Flying or Falling? Can you have one without the other?
The thing about depression is that you don’t know how bad you feel until you don’t feel bad anymore. It’s like wearing a veil that subtly shades everything in your life until you can’t remember a time when rainbows weren’t made in varying grays and when the sky didn’t feel like a weight on your shoulders. But then perchance you get better and glimpse for a moment what everyone else sees: that the sky has been inspiring men to fly since long before Icarus and Daedalus took their ill-fated flight. And while one fell broken to earth and the other soared onward with a broken heart, both knew for a moment what it felt like to be held. Weightless. With the sun in their faces.
Once you know what not-depressed feels like – I won’t call it happiness since while that too is very real, it is fleeting and I’ve found it is better to be surprised by joy rather than expectant of continuous happiness – you want the key to get out of your cell. I know this feeling well. With a personal history of several depressive episodes and with a family tree shaped like a weeping willow, I can recite drug names and treatment methodologies like an encyclopedia. But my experience goes far beyond the academic past tense. I am currently taking an anti-depressant and have been for a couple of years now. I may be on one for the rest of my life. I hope not which is why I’m forever searching for alternatives.
There are other keys. Medicine, yes, and also therapy, electro-shock treatments, journaling, supplements, light – the list is long but there is one whose effectiveness is consistently backed by research. Exercise, time and again, has been shown to alleviate mild depression even better than anti-depressants and to ameliorate more severe depressive episodes, especially when used in conjunction with other therapies. It’s such a cure-all that it is often the first thing good doctors prescribe. But it isn’t quite so simple and a new study shines light on the nuanced way that exercise and depression interact.
Dr. Madhukar H. Trivedi, a professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas, studied 126 patients who had been on SSRIs (selective serotonin reuptake inhibitors – a type of anti-depressant) for at least two months and were still depressed. He divided the groups in half with one group doing light exercise several days a week and the other group doing more intense exercise for the same amount of time.
First, the good news: At the end of 4 months “29.5 percent [of study participants] had achieved remission, ‘which is a very robust result,’ Dr. Trivedi said, equal to or better than the remission rates achieved using drugs as a back-up treatment.”
Now for the confusing news: Patients who did the more intense exercise were more likely to achieve a remission of their depression. Unless they were women with a strong genetic history depression (aHEM). This group was the least likely to feel better but when they did, it was with the slower, easier exercise. Also, people in the intense exercise group were more likely to quit exercising than people in the more relaxed group.
The bad news, part 1: This left fully 70% of patients still depressed despite exercising and taking meds.
And the bad news, part 2: There was no control group in the study so who’s to say if it was the exercise or just good ol’ time that made the difference? Or the placebo effect?
For myself, exercise has been crucial to managing my depression and anxiety (I’m like one of those barrels full of plastic monkeys when it comes to mental illness, you pull one out and a whole slew come out entangled with it). Exercise, especially intense exercise, always, always makes me feel better. Lots better! Unfortunately it makes me feel so much better that it became my one and only coping tool which is a good part of how I ended up an exercise addict.
I don’t know what the solution is. Balance is hard for me to find and even harder for me to stick with. And yet I keep trying to glue more feathers to my wax wings in hopes of flying again. Even if it means I fall, broken. Everyone always feels so bad for the overzealous Icarus who was felled by his own ecstasy but they forget that before that he was flying. And even when he plunged headlong into the ocean I like to think he knew again – just for a moment – what it felt like to be held. Weightless. With the sun in his face.
Have you ever experienced depression? What has worked for you (or not worked)? Anyone else kinda want to drop-kick a researcher who doesn’t have a control group?
Can we have a drop-kick line? Kinda like the Rockettes, only meaner…
As you know, I’ve also had depression and anxiety issues pretty much my whole life. I decided to get off anti-depressants about 1 1/2 years ago, just to see of I could manage on my own (with the help of therapy). It’s such an individual thing: what works for me may not work for anyone else. Staying on anti-depressants is the best answer for lots of folks, and there’s nothing wrong with that. (In fact, there have been times when I’ve wondered if I should go back on them.) I do know that exercise is also a life saver for me, and moving from Massachusetts to California has helped a lot, as well. We do get a whole lot of sun in these parts!
Finally, I know I need to be doing something creative. It’s kind of vital to my survival. I think we all have that something that we NEED, whether it’s art or sports or what have you. So often we’re denied it, and that can make life a whole lot harder.
I was depressed for over a decade. Various factors helped me. Leaving an ununderstanding enviroment that thought that depression was a strictly spiritual problem, not an emotional or physical one. I went into a supportive enviroment and my progress was slow to get my optimism and sense of purpose back. It took years after leaving the enviroment that had contributed to it to get well again. I knew why I was depressed but I could not see the forest for the trees until I was away from it. The problem with the way depression is usually treated is just giving drugs with out figuring out the cause. As studies show the real, versus percieved, effect of pharmaceuticals is too low to be depended on with out therapy but therapy is expensive and not more effective. http://www.sciencebasedmedicine.org/index.php/antidepressants-and-effect-size/
I do use excercise to deal with depression and the axiety that comes with it.I still get mild deepression but now I have the tools to cope with it so it is like the common cold of the soul. It comes and it goes and it is a bother but I try to take care of myself and remember it will pass.
I have always drawn or painted all my life. It is such an escape. Drawing just lifts me out of myself. I can immerse myself in it for hours without noticing the time. Exercise is a bit like that but with the added benefit of keeping fit and I suppose it can be a sharing experience but Art is the thing which boosts my happiness meter the most.
Depression…does anyone get thru new motherhood without having SOME PPD? I mean, maybe not “clinical” but isn’t it normal to have some sort of PPD. After all your world just changed, your hormones changed, and all of a sudden you have a new life to take care of…after undergoing a MASSIVE hormonal shift and your body is beatup and tired. Yeah, I think that would make anyone depressed for a bit! 🙂
Drop kick a researcher without a control group? YES. I am lecturing about this topic at least 18 times in each of my classes this fall. It is the epitome of “bad science”.
That said, studies like these would benefit from control groups, but there is still so much variability in other factors it is nearly impossible to separate the effects of one variable, unless your sample size is HUGE.
God, I’m a nerd.
This is perfect. I have never been one to think I am depressed, nor have I been diagnosed as depressed, but it is common knowledge in my family that if I don’t work out one day (even 15 minutes) I am a mess. When I don’t exercise, my mind and emotions are awful. My family suffers for it and I am the meanest mom ever :(. OY
Thankfully I have learned that I can fix all mood issues in 20 tough minutes and therefore have been able to kick my over-exercise problem from years ago.
Even after reading this, I still have “Toy Story” stuck in my head after that picture and quote above. “It’s not flying, it’s falling with style.”
🙂
Great point!
Yeah, I’ve been there. Twice. It’s impossible to fully explain depression to someone who hasn’t experienced it (but you did a darned good job there, Charlotte!).
Frankly, I don’t know what helped me. I didn’t have a control group…. I do know that intense exercise brings me a definite mood boost. Whether or not that is what’s keeping the black dog off my doorstep I certainly don’t know.
As for control groups, I find it hard to believe researchers still design experiments without them. Even with a control group, though, there are so many other pitfalls. I think that, even in the best journals, only about 25% of the experiments are worth their weight in petri dishes.
I definitely wouldn’t call it depression, but a great sweat session can pull my head out of my posterior in terms of mood. I get a lot of “decision fatigue” in life (work especially), and just the simple, repetitive act of putting one foot (or arm if I’m swimming) in front of each other or moving something heavy and counting reps is like active meditation. Clearing the cache of decisions I have to make, per se. I rarely end a workout in a worse mood than when I start, no matter how bad the actual run/ride/swim is.
I think the big thing with exercise and sports is that it gives me a sense of purpose. While it can’t cure my depression/anxiety, I think it gives me a reason to get out of bed in the morning. It can also lift my mood a little. Unfortunately I think I’ll always needs anti-anxiety meds though.
I”m generally one of thos eoverall positive people, but my husband battles sometimes with depression. For him, exercise makes an incredible difference in his mood and ability to deal with stress. I know it sure gets me going, and once I”ve worked out in a day I already feel like I’ve accomplished so much that the rest of the day can’t be so bad either 🙂
I have been pretty depressed at at least one point in my life, and hadve some low-grade anxiety issues, but looking back, I think it had a lot to do with Accutane. Or an eating disorder. Or maybe it’s just my personality – I’m generally on the fence between happy and sad. And that’s ok with me. But exercise certainly lifts my mood!!! Even just a walk. Something else that made a HUGE difference was the book Feeling Good.by David Burns. I did a TON of work using its techniques and it really changed my thoughts and therefore, my feelings.
The only time in my life I was severely–by that I mean suicidally– depressed, I was on Accutane. Once I stopped taking it and it was out of my system, I went back to my natural state of simple melancholia.
Thank you, Charlotte, for this post. It’s so well timed. I’ve been in a bit of a black hole and just yesterday faced the choice of slow or vigorous yoga. To me it was a no-brainer–the constant breath and movement of Ashtanga keeps the blues away, at least for those 90 minutes, whereas a slower class gives my mind ample opportunity to torture myself. That’s interesting that the researchers found that gentler exercise worked better for that set of women. I always think that since depression feels slow, deep and depleted, intensity helps, but for anxiety, relaxation and slowing down would help. I’d also be curious to know what the baseline activity level of the participants was–maybe intense exercise was more effective for people who are already used to it?
“Anyone else kinda want to drop-kick a researcher who doesn’t have a control group?” <– hahahahah. Amen sister! I just wanted to say that I love your blog. Succinct, relevant, and showcases topics that are pertinent to a broad base, written in an attention-grabbing style. Props.
Oh, girl.
This encourages me (weird, right?) so much
to know that I’m not alone in the world of, “but I’m doing what I’m supposed to!”
Exercise helps me sometimes.
Eating good food helps me sometimes.
Buying cute shoes helps me sometimes.
But nothing helps all the time.
I’ve been in a valley for the last three months or so,
which makes me feel
a) Singularly ungrateful
b) Stupid
I can’t figure out what’s going on, or how to change it,
aside from trying food, exercise, sunshine, and vitamins.
I hear you.
I understand.
But hey, at least we’re not alone with the Black Dog, right?
*love*
I also have a weeping willow family tree and take an anti-depressant. My doctor thought I could come off of it…man was i anxious and then excited…but sadly no. Mine is here forever! But i am ok with it. I also take a mood stabilizer and man did my rainbows and clear blue skies show up then. I didn’t know how much better I would feel when I took that also. I HATE picking up my meds every month but my family likes having a mother who is functional(when i was a teenager my mom stayed in bed.all.the.time) and I like being functional. I agree…hard intense exercise does wonders for me. i crave it.
I hate research studies. If you want to believe in something…then someone has done research on that topic. 🙂
Charlotte,
Interesting post as usual.
I suffered from severe depression between ages 5 to 29 years old.
I tried to kill myself several times and on one occasion was almost successful.
In 2008 I had a massive nervous breakdown that left me in the hospital and out of work for weeks.
In 2010 I had another nervous breakdown that caused a huge shift in my life’s plan.
And in April of 2010 I resigned to depression being my fate in life and that there was nothing I could do about it.
Then, I committed to Yoga in November of 2010 and witnessed the disappearance of depression occurring naturally from my life.
Its been almost a year now and I am the happiest I have ever been in my entire life.
Ugggghhhhhhh to studies like this.
I dealt with my depression through exercise! But although I dealt with it through intensive exercise, I now find that I do much better with more gentle exercise to maintain a positive state of mind. If I do too much intense exercise, I just feel worn out, these days. Walking for a couple hours each day does the trick for me.
I totally agree it is difficult to impossible for someone who has never had depression to understand it. Those clear days I look back at my actions and think, “what the heck was I thinking/doing!” But when your in it you just can’t see/think clearly.
Exercise definitely helps me out a lot, I wish I could say it was enough!
I’ve never been officially diagnosed with depression, but it’s certainly in my genes and I would say I have suffered mild to moderate depression/grief at different points. For me, exercise helps immensely, especially if I’m outdoors–sun, fresh air, anything to wake up the senses and keep me present. Also, I see a naturopath who prescribed a homeopathic remedy for grief (ignatia amara) that worked WONDERS. A good fish oil supplement helps too. I’m also looking at cutting refined sugars because I see a mood connection there….
I’ve struggled with depression off and on most of my life. The last three years since making some major lifestyle changes, i.e, working out regularly and eating real food have been much much better. I still have down periods but the downs are nearly as low or as long. I think *know* not eating sugar so much helped too.
I have been depressed for about 1.5-2 years twice in my life. Your comment about not knowing you are depressed, or how depressed you are, until you are through it is so absolutely true. Each episode was different for me, happened for different reasons, manifested differently, and was treated differently. On neither occasion was I diagnosed nor did I seek professional help. The first time, I was a mess, with exercise and eating becoming addictions abused in the name of “coping.” The second time, I recognized that I was sliding, yet stopped exercising and eating. Another genius move. 😛 After a while, I started taking SAMe, an OTC mood elevator, which did then and continues now to help immensely by keeping the lows much less intense and shorter lived. Thankfully, I’ve achieved good balance and shaken the depression once again. Thanks for another relevant post.
I work in research support (human subjects ethics protections, now doesn’t that sound like a fancy name for “administration”?) and am studying epidemiology. And it pains me to see studies that are poorly designed. No one else seems as bothered by this as I am. I keep saying, “But they have four cases for every control! Can’t you see that’s BACKWARDS? I feel like I’m taking CRAZY PILLS!”
And yes, I have had depression and anxiety problems, and pills just did not do it for me. But regular exercise does. It can be light or intense, but regular is important.
Oddly, I get the same high from coxing a rowing crew. I mean, I’m sitting still and all, but throughout practice I’m still thinking like an athlete and verbalizing all that thinking over the mike to help other people. I wonder how much of the help is in the physical nature of exercise vs the mental nature of it?
Research on these things is always so muddled in my opinion, because there is that very human factor. I wonder if part of it is not the exercise itself, but the action of getting up/out and doing something. They say staying in bed and the like helps to feed depression so part of it might be that…
I do, however, think there is something to be said about exercise that takes place outside – especially in the sun, due to Vitamin D (and its proven effect on mood)
Barrel full of monkeys–I like the line!
I’m also prone to depression and anxiety. The meds made me feel blah and fuzzy, however not having them led me to use (and abuse) caffeine and food to keep myself energized. i know exercise–especially intense exercise–lifts my mood and kills the anxiety, but I haven’t found the motivation to workout regularly.
I had no idea I was depressed until our family therapist asked to speak to me one on one. I had always thought that depression was to be incapacitating and since I wasn’t incapacitated it came as a shock to me to hear. I’m in the military so exercising has been a part of my daily life for about 12 years. Apparently, exercising alone didn’t alleviate my depression so I’ve been on anti-depressants for about a year now. The combination of the two has worked wonders for me! The last time I remember being this happy was back in High School…..go figure….and I’m in Iraq right now. Who could be happy in a place like this?…..This girl, right here!! 🙂
I found out that exercise is good for people with depression the only problem is getting them to have the motivation to do some exercise.. the fact that the believe they are depressed stops them from doing anything in life before the even try!