for a
| couple weeks. By the time I'm able to do a sustained 10m+ walk
| it's winter.
|
| Went to visit California as a not-tech-employee for the first
| time, so I saw San Luis Obispo and Los Angeles for the first
| time. And the same habit kicked in, in SLO I ended up hiking
| for the first time on what I find out later was not a _real_
| trail, end up hiking every day that week.
|
| Get to LA and it's nothing like I would have thought.
| Egalitarian, tons of stuff to do, and Waymo is a godsend.
| Whenever I get antsy there's somewhere to go and a way to get
| there.
|
| 2 weeks later, I got an apartment in LA, moving away from
| Northeast for the first time in my life. I could see me just
| spending another 4 months decaying in Boston until its barely
| warm enough out to take a 30m walk, and I'm tired of that
| cycle..
|
| All that to say, I'm fit, I had a great career in high school
| sports, I played basketball occasionally, but couldn't _really_
| get active _consistently_. Treadmill was never stimulating
| enough to keep my attention on anything other than being bored.
| In retrospect, I really wish I heard this old saw ~all of us
| know and heard it as " _moving around_ " instead of exercise.
|
| (n.b. this was all under active mental health care x
| medications spanning a decade+. It's not that the mental health
| care was useless, I don't think I could have done what I did
| without it. But it couldn't "fix" me on it's lonesome, only
| enable me to get moving.)
|
| * in retrospect this was wrong, plenty of newbies, and one of
| the most welcoming social environments I've been in. just
| people out there all trying to do the same thing and supporting
| each other.
| cheald wrote:
| That's a great way to think about it. "Get moving" is a lot
| less intimidating and feels more achievable than "exercise"
| which conjures images of marathons and four-plate squats.
| LorenPechtel wrote:
| Getting moving *is* exercise.
|
| No way could I do a gym and these days most things in a gym
| would be just begging for joint pain. But the wilderness is a
| great gym (assuming you know what you're doing safety-wise, I
| see too many idiots out there.)
| Jtsummers wrote:
| > Getting moving *is* exercise.
|
| There's a difference between what something is and what
| something is perceived as. For whatever reasons they may
| have, many people have a strong negative emotional reaction
| to the idea of exercising, ask them to go for a two mile
| walk around the neighborhood with you and they'll balk. But
| then you take them to a city like Rome and they'll walk 20
| miles in a day without even realizing it.
| refulgentis wrote:
| (context: gp poster) It's extremely funny to contemplate
| what my resume would say about my intelligence vs. it
| taking 11 years of _really_ worrying about my mental
| state consistently, occasionally trying to precisely
| define "exercise" via my mental health professionals and
| get in the weight room, when I knew the whole time about
| that phenomenon. i.e. I'd play pickup basketball for 3
| hours post-high school but wouldn't run for 10 minutes.
| (not saying you're wrong, the opposite, it is the
| fundamental core lesson. intellectual error was
| forgetting to expand "exercise" to include walking to
| places I wanted to be)
| burningChrome wrote:
| _get moving_ is the key.
|
| Some of my best friends are personal trainers and they say
| the same thing. When you tell people just moving essentially
| gives you what they refer to as "free exercise". The kind
| that doesn't make people feel like they have to get up off
| the couch, change their clothes, go to the gym, get on the
| treadmill, lift their weights, etc.
|
| Just walking around the block. Just walking up a few flights
| of stairs. Just doing _something_ that doesn 't feel like you
| have to have a huge investment is sometimes the best way to
| start - then transition into more structured stuff like wight
| lifting or running or anything else. And you still get the
| benefits for almost nothing. Walk a few flights of stairs and
| your legs start to burn, your lungs open up, you increase
| your blood flow, and you release endorphins. And it didn't
| cost anything if you can just include it in your day-to-day
| activities.
|
| Not sure how many times I make extra trips to my basement
| just to get in a few more stairs. lol
| Insanity wrote:
| Nail on the head. I know that exercise will make me feel
| better, but during a period of depression/grief I could not
| even get out the house.
| AnthonBerg wrote:
| To my surprise, it has been my experience that this turns out
| to be _pulmonary_. It was always the chicken-and-egg of...
| breathing.
|
| Seems like this has been my story:
|
| Severe prolonged stress floored me. Turns out that the
| autonomous control of bronchoconstriction and dilation had
| gone out of wack, into dysregulation. My lungs were basically
| clamped shut. (Muscular tension and sundry dysregulation from
| severe prolonged stress makes sense, right? Applies to the
| lungs too!)
|
| Exercise worked when I could get myself to do it... _because_
| exercise forces lungs to open.
|
| And the nervous system and brain, well it requires lots of
| oxygen. In order to learn. And unlearn.
|
| --
|
| edit: Also interesting: Ketamine therapy worked. And...
| ketamine is a bronchodilator!
| ambicapter wrote:
| That's interesting. I've noticed when I go for a long-
| enough run and my body warms up to an optimal state,
| breathing feels easy and effective. I wish I could breathe
| like that all the time.
| cultofmetatron wrote:
| its amazing that we haven't found anyone dualwielding the skill
| of therapist and personal trainer. we already have things like
| sex surrogacy (https://www.webmd.com/sex/what-is-sexual-
| surrogacy) so its not like it would be that weird by
| comparison.
| KellyCriterion wrote:
| You can also have a "deeply-disciplined routine" and get thrown
| out of it and hit depression because exactly by that one
| impact.
|
| Source: Myself.
| gloxkiqcza wrote:
| I'm not sure if you need to hear this but in case you do:
| There's only one way to get back to it and the sooner you do
| it, the easier it is. First week is hardest, then the
| positive feedback loop starts kicking in. Do not to think
| about it, just get it done.
| undeveloper wrote:
| reread what you replied to
| KellyCriterion wrote:
| What most people without this "experience" never
| understand:
|
| you just _cant_
|
| If you've seen a distinct "low bar", its nearly impossible
| to get straight up above this bar
| heavyset_go wrote:
| > _Exhortation to develop those good habits in the good times,
| I suppose._
|
| This is what medication for more severe cases of things like
| depression is supposed to offer: an opportunity to learn,
| usually through therapy, to cope with the condition in a
| healthy way.
| hu3 wrote:
| Yup!
|
| Same thing for ADHD.
|
| Medication helps having willpower/focus to develop better
| habits and realize you are not a useless dumb human. It's
| just that your brain is a little finicky to get going
| sometimes.
|
| In fact the few diagnosed ADHD people I know are wicked
| smart. It's just that their brain overclocks to unproductive
| levels without medication.
| yomismoaqui wrote:
| Motivation is fleeting but routine persists.
|
| When there is something that you want to do regularly
| (exercise, doing the final boring part of some sideproject,
| cleaning the house...) you remove willpower from the equation
| and set a day and a time.
|
| For example, everyday from 18 to 19 I work on my sideprojects,
| or saturdays from 16 to 18 is house cleaning time. There is no
| question if I want to do it, it is set at that time and I have
| to do it, period.
|
| The nice thing about routine is that the first times it is
| hard, but after some repetitions your mind (and body) begin to
| get used and it transforms into a routine and then it's like
| it's written in stone. That time period of that day X is for Y
| and it is what it is.
|
| Routine can be used for bad things but also for good things.
| jjtheblunt wrote:
| I bet simply having a dog needing walking tips the scales
| into an exercise routine at some level.
| multiplegeorges wrote:
| It did for me. You have to be truly heartless to see a dog
| being sad about not going outside. So you take it for a
| walk, then another and another. Soon enough you're
| researching hiking trails in your region and getting
| healthier.
|
| Dogs are the best.
| specproc wrote:
| God yeah. So much healthier and happier in my forties than
| my thirties, and it's all down to my executive assistant.
| smeej wrote:
| > There is no question if I want to do it, it is set at that
| time and I have to do it, period.
|
| Gosh it must be nice to have at least an ordinary amount of
| executive function skills. Is it really this easy for
| neurotypical people to build routines? That's really all it
| takes?
|
| I don't see how this removes willpower at all. It just
| determines what time you have to use it.
| cheald wrote:
| It still requires willpower, but to use a metaphor, it's
| much easier to travel down a well-trod path than it is to
| cut a new path through the jungle. Repetition and
| consistency establishes the path, so the willpower required
| to travel down it the next day is reduced over time.
| Establishing a pre-set time and committing to that time
| ahead of time removes the "will I or won't I" decision at
| "go time", when you're most likely to falter.
| kayodelycaon wrote:
| This method requires a significant amount of executive
| function.
|
| My body doesn't feel the passage of time consistently. So
| my mind is never prepared to switch activities when it
| needs to.
|
| And there are times my brain stops working on a
| particular task and nothing can get it started again.
| It's like a leg going out, you just can't stand on it.
|
| This isn't occasionally where habit could be picked back
| up. This has been a problem every day of my life.
|
| In my experience, this has been the death of every bit
| advice I've gotten from a neurotypical person. A lot of
| them keep circling back to discipline or trying harder as
| a solution to a problem they can't make sense of. Lack of
| understanding isn't their fault, this is so far outside
| their frame of reference they can't make sense of it in a
| single conversation. Fortunately understanding isn't
| required, only the acceptance that other people have
| limits they don't have themselves.
| technothrasher wrote:
| I would imagine you'd get this advice from other non-
| neurotypical people too. My son is neurodivergant, and
| strict routine like what is being described is about the
| only thing that keeps him able to handle most daily life
| tasks regularly. But plenty of other advice he constantly
| gets frustrates him similarly to the frustration you seem
| to be describing. We call it "you've just never had it
| cooked right" advice. So I feel your exasperation.
| skywhopper wrote:
| It really doesn't remove that for everyone. Glad if it
| works for you.
| bluerooibos wrote:
| All you need to do is go to sleep before 12 every single
| night and wake up at 7am without fail, hit the gym and
| crank out a few sets of squats, hit the pool and the sauna,
| read a chapter of that book, and then cook yourself an
| amazing breakfast, all before 9am.
|
| If you're a real go-getter, though, you'd wake up at 6am
| and do some vibe coding for an hour on that side hustle.
|
| Super simple.
| roguechimpanzee wrote:
| I know you're being smart but these things are all
| possible if you want to make them happen
| andy99 wrote:
| People would rather blame external factors and not take
| responsibility.
|
| It's actually insulting to people who work hard that some
| people assume they have it easy somehow, like the "must
| be nice" comment upstream. Not everyone takes the view
| that you can't control what happens to you, it's pretty
| easy to see who does.
| chrisweekly wrote:
| "smart"? I'd say "sarcastic"
| tdeck wrote:
| Don't forget to spend a few minutes journalling self-
| affirmations.
|
| https://m.youtube.com/watch?v=_o7qjN3KF8U
| recursive wrote:
| This but unironically. I don't post on LinkedIn or
| anything. But sometimes it seems like all the agonizing
| people sometimes do over whether or not they should
| follow their plan (fitness, diet, productivity) makes it
| ten times worse.
|
| It can be possible to decide to do something in advance,
| and then... just do it. The more times you do it the
| easier it gets. My wife comments on this sometimes. I
| guess not everyone has this? Maybe it can be learned? I
| don't know.
| RickJWagner wrote:
| I subscribe to Arnold Schwarzenegger's newsletter, which has
| a surprising amount of great, well researched content.
|
| Right after New Year's Day, he said pretty much what you
| said. Discipline beats Herculean effort that's sporadic.
| WalterBright wrote:
| Scott Adams said it a different way - systems over goals.
| shevy-java wrote:
| > saturdays from 16 to 18 is house cleaning time.
|
| > Routine can be used for bad things but also for good
| things.
|
| So your willpower causes such routines to work. Not everyone
| works that way. And not everyone not working that way has
| depression. I don't think one can generalise this to
| "routines will fix your depression".
|
| > but after some repetitions your mind (and body) begin to
| get used
|
| I also don't buy into that. A good counter-example is tobacco
| smokers. Some manage to quit the moment they decide they want
| to quit, with no substitutes. Others try with substitute and
| interestingly for many who try, that also works, but for some
| it does not. And some can barely ever quit smoking. And a lot
| of this has to do with how their brain works.
|
| Matthew Perry spoke about that with regard to his alcohol
| addiction. People are different. I personally never started
| with smoking, for instance, because I never trusted myself to
| be able to (want to) quit again - so at the least I was
| consistent in this regard (plus also, because in our youth,
| so many others started to smoke suddenly, and I always felt
| it was a very stupid reason to smoke merely because others
| would do so, even at an early age. Their rationales would not
| be mine and I failed to see the point in adopting their
| positions and make them my position).
| trueismywork wrote:
| The same routine for good things can turn into being a bad
| thing. Brcause it can make you inflexible. So there's a trade
| off there.
|
| For me, it was when I was in a situation where I had to work
| 80 hours a week to keep my job. I had to get rid of my
| routine for 8 months and I am happy I did it otherwise I
| would he poor today.
| exe34 wrote:
| Being inflexible is only a problem for other people! :P
| skywhopper wrote:
| Glad that works for you, but please know if you are giving
| advice to individuals, that not everyone can work this way.
| In fact, for some people, this sort of artificial structure
| actually makes it harder to get the stuff done, and just
| makes things worse.
| WalterBright wrote:
| > Motivation is fleeting but routine persists.
|
| Ahnold Schwarzenegger said that the gains in an exercise
| program happen when you really don't want to do it, but do it
| anyway.
| ericmcer wrote:
| It is really easy to have a routine when you are single and
| healthy in your 20s. It stops working so well later on. If
| you have friends, partner, kids, parents, pets, work, health
| issues etc. the routine is going to be challenged. If that
| only happens once every few months no big deal, but now that
| I am in my late 30s with a partner, kid, 3 pets and elderly
| parents. I literally have something derail my day almost
| every single day. Carefully planning my week would be a
| recipe for misery.
|
| I think really successful people are ones that just don't
| give a shit, like full on narcissism. Like my dream is X, I
| need to do Y today. The dog is sick? My kid needs a ride? My
| parents need help? Not my problem I am doing Y full stop.
| chaostheory wrote:
| I'm in the same situation as you as well many other people
| who still workout. The trick is to remove as much friction
| as possible for working out and adding friction to
| activities that aren't good for you. For example, if you
| don't have time for the gym, make it easier to workout at
| home, make working out the very first thing you do when you
| wake up, etc...
| parpfish wrote:
| An easier routine for me to manage house cleaning is to set
| up a calendar with one little chore each day.
|
| List out what needs to be done every week, every month, every
| season, and set them up to repeat.
|
| Every day you do your little two minute task (clean the
| bathroom mirrors; vacuum a single room), so you get a little
| win. And they're each so small that it never feels like you
| need to switch into a long "cleaning binge" that you need to
| dread.
| darrenf wrote:
| I found this to be true, and that it perfectly dovetailed
| with TFA.
|
| When I was at my absolute depth (so far...) back in 2013, I
| would see my counsellor at 1130 on a Saturday. I'd be able to
| recount the darkness of the previous 7 days in stark vivid
| detail, yet cheerfully and not feeling at all depressed in
| the moment. The counsellor asked what I did on Saturday
| morning except the session and my answer was, well I do
| Parkrun[0] of course. I always do Parkrun. It's in my
| calendar, it's not really negotiable. It might have been the
| only time I managed to get out of bed all week, but, I mean,
| how can I possibly skip Parkrun?
|
| I never actually linked the exercise to the boost in my
| mental health until I had it pointed out to me at that
| moment. I go for a run and I feel better _because of the
| run_. I would spend the whole 5km stewing and ruminating and
| maybe in tears but half hour after getting home I could
| function! it's stuck with me ever since, and I've never (yet)
| been so down again.
|
| Tomorrow will be my 429th Parkrun :)
|
| [0] https://www.parkrun.com/
| cheald wrote:
| That's amazing! I'm so glad for you that you found
| something that works and which can keep you going!
| Terr_ wrote:
| > Motivation is fleeting but routine persists.
|
| That makes me think of a philosophical comic on quitting
| smoking. [0] Rather than cerebral willpower, a lot of value
| comes from indirectly shaping what your animal-brain does or
| doesn't encounter/expect every day.
|
| [0] https://existentialcomics.com/comic/13
| mustaphah wrote:
| Once exercise becomes a habit, it's very easy to do even on
| days when your mood is terrible. A strict routine (initially)
| is the trick to making things easier forever.
|
| You definitely want to build that habit when you're at your
| best.
| hannob wrote:
| True, but the same is true for therapy. Finding a good
| therapist isn't easy, and having depression certainly doesn't
| make it easier.
| baincs wrote:
| That may be true if you're severely depressed, but I think it
| can save you if you're starting to get depressed. That's what
| happened to me at one point, and an online comment saved me.
|
| I was like 60% depressed but on my way there. I just took my
| first computer science class in college but I was overly
| ambitious when I participated in an undergrad CS research. The
| stress and imposter syndrome was shoving me to the downward
| spiral.
|
| I posted some gloomy thoughts on an online forum. It was long
| ago, but I remember the post contained how I could kind of
| relate to the villain while watching the movie The Dark Knight
| Rises.
|
| Some online person advised me "lift weights". I had never tried
| seriously lifting weights, but I was living in a student
| apartment 10 minutes away from the student gym, so I decided to
| give it a try. I can't forget the sensation when I did a set of
| bench press. After a period of amassing so much stress, each
| rep felt like I was reaching my hand into my brain, directly
| scooping out the waste and tossing it away.
|
| I became much more active after that, and successfully finished
| the research and the degree.
|
| It's like how homelessness is more reversible for people who
| became homeless less than a year ago, and why organizations
| focus on those groups.
| iamacyborg wrote:
| Motivation generally follows action, not the other way around.
| javanissen wrote:
| I think the real exhortation is to develop a multi-pronged
| strategy for managing depression. I didn't feel like my
| depressed life got durably better until I had both exercise and
| therapy, and there are still times where things aren't going
| well with no clear discernible reason. I suspect that adding a
| low dose of medication on top would help.
|
| Every additional coping mechanism you add, that works well for
| you, provides defense in depth.
| broof wrote:
| Also the bad times can be a great time to build good habits.
| I've tried and failed to develop an exercise routine many
| times, but it wasn't until I was laid off for 6 months that it
| finally stuck. I had a friend who went to the gym every day in
| the middle of the day so I didn't really have a reason not to
| go. 6 months was long enough for the habit to stick and fast
| forward years later and I still have the habit. It's been so
| good that I regularly think about how good it was that I had
| the opportunity to be laid off.
| unsupp0rted wrote:
| I take this to mean therapy for depression (particularly for men)
| is barely effective at all and exercise is not quite as barely
| effective at all.
|
| If therapy for depression were a pill, I'm not sure it'd
| demonstrate enough efficacy to get approved.
| EA-3167 wrote:
| The problem is that the same is true for many medications and
| other treatments, but if you're in the "lucky" minority (a
| pretty large one) for whom there's some relief... it's worth
| the try. It's not like choosing bleeding and emetics instead of
| chemotherapy for cancer, it's just the best we have right now
| to treat a complex system that we barely have the earliest
| understanding of.
| pfisherman wrote:
| Adding to this, the molecular mechanisms of psychiatric
| disorders such as depression, bipolar disorder, and
| schizophrenia are not well understood. People prefer their
| brains and skulls intact so taking brain samples for study is
| not possible.
|
| Diagnosis and grading is fuzzy - a cluster behavioral
| symptoms observed and reported by patients, family members,
| and clinicians.
|
| Based on some of the genetic evidence, which can also be
| fraught, it is likely that something like depression is in
| fact a grouping of a bunch of separate underlying disorders /
| causes that all result in the same (easily) observable
| symptoms. Hence why some treatments work on a subset of
| patients, but are ineffective in others.
| derbOac wrote:
| Psychotherapy is similar to pharmacotherapy in effect size but
| longer lasting after discontinuation. Given that the latter has
| been approved, it's safe to assume psychotherapy would be
| approved if it were a pill.
| throw128 wrote:
| Anecdotal obviously, but from my experiences and those in my
| friend-group, therapy seems actively harmful in many
| circumstances. Therapy can be an enabler of bad behavior,
| helping to build a new fancy framework of excuses just as
| easily as it can help you land somewhere better. How long has
| it been since you've seen something bad (maybe it was just
| slightly selfish, maybe it was something worse and chronic)
| waved away as "self-care"? Or if you've lost faith in people or
| communication generally, then you're not going to feel better
| by going through many rounds of therapist mismatch and at some
| point you've aggravated problems rather than fixing them.
| Fortunately for the industry, measuring the harm is just as
| difficult as measuring the benefits. The advice to "just
| exercise more" may not help, but at least it really can't hurt.
| chrneu wrote:
| > Therapy can be an enabler of bad behavior
|
| Be aware that a lot of therapists are aware of this and
| actively try not to do this.
|
| Unfortunately, services like BetterHealth allow clients to
| select their therapists in ways which results in people
| doctor shopping to get what they want. Doctors want to get
| paid so they'll say/do whatever to keep clients.
|
| It's like the antibiotic issue with internal medicine. People
| will see a bunch of doctors until they get what they want.
| throw128 wrote:
| Yes but isn't this pretty fundamental to the process? You
| could look for more qualified/expensive people, but even if
| it were free and everyone was extremely qualified then
| there's still customer-satisfaction metrics to try and
| game.
|
| To bring it back towards exercise, it's fair to say that it
| literally cannot hurt and might help, which is more than
| you can say about therapy. And at least it is very, very
| telling whether a therapist is working questions about
| sleep/exercise into the very first interactions. Anyone who
| does not is definitely a quack.
| ebiester wrote:
| I think the major problem we have is we are lumping depression
| and anxiety into the same category.
|
| Some people probably do have issues quickly resolved by SSRIs.
| Others are magically fixed by bupropion while it spikes anxiety
| in others. Others have major trauma that they have to work
| through and many therapies (like internal family systems
| therapy, as one example) are great at handling that. Others are
| stuck in cognitive distortions and merely learning about them
| and handling them (through cognitive behavioral therapy) can be
| life changing.
|
| But if you have major trauma in your past, exercise is probably
| not going to do much. If you are heavily overwhelmed and your
| body is stuck in perpetual flight or fight) exercise and
| meditation might be a giant help.
|
| But right now the practitioners are aware of this, but it's
| really hard to double blind test these divisions until people
| can do the analysis first. And at that point, you've basically
| already started therapy.
| emsign wrote:
| It's almost as if humans were optimized to constantly move around
| all day by evolution. Huh. Who would have thought.
| srameshc wrote:
| I will speak from my experience. I have diabetes and I try to
| manage it well, with workout. But sometimes when the sugars are
| high for a while, I can feel it, the sadness, the hopelessness.
| It took me a while to understand that is high sugar levels and a
| mild form of depression. Now I will do some workout when I feel
| that and after a little workout, I can see how my mind also start
| to feel better. This is not a solution for everyone who is
| experiencing depression probably but might help some who are
| experiencing because of high sugar levels.
| hu3 wrote:
| hey friend, I'm glad to hear you found a way to improve things.
| It's not easy.
|
| I also notice my mind better after workouts.
| gehsty wrote:
| If it helps anyone I take antidepressants and have had a positive
| experience with them. Depression can be caused by a chemical
| imbalance and no amount of exercise or talking about it will fix
| it.
|
| One of the most frustrating things when your really low is people
| giving advice like do exercise to feel better - please don't do
| this.
| ge96 wrote:
| that $5K deductible though...
| gehsty wrote:
| Apologies - one of the very few great things left in UK is
| the NHS and my diagnosis was free and my prescription is
| PS9/month.
|
| I take sertraline (Zoloft in the US I think) and that is
| cheap - $20/30 month.
| ge96 wrote:
| I'm not even talking medication, talking about cost of
| therapy it's like $200 per session sometimes but yeah all
| depends
|
| I had to pay $3K for an MRI in cash one time, which yeah
| you get what you pay for but my buddy pays $2.8K/mo in
| insurance for his family, like that's a big chunk of his
| monthly pay
|
| Oh I want to be clear no snark towards you this is the
| cliche topic of healthcare in US
|
| Regarding the topic at hand though, yeah I lift 5 days a
| week and do a half hour of maximum inclined walk for those
| days as well. Mental health but also I want to be ripped.
| Helps my job has a gym and I'm the only one in there in the
| mornings. We also walk like 2 miles at work, in circles
| around the parking lot, talking to co-workers 4 days a
| week.
|
| My main problem is anxiety, like I wish I could walk
| downtown in a city and do street photography but I fear
| that someone will ask me for money or get robbed. The funny
| thing is I'm a big guy, like 6', I bench almost 300 lbs.
| I'm not like a stick. I have a fear of crowds too I can do
| shopping but sometimes in like a WalMart that's a lot of
| people and of course I'm terrible with women, the fear even
| if I have the bod. I'm just scared of eye contact and low
| self-esteem even having a six-fig job my self-determined
| value is whether a woman will say yes to me or not, it's
| funny. I don't have a fear of speed I can drive 160mph+ on
| the highway, helps to have a good car.
|
| But for the moment I'm working towards freeing myself from
| debt and then being able to live a life where I'm not in
| fear of losing my job. I'm a privileged person, this is
| brought on by myself eg. dropping $1.2K a night at a strip
| club or $600 Venmoing a band to play song requests. I'm
| complaining about therapy cost lmao.
| lowdownbutter wrote:
| > my diagnosis was free
|
| As long as you don't factor in your taxes.
| dns_snek wrote:
| Do you think they're stupid and just don't realize that
| they pay for it with taxes?
|
| You're not factoring in the most critical piece of
| financing - the mental burden. You don't want to be stuck
| figuring out how to get enough money to pay for mental
| health services when you need them the most. That's when
| your earning potential is at its lowest, and every minor
| obstacle to getting help gets magnified ten fold.
|
| That may as well be a death sentence unless you're
| privileged enough to be able to easily pay for it with
| savings. Realizing that you need help, figuring out how
| to access it, and actually following through is hard
| enough as it is without any added financial burden.
| scosman wrote:
| Exercising can help. It's not bad advice or inappropriate to
| suggest it. People shouldn't suggest it as if it's a cure all
| and certainly shouldn't suggest you just need to buck up, but
| the study is showing it can really help.
|
| Context: I'm "using" SSRIs, talk therapy, psychotherapy,
| strength training and endurance training -- all in parallel
| right now.
| altruios wrote:
| > Depression can be caused by a chemical imbalance and no
| amount of exercise or talking about it will fix it.
|
| This is a debatable. As far as I understand things: 'chemical
| imbalance' has no tests to confirm that's actually true, That's
| just a story they tell to relax people.
|
| Which is orthogonal to the point that antidepressants can work
| for some people.
|
| We don't know how depression works. It very well may be many
| little things dressed in a trench coat.
|
| https://www.sciencedirect.com/science/article/pii/S266656032...
|
| https://www.nature.com/articles/s41380-022-01661-0
|
| https://www.neurocaregroup.com/news-insights/the-death-of-ch...
| javier123454321 wrote:
| Jim Carey had the best way to think about this: "I believe
| depression is legitimate. But I also believe that if you don't
| exercise, eat nutritious food, get sunlight, get enough sleep,
| consume positive material, surround yourself with support, then
| you aren't giving yourself a fighting chance."
| gehsty wrote:
| I wonder what his thoughts are on post natal depression? Of
| course those things help but there can be factors outside of
| people's control that can lead them down this path...
| BeetleB wrote:
| If you say that to a depressed person, they are going to sink
| deeper into despair. Most people (even those who are not
| depressed), are not meeting that bar.
|
| Always remember, being true is not the same as being helpful.
| achierius wrote:
| > Depression can be caused by a chemical imbalance
|
| And yet many other times, it can be caused or exacerbated by
| situational and psychological factors, including "being stuck
| at home all day".
|
| > One of the most frustrating things when your really low is
| people giving advice like do exercise to feel better - please
| don't do this.
|
| Worse, antidepressants actually cause significant harm to many
| people who take them, often without even improving their
| depressive symptoms. This is very bad, and I would say
| significantly worse than giving general advice that might be
| inapplicable to some people.
|
| There's no one-size-fits-all solution, and some people probably
| _are_ legitimately just in need of more motivation to go
| running or biking or whatever else will get them the exercise
| they need.
| D-Machine wrote:
| "Chemical imbalance" theories of depression (e.g. "serotonin
| hypothesis") have been scientifically discredited for well over
| a decade now.
|
| EDIT: For a recent overview, see
| https://www.nature.com/articles/s41380-022-01661-0
| stormed wrote:
| I decided to go unmedicated from SSRIs/mood stabilizers in 2024
| and it changed my life for the better. Prior to stopping, I
| thought I was physically unhealthy until I found out excessive
| overheating & exhaustion was a common side effect of Zoloft.
| Since then, I've lost around 40 pounds and have been able to
| regularly exercise without issues. My mental health also improved
| with forcing myself to get vitamin D outside. It can be the
| simplest of things to improve your life, but it can be easy to
| forget (especially WFH).
| PeterStuer wrote:
| Did you get the "brain zaps" when coming off the SSRIs? How
| long did it take?
| cung wrote:
| Nearly as effective? It's significantly more effective!
| imzadi wrote:
| This is only talking about therapy and not medication. The
| original study is a bit light on details
| https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
|
| > For the 57 trials (2189 participants) comparing exercise with
| no treatment or a control intervention, the pooled SMD for
| depressive symptoms at the end of treatment was -0.67 (95%
| confidence interval (CI) -0.82 to -0.52; low-certainty evidence),
| showing that exercise may result in a reduction in depressive
| symptoms. When we included only the seven trials (447
| participants) with adequate allocation concealment, intention-to-
| treat analysis and blinded outcome assessment, the pooled SMD was
| smaller (SMD -0.46, 95% CI -0.88 to -0.04). Pooled data from the
| nine trials (405 participants) with long-term follow-up provided
| very uncertain evidence about the effect of exercise on
| depressive symptoms (SMD -0.53, 95% CI -1.11 to 0.06; very low
| certainty evidence).
|
| Like, what does -0.67 really mean in this context. I read the
| study and it is not really explained. Maybe I'm too dumb to get
| it, though.
| verteu wrote:
| It's a standardized mean difference, which I believe can
| roughly be interpreted as: "treated groups had 0.67 stddev
| lower depression score than control groups."
|
| That's a pretty substantial improvement - consider someone
| who's more depressed than 75% of the population becoming
| completely average. (Because the 75th percentile is about
| 0.67stddev above the median.)
| D-Machine wrote:
| You cannot say if this is a substantial change or not,
| because you need to know by _how much_ the groups actually
| differ on average, i.e. you need the unstandardized effect
| size, expressed as a mean difference in the scale sum scores,
| or as an actual percentage of symptoms reduced, or etc. In
| general, there are monstrous issues with standardized mean
| differences, even setting aside the interpretability issues
| [1-3].
|
| See also my response to GP.
|
| [1] https://journals.plos.org/mentalhealth/article?id=10.1371
| /jo...
|
| [2] https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.134
| 8/0...).
|
| [3] https://www.tandfonline.com/doi/abs/10.1080/00031305.2018
| .15...
| D-Machine wrote:
| It means nothing, standardized effect sizes have no clinical
| meaning here, they are purely statistical. To measure if these
| kinds of changes matter, you need to determine the Minimal
| (Clinically) Important Difference [1-2]. I.e. can clinicians
| (or patients) even notice the observed statistical difference.
|
| In practice, this is a change of about 3-5 points on most 20+
| item rating scales, or a relative reduction of 20-30% of the
| total (sum) score of the scale [1-2]. Unfortunately, anti-
| depressants are under or just barely reach this threshold
| [3-4], and so should be widely to be considered ineffective or
| only borderline effective, on average. Of course this is
| complicated by the fact that some people get worse on these
| treatments, and some people experience _dramatic_ improvements,
| but, still, the point is, depression is extremely hard to
| treat.
|
| Unfortunately, this also means that if exercise is only
| _nearly_ as effective as therapy for depression, it may mean
| that the benefits of exercise are not actually really
| clinically observable, if measured properly and not just based
| on arbitrary statistical significance.
|
| EDIT: There is less data on MCIDs for therapy, but at least one
| review suggests therapy effects can be in the 10+ point range
| [5]. But the way the exercise study is presented, with
| standardized effect sizes, we have no idea if the results
| matter at all [6].
|
| [1] Button, et al. (2015). Minimal clinically important
| difference on the Beck Depression Inventory - II according to
| the patient's perspective. Psychological Medicine, 45(15),
| 3269-3279. https://doi.org/10.1017/S0033291715001270
| [https://www.cambridge.org/core/journals/psychological-
| medici...]
|
| [2] Masson, S. C., & Tejani, A. M. (2013). Minimum clinically
| important differences identified for commonly used depression
| rating scales. Journal of clinical epidemiology, 66(7),
| 805-807. [https://www.jclinepi.com/article/S0895-4356(13)00056-
| 5/fullt...]
|
| [3] Hengartner, M. P., & Ploderl, M. (2022). Estimates of the
| minimal important difference to evaluate the clinical
| significance of antidepressants in the acute treatment of
| moderate-to-severe depression. BMJ Evidence-Based Medicine,
| 27(2), 69-73. https://doi.org/10.1136/bmjebm-2020-111600
| [https://ebm.bmj.com/content/27/2/69.abstract]
|
| [4] Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should
| antidepressants be used for major depressive disorder?. BMJ
| evidence-based medicine, 25(4), 130-130.
| https://doi.org/10.1136/bmjebm-2019-111238
| [https://ebm.bmj.com/content/25/4/130.abstract]
|
| [5] Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G.,
| Hollon, S. D., & van Straten, A. (2014). The effects of
| psychotherapies for major depression in adults on remission,
| recovery and improvement: a meta-analysis. Journal of affective
| disorders, 159, 118-126.
| https://doi.org/10.1016/j.jad.2014.02.026
| [https://pubmed.ncbi.nlm.nih.gov/24679399/]
|
| [6] Pogrow, S. (2019). How Effect Size (Practical Significance)
| Misleads Clinical Practice: The Case for Switching to Practical
| Benefit to Assess Applied Research Findings. The American
| Statistician, 73(sup1), 223-234.
| https://doi.org/10.1080/00031305.2018.1549101
| commiepatrol wrote:
| I read the title as "Exorcise". I'll show myself out.
| Simulacra wrote:
| I found this to be contradictory with my mental health period
| even after losing nearly 100 pounds, and going from zero to
| walking 8 to 10 miles a day, my mental health did not improve. It
| felt good to accomplish goals, two life-changing goals, really,
| but my overall disposition and deep depression did not change. I
| have no explanation for this.
| nineteen999 wrote:
| It may be worth looking into childhood trauma if that's
| something that may be applicable. I had a similar experience,
| after losing 35kg over 3 years I felt and looked great on the
| onsite, even having to overcome back surgery during that period
| as well, felt like I'd conquerered the world. I thought I'd
| "done enough work", but as I found out, sometimes there is work
| to be done on the inside as well.
| jimmar wrote:
| I took meds for depression a few years ago. I don't know that
| they did anything other than signal to myself that I wasn't ready
| to give up. They may have served as a kind of "dumbo's feather"
| that helped me get through a rough patch. Exercise might be
| similar. People who choose to exercise make the statement to
| themselves that they are worth doing something positive for. Some
| mental health problems resolve with time and without medication,
| and in those cases, exercise might be a great way to address
| them. But if you're struggling, call your doctor and make and
| appointment. Medication is sometimes the answer.
| jokoon wrote:
| I tried intensive workout
|
| It's unhelpful because I got tired, and then I stopped workout
| entirely
|
| Now I just do fast walking and it's nice
| cpursley wrote:
| Have you tried lifting weights (different pace than HIT)?
| denim_vampire wrote:
| I think one of the tricky things about depression is how unique
| each person's experience with it can be. I can only speak from my
| own history. For me, medication was indispensable in getting me
| to a point where lifestyle changes could occur.
|
| That being said, I do believe that exercising, eating right,
| maintaining a healthy sleep schedule, etc., all the boring
| lifestyle things have been key to preventing myself from slipping
| back into that depressed state, years after stopping medication.
| einsteinx2 wrote:
| It's also fantastic for anxiety, or at least it has been for me.
| Though I've heard anxiety and depression are often linked so I
| wonder if there's some common underlying mechanism by which it
| helps either both.
| taeric wrote:
| I would assume that "doing something" is the key here?
| Successfully doing exercise probably has add on benefits that you
| can more successfully do other things afterward. But successfully
| reading a book can help me get out of depression. Successfully
| cleaning the kitchen. Really, just successfully doing anything is
| a huge cure against depression.
| yoyoma1234 wrote:
| No, it's more specific - doing something physical.
|
| Cleaning dishes yes, reading a book no
| taeric wrote:
| My point in including both is that both can be surprisingly
| effective and turning my mood around. Despite them being very
| different. Included the dishes because that is physical and a
| chore that most people actively dislike.
|
| Edit: Just to be clear, per my other post sibling to this, I
| should say that they can both seem to be very effective at
| turning my mood around. I do not, necessarily, think either
| is causal on their own.
| filchermcurr wrote:
| I'm not sure this is the type of depression being talked about
| here. It's unfortunate that we have conflated periods of being
| sad / down with clinical depression. I have no doubt that
| reading a book or cleaning the kitchen or accomplishing a goal
| can help with feeling down or general sadness, but clinical
| depression is a whole separate beast without such easy a fix.
| taeric wrote:
| Who said these were "easy" fixes, though? I am emphatically
| not claiming that "just doing something" will work. Though,
| fair that what I put there can seem that way.
|
| I am more trying to claim that "just doing something" has an
| annoying track record of looking like "it" is what worked. I
| would fully believe that, in reality, the thing that worked
| was already at play before the success started happening.
| That is, fully depressed people don't succeed at any of these
| things.
| ElijahLynn wrote:
| The audiobook Spark by Dr. John Ratey, psychiatrist is a great
| listen with a bunch more evidence based arguments to support that
| exercise is better then drugs for depression.
|
| I highly recommend the audiobook as it is read by him and he is
| very enthusiastic about his research.
|
| The one quote I remember from the book is that he stopped
| prescribing Prozac and started prescribing treadmills...
| D-Machine wrote:
| Unfortunately, if exercise is only _nearly_ as effective as
| therapy for depression, it _may_ mean that the benefits of
| exercise are not actually really clinically observable, if
| measured properly and not just based on arbitrary statistical
| significance.
|
| Standardized effect sizes like the ones reported here have no
| clinical meaning, they are purely statistical. To measure if
| these kinds of changes matter, you need to determine the Minimal
| (Clinically) Important Difference [1-2]. I.e. can clinicians (or
| patients) even notice the observed statistical difference.
|
| In practice, this is a change of about 3-5 points on most 20+
| item rating scales, or a relative reduction of 20-30% of the
| total (sum) score of the scale [1-2]. Unfortunately, anti-
| depressants are under or just barely reach this threshold [3-4],
| and so should be widely to be considered ineffective or only
| borderline effective, on average. Of course this is complicated
| by the fact that some people get worse on these treatments, and
| some people experience _dramatic_ improvements, but, still, the
| point is, depression is extremely hard to treat.
|
| EDIT: There is less data on MCIDs for therapy, but at least one
| review suggests therapy effects can be in the 10+ point range
| [5]. But the way the exercise study is presented, with a
| standardized effect size, we can have no idea if the results
| matter at all [6].
|
| [1] Button, et al. (2015). Minimal clinically important
| difference on the Beck Depression Inventory - II according to the
| patient's perspective. Psychological Medicine, 45(15), 3269-3279.
| https://doi.org/10.1017/S0033291715001270
| [https://www.cambridge.org/core/journals/psychological-medici...]
|
| [2] Masson, S. C., & Tejani, A. M. (2013). Minimum clinically
| important differences identified for commonly used depression
| rating scales. Journal of clinical epidemiology, 66(7), 805-807.
| [https://www.jclinepi.com/article/S0895-4356(13)00056-5/fullt...]
|
| [3] Hengartner, M. P., & Ploderl, M. (2022). Estimates of the
| minimal important difference to evaluate the clinical
| significance of antidepressants in the acute treatment of
| moderate-to-severe depression. BMJ Evidence-Based Medicine,
| 27(2), 69-73. https://doi.org/10.1136/bmjebm-2020-111600
| [https://ebm.bmj.com/content/27/2/69.abstract]
|
| [4] Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should
| antidepressants be used for major depressive disorder?. BMJ
| evidence-based medicine, 25(4), 130-130.
| https://doi.org/10.1136/bmjebm-2019-111238
| [https://ebm.bmj.com/content/25/4/130.abstract]
|
| [5] Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G.,
| Hollon, S. D., & van Straten, A. (2014). The effects of
| psychotherapies for major depression in adults on remission,
| recovery and improvement: a meta-analysis. Journal of affective
| disorders, 159, 118-126.
| https://doi.org/10.1016/j.jad.2014.02.026
| [https://pubmed.ncbi.nlm.nih.gov/24679399/]
|
| [6] Pogrow, S. (2019). How Effect Size (Practical Significance)
| Misleads Clinical Practice: The Case for Switching to Practical
| Benefit to Assess Applied Research Findings. The American
| Statistician, 73(sup1), 223-234.
| https://doi.org/10.1080/00031305.2018.1549101
| shevy-java wrote:
| This kind of makes sense. Most forms of depression have to do
| with not wanting to do something or lacking motivation to do so.
| Whereas in sports, people get busy usually, they do something,
| even if it may just be soccer playing. Exercise is also usually
| good for one's physical well-being, blood circulation increases,
| muscles may improve, pain may go away (depends on the exercise,
| but usually say, two days after some heavy work out, most people
| may feel better than before, unless it was some extreme exercise
| that caused injury).
|
| I don't think this works for all type of depression though.
| cj wrote:
| I wonder if there's some survivorship bias. E.g. did they only
| study people who started and maintained a routine vs. everyone
| who started a routine but couldn't stick with it due to
| depression symptoms
| eastbound wrote:
| Observation bias. Those who succeed to drive themselves to do
| an effort, are already out of the depression. Try doing 7hrs
| sports a week and falling into depression: You won't have the
| energy. It's not sports that gets you out of depression, but
| sure it's a stage on the way back and you gotta constantly give
| it a chance.
| resumenext wrote:
| Therapy carries a huge risk, so maybe if you compare average
| outcomes exercise is only _nearly_ as effective, but if you
| consider the 2 overall exercise comes out way, way ahead imho.
| javanissen wrote:
| Is the huge risk being involuntarily committed?
|
| If so, that is a risk that is very dependent on local laws. I
| would be much more cautious about seeking mental health care in
| Florida, where the Baker Act makes it very easy, than in
| Connecticut [0]. The risk of being involuntarily committed
| also, of course, has to be balanced against the risk of
| forgoing mental health care when you need it and then injuring
| or killing yourself.
|
| [0] https://psychiatryonline.org/doi/10.1176/appi.ps.201900477
| isk517 wrote:
| Exercise is great, just make sure to take sometime to evaluate
| where you are at mentally. I was running about 40 miles and doing
| 5 hours of lifting per week to try and stay a head of my
| depression, and when I finally burnt out everything came crashing
| down all at once.
| MikeNotThePope wrote:
| Exercise is great for addressing feelings related to being
| physically inactive. It won't address other mental health
| issues, such as learning to control your emotions & fostering
| healthy relationships.
| nerdsniper wrote:
| > Exercise is great for addressing feelings related to being
| physically inactive.
|
| That definition is probably too narrow.
|
| https://en.wikipedia.org/wiki/Neurobiological_effects_of_phy.
| ..
| observationist wrote:
| There's a deeper level to the way you calibrate your mental
| operation. If you're under a lot of mental stress, your body
| is evolved to prime you for physical effort, beyond the fight
| or flight responses. By engaging in exercise, you're
| resetting your physical condition, and that can put you in a
| much better position to mentally cope with whatever is
| happening.
|
| This is something that has very deep evolutionary roots. A
| looming project deadline, a relationship crisis, feeling
| burned out, general malaise about your place in life - all of
| those stressors can bring about different neurochemical and
| hormonal changes that are in whole or in part dealt with in a
| healthy way by engaging in strenuous physical activities.
|
| That puts you in a position to gain perspective without the
| immediacy of the negative emotion, so you don't have to feel
| anxious, or have subtle negative threat framing around
| everything.
|
| You can abuse that, like anything else, and mask real
| negative factors in your life, or it can be a phenomenal and
| healthy way to deal with the negative framing of otherwise
| neutral or even positive circumstances in your life.
| pedalpete wrote:
| There is a tri-lateral(?) relationship between exercise, sleep,
| diet, and how the three impact mental health.
|
| A waste product of exercise is Adenosine. Adenosine build-up
| leads to increased sleep pressure, and improved Neural Function
| of Sleep, not just "being unconscious".
|
| This is where things get a bit interesting when we look at
| depression. For many people, depression results in decreased
| Neural Function of Sleep (specifically slow-wave activity) even
| though sleep time often increases.
|
| However there is also some evidence that restricting slow-wave
| activity can act as a "reset" button. The researchers I have
| spoken to about this are either in the "too dangerous to do the
| research" camp, or "distrupting slow-waves for a very short
| period, then increase slow-wave activity".
|
| Of course, sleep and exercise would only be a single pathway to
| improving depression outcomes. Exercise alone, and the dopamine,
| oxygenation, and many other outcomes are also likely to come into
| play.
|
| Comparing this to pharmaceutical or behavioural therapies, I can
| see why they'd be as effective. You're treating the entire
| system, not just trying to change a single chemical in the brain,
| specifically when we aren't even measuring the chemical before or
| after treatment.
| lifeisstillgood wrote:
| This leads to a fairly obvious conjecture :
|
| That since for 100,000 years humans were roaming the landscape
| gathering or hunting, and for 10,000 years engaged in heavy
| agricultural work, is the modern day rise in depression not just
| correlated but caused by the modern day reduction in daily heavy
| exercise?
|
| It's such an obvious idea I am wondering if folks know of any
| research / studies on it?
| bradlys wrote:
| I exercised for years. I'm talking multiple hours a day. It was a
| part time job. It never improved my mood.
|
| Some people don't suffer from chemical imbalances, unhealthy
| habits ruining their mood, or whatever your snake oil will
| magically cure. There's a term called Shit Life Syndrome and some
| people just have that as their long term situation.
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