Exercise and depression: When does it help (and when doesn’t it)? Why?

Last year I discovered that half an hour of nice fast walking can bring me down out of a hypomania or mixed state or whatever you want to call it when I start getting unpleasantly overenergized. (Heavy exercise can make some people hypo/manic, so be careful if you decide to try this at home.) I exercise a lot now because it does stuff for me and because I’m in good enough mental health to do so. When I’ve been depressed, no matter how many times I read that exercising was supposed to make me feel better, it never did in the short term, and (due to inability to find energy to do things like stay awake for long periods of time) I was not able to keep it up long enough to make a difference.

But it does help ease depression, on average, which means that some people are probably getting a lot of benefit from it, other people little or no benefit, and most people in between. (This doesn’t count the people who are not able to exercise due to depression, although possibly it should – if you cannot put the treatment into action due to the disease, the treatment is inappropriate for you at that time.)

Earlier today I read an article on a study showing that women on a *supervised* exercise regimen who were *also taking medication* improved more (on average) than women who were also taking medication but did not have the benefit of a supervised exercise regimen. Note “supervised” and “also taking medication”; they were not just told that if they exercised more they’d get better, but were actually provided with the support necessary to exercise. And they were not exercising-instead-of-taking-medication the way some well-meaning dumbasses tell depressed people to do. Supervised exercise was the supplement, not the treatment, and it helped.

I’m hoping there’s a follow-up comparing people with supervised exercise regimens + medication to people with supervised exercise regimens without medication. The women in the study were ones who had failed to show improvement on medication for two months – so was it that (on average) the supervised exercise made it possible for the medication to work? Or was the supervised exercise (on average) doing what the medication wasn’t?
My long-range pie-in-the-sky hope is that this takes off enough that eventually we’ll have government and insurance-company support for supervised exercise programs as an adjunct to other treatments. Helping with depression and making the rest of you healthier too…curative and preventive treatment at the same time.

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16 Responses to Exercise and depression: When does it help (and when doesn’t it)? Why?

  1. Micky says:

    About 3 years ago I dropped into a black hole – four months of absolute terror. I wanted to end my life, but somehow [Holy Spirit], I reached out to a friend who took me to hospital. I had three visits [hospital] in four months – I actually thought I was in hell. I imagine I was going through some sort of metamorphosis [mental, physical & spiritual]. I had been seeing a therapist [1994] on a regular basis, up until this point in time. I actually thought I would be locked away – but the hospital staff was very supportive [I had no control over my process]. I was released from hospital 16th September 2004, but my fear, pain & shame had only subsided a little. I remember this particular morning waking up [home] & my process would start up again [fear, pain, & shame]. No one could help me, not even my therapist [I was terrified]. I asked Jesus Christ to have mercy on me & forgive me my sins. Slowly, all my fear has dissipated & I believe Jesus delivered me from my “psychological prison.” I am a practicing Catholic & the Holy Spirit is my friend & strength; every day since then has been a joy & blessing. I deserve to go to hell for the life I have led, but Jesus through His sacrifice on the cross, delivered me from my inequities. John 3: 8, John 15: 26, are verses I can relate to, organically. He’s a real person who is with me all the time. I have so much joy & peace in my life, today, after a childhood spent in orphanages . God LOVES me so much. Fear, pain, & shame, are no longer my constant companions. I just wanted to share my experience with you [Luke 8: 16 – 17].
    PEACE BE WITH YOU
    MICKY

  2. resonance says:

    That’s great if that one treatment worked for you personally, although I’m not aware of any studies on religion, with control groups. Because depression often recedes on its own after a time, and because people who seek out Christianity (or spirituality) may not be representative of depressed people in general, we need to compare two groups of people who are representive of depressed people and assign one group to become involved in Christianity (i.e., MORE involved in Christianity, since the majority of people in the U.S. at least are Christian already, including the depressed ones) and one to stay as they are. Otherwise we don’t know if reports of peoples’ depression are due to it receding on its own over time, or if they’re due to people who become heavily involved in Christianity do so because they’re different in other ways from people who don’t (for example, maybe they would have gotten better without heavy involvement in Christianity, because they have different predispositions). Because the only difference here would be whether the group gets involved in Christianity or not, that would let us know about the actual effect of Christianity, not the actual effect of being the kind of person who is attracted toward heavy involvement in Christianity. And because the two groups are made of similar people, we know that extra improvement (or for that matter, worsening of depression) in the Christianity-assigned group is due to the Christianity, because both groups are likely to get better on their own to the same degree.

    This won’t happen, because people tend to object to forced conversions and to pressure to convert in general, and because most review boards in the country would object to forcing people to convert (as do I). There are other methodological ways to get around that some, although they’re not ideal.

    It’s too bad that like some other treatments, Christianity (or even religion in general) has not worked for the many depressed Christians out there. Depressed Christians who do all the things you say and are still depressed get pissed off at comments like yours, because it’s like being told that if you just exercised more, did yoga more, meditated more, you’d be fine. When they’re already exercising more than you, doing more yoga than you, meditating more than you, and are more religious than you.

    I’m also guessing that you don’t actually mean Christianity here – you mean your own take on Christianity. That’s a tiny little narrow version of what religion is, and what spirituality is, and if we only investigate your own personal take on Christianity we won’t find out what’s actually causing change, if there is any change being caused (many people, for example, are convinced that things like acupuncture or being healed by a new age psychic works for their depression, when it’s just receding on its own).

    If we actually want to help people, we’ll look at commonalities across religions and see what’s helping people (again, if there is help going on). Then we can take that and use that to help people. That way, it’s about helping depressed people, not about using mental illness to attempt religious conversions. For example, maybe a supportive community helps, and we should be focusing on fostering the many supportive communities that already exist, not just the ones that adhere to your brand of Christianity.

    Did you have anything to say about exercise (the topic of this entry), or are you just using blogs about mental illness as a convenient platform to spam people with proselytizing? And are you going to come back, or is this just a hit and run on my blog (that you’ve cut-and-pasted to other blogs as well), having to do with your attempts to make people adopt your own religious and political agenda, rather than primarily to do with helping people?

  3. Micky says:

    Resonance Said:
    Did you have anything to say about exercise (the topic of this entry), or are you just using blogs about mental illness as a convenient platform to spam people with proselytizing? And are you going to come back, or is this just a hit and run on my blog (that you’ve cut-and-pasted to other blogs as well), having to do with your attempts to make people adopt your own religious and political agenda, rather than primarily to do with helping people?

    Greetings Resonance
    I felt some pain reading your comments. I imagine you were RAGING over your fear, pain and shame [repressed]. I imagine you are a RAGEAHOLIC and CONTROL FREAK – you have a conscious fear of intimacy and an unconscious fear of abandonment. The only way you will relieve your DEPRESSION [sin] is to go back to the CHAMBER OF HORRORS [your childhood] and RECOVER your INNER CHILD who I imagine you ABANDONED a long time ago.. That CHILD is GOD!! I suggest [first] that you get down on your knees and ask JESUS CHRIST to forgive you for the above DIATRIBE [sins]. I love you, Resonance!! Do you love me? How do you FEEL?
    PEACE BE WITH YOU
    MICKY

  4. resonance says:

    My childhood was fairly decent, and I’ve never had rage issues. Intimacy makes me happy and comfortable, although you are correct in surmising that I would not want to get intimate with you. I’m not depressed, and medication, not copying your religious beliefs, brought me out of it. While it’s flattering that you think I was God as a child, I sincerely doubt that was the case. I am mildly sorry that I cannot fulfill your dramatic fantasies of me as a furious, terrifying, yet deeply emotionally wounded human being who will achieve TV-movie-style redemption; my playing a part you have scripted for me seems to be very important to you.

    I have no specific love for you, beyond the compassion I feel for people of the human race in general. I don’t know you. I’ve read two paragraphs you’ve written. I’m tending toward less compassion toward you than I feel toward the average person based on your using my blog for something I didn’t even implicitly invite you in for, and based on your attempts to insult me. At best, your remarks have been unrelated to the subject matter, and at worst, spam.

    As for how I feel, I’m amused, and am enjoying the fact that I’m emotionally stable enough to see your comments as inappropriate to the context, uninformed, etc., and to not waste emotional energy on them, so that I can put it toward things in my life that help me and other people.

    If you still feel pain when reading this, you might want to consider looking at your discomfort when others won’t play the scripts you have assigned to them. It may be that they’re just not going to, and you will have to deal with that instead. You may also want to look into your tendency to call people you love names, when they don’t agree with you, and to diagnose them with problems you’re not qualified to diagnose and blame their objections to what you say on that.

  5. Micky says:

    Greetings Resonance
    I felt some pain and sadness reading your comments [meaningless words]. Can you see how defensive you are (My childhood was fairly decent, and I’ve never had rage issues.)? Your process is not about me but unprocessed issues from your childhood. I imagine that you are a “scared little child”, who has escaped into his head, because he/she is too terrified to face his/her demons. Were you abused, as a child? I love you, Resonance and you will be in my prayers. Have you thought about seeing a therapist? How do you FEEL, not what you THINK? Do you know what a FEELING is, Resonance?
    PEACE BE WITH YOU
    Micky

  6. Michael says:

    Micky seems to enjoy telling this story. Verbatim. To all sorts of people who haven’t expressed interest.

    http://www.blingo.com/search?q=%22but+somehow+%5BHoly+Spirit%5D%2C+I+reached+out+to+a+friend+who+took+me+to+hospital%22&sourceid=firefox&s=0&s=0

    Resonance, investigating the role of religion in recovery from mental illness probably doesn’t require research that’s quite that stringent. I’d be persuaded if there were simply archival evidence suggesting that people who have a strong conversion or revelatory experience tend to _subsequently_ show improvement, relative to people of similar beliefs and practices who don’t have that kind of experience. Of course, that just scratches the surface of the forms religious experience can take.

  7. Michael says:

    On another note, I share your frustration that articles don’t more frequently report what percentage of participants benefited from a given treatment, as well as the overall group improvement. In terms of theoretical understanding, there’s a big difference between a treatment that cures a small number of people vs. one that gives a slight benefit to most people.

    I’m not very fluent in clinical literature. I think that a lot of clinical studies might do this (e.g., reporting the percentage of participants who improved by a least a minimum number of points on the HAM-D scale). It’s almost unheard of in social psych, though.

    I recall that this perspective was also discussed in the Psych Science review article on harmful therapies from last month. The author suggested that we look not only at whether some treatments have negative overall effects, but also at whether some treatments that appear to have null effects are actually helping some people and hurting others. I should review that to see what his specific suggestion was. It was a great article in general.

  8. resonance says:

    Micky: There are certainly things I wish I could have changed about my childhood, but there wasn’t abuse. What kind of statement correcting your
    inaccurate belief would you not consider defensive? Can I disagree with you in any way without you calling me defensive? Can your friends and family disagree with you without you calling them defensive? Can anyone disagree with you without you needing to believe they’re a rageaholic who was abused as a child?

    And yes, unfortunately, my “process” has to do with your comments on my blog. It is in response to them, about them, and focused on them.

    I’m fairly familiar with feelings, having had overly intense ones most of my life that have calmed down with age and medication. (Now I just have normal feelings like other people, and I relish that.) You’re not doing a very good job of provoking feelings in me, though; to be frank, you suck at trolling and I’m guessing you’re pretty new to it. You’ve missed most of my hotbuttons because you’re not very good at guessing what my issues are. You have gotten every single one wrong, in fact. You’ve also gotten my gender wrong, btw.

    I’ve had therapy at various times over the years. It’s a good bet that I’ve had more therapy than you had. I’m pleased to see you acknowledging that JESUS CHRIST might not be able to solve everything, though. JESUS CHRIST doesn’t seem to have solved your tendency to say nasty things to other people while telling them how much you love them. That is a tendency that abusers frequently display, btw. Are you projecting your childhood and yourself onto me?

    Anyway, it’s been fun, and it’s also been good practice interacting with people who are pissed off at me, in denial, and spamming my blog, without getting upset or taking it too seriously. It’s going to make it easier to deal with people who are saying similarly stupid things, but are much better at provoking strong emotions.

    I’m going to shift my energy back to science now, but thanks for the ride.

  9. resonance says:

    And now, the science!

    Michael –

    I’d be willing to consider the archival evidence, if it exists. I think I might be even more convinced by a large-scale study that controls for stuff like pre-existing religiosity and family religiosity.

    On another note, I share your frustration that articles don’t more frequently report what percentage of participants benefited from a given treatment, as well as the overall group improvement. In terms of theoretical understanding, there’s a big difference between a treatment that cures a small number of people vs. one that gives a slight benefit to most people.

    I hadn’t thought about it that way, but very true. Does the variance handle that? I can’t even remember what people are required to report in APA papers now.

    I recall that this perspective was also discussed in the Psych Science review article on harmful therapies from last month. The author suggested that we look not only at whether some treatments have negative overall effects, but also at whether some treatments that appear to have null effects are actually helping some people and hurting others.

    Ooh. Send it to me if you find it and I’ll post about it. (If you like, you can guest-post about it…)

    Both those things are really important methodologically. Maybe I should brush up on methodology and do a series of those posts. It’s not specific to mental illness, but I want to write about science education, too…

  10. Michael says:

    Variance is a weak guide to things like bimodal distributions. Also, high variance hurts your power, meaning that you’re more likely to get a null result and throw out a treatment that helps some people, rather than getting a significant result and assuming you can go ahead with a treatment that actually hurts some of them.

    As for the paper, check out the link I put in my comment…

  11. Micky says:

    Greetings Resonance
    What sort of therapy [I’ve had therapy at various times over the years.]? What is a normal feeling [(Now I just have normal feelings like other people, and I relish that.)]? FEELINGS are just that – FEELINGS!! I see that you are still RAGING over your TERROR [JESUS CHRIST doesn’t seem to have solved your tendency to say nasty things to other people while telling them how much you love them.]? Another example [You’re not doing a very good job of provoking feelings in me, though; to be frank, you suck at trolling and I’m guessing you’re pretty new to it.]? You are obviously a DEMON!!
    But I am afraid that as the serpent deceived Eve by his cunning, your thoughts will be led astray from a sincere and pure devotion to Christ [2 Corinthians 11: 3]. Begone Satan!!

  12. O says:

    Hi Resonance.

    I think that it is rather unfortunate that you have someone trying to be all preachy here on your blog and telling you stuff about yourself that you apparently did not know (magical! divine powers, I’m sure). Anyway, I believe that if someone finds that they can help solve their problems by the addition of religion and faith… well… good for them, but it does not work for everyone or for every problem. So I think debate is cool, but preaching is really self-righteous and all. I, personally do not believe that Jesus loves me and this is for a few reasons… i grew up in a fairly religious household, but have come to not really believe and really question faith and religion. Furthermore, Jesus does not love me because I am Jewish… lol. So there ya go!

    You? a DEMON? *That* is pretty funny. What ever happened to “love thy neighbor” and all that crap. As long as a person is moral… well, i tend to think they are not satan or satan’s spawn or whatever…

    Don’t waste your time on fanatics. No matter what you say they will just keep arguing. I love it when people always think they are right… awesome.

    Be well ❤

  13. Jason says:

    There have been studies showing that regular exercise is just plain superior to any known anti-depressants in long-term management of depression. Not only that, but one study in particular showed that *introducing* a regular running regimen to one group had more sustained long-term effect on reducing relapse than introducing Zoloft.

    The caveats to such studies are, as you point out, that anyone can take a pill, whereas it takes a lot of motivation, energy, discipline, and *belief* enough to maintain these for someone to develop an exercise routine. Also, since psychiatrists can neither make their patients exercise nor get paid for attempting to do so, well…

    So kudos, Resonance, for your own determination. I too find it very hard to get into a routine when I’m already depressed or anxious (or, well, to get out of bed and leave the house, never mind an exercise “routine”), and sometimes it is motivating just to remind each other what a difference it can and does make.

  14. resonance says:

    Hi, Jason. Can you point me toward those studies?

    My ability to exercise has very little to do with determination, and a great deal to do with being mentally healthy enough to be motivated to get out of the house and do something active, and healthy enough to not be exhausted just by the effort to get out of the house. It’s not something I do through determination, it’s something that mental health allows me to do, and poor mental health does not.

  15. Micky says:

    Jason Said:
    There have been studies showing that regular exercise is just plain superior to any known anti-depressants in long-term management of depression.

    Greetings Jason
    Regular exercise is fine (endorphins) and gives one the feeling of being connected, but sadly doesn’t deal with ones DEPRESSION [unresolved issues from ones childhood]. Exercise, whether it be jogging, dancing or working out in the gym can end up being, just another addiction. What happens if one breaks a leg?
    PEACE BE WITH YOU
    MICKY

  16. Jason says:

    Sorry if this double-posts; I got a WordPress error…

    This is a good study on CBT vs meds in relapse and recurrence prevention. Note that despite their conservative wording of the results, these data show that if you had to have *temporary* treatment (ie, not for the rest of your life), CBT will have more impact on your future mental health than taking medications, and is no less effective than taking medications for the rest of your life.

    Results Patients withdrawn from CT were significantly less likely to relapse during continuation than patients withdrawn from medications (30.8% vs 76.2%; P = .004), and no more likely to relapse than patients who kept taking continuation medication (30.8% vs 47.2%; P = .20). There were also indications that the effect of CT extends to the prevention of recurrence.

    Conclusions Cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication.

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