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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 62. This is the beginning of the thread.
Posted by Bob on August 8, 2006, at 11:06:56
I was wondering if a few of you could weigh in on exercise as it relates to serious depression. I have always heard people say that exercise helps depression, but I almost have to laugh when this is brought up. The only thing I can gather is that it helps in light to moderate cases. Maybe I'm much sicker than others I've heard of, but I am rarely able to engage in physical exercise because of my depression, and on the infrequent occasions when I could, instead of making me feel better, I have some sort of strage rebound type effect that makes my problems significantly worse in the ensuing days, if not immediately. I've never been able to figure out why the counterintuitive effect occurs, seemingly contradicting a large body of evidence and advice I've come across over the years.
Posted by Maxime on August 8, 2006, at 11:06:59
In reply to Exercise and depression, posted by Bob on August 5, 2006, at 17:00:55
I find it helps ... when and if I can motivate myself to do it. I have severe depression. I have been exercising a lot lately and it is helping ... not curing me though. We know it releases natural endorphins that make you feel better. But getting to point where you can exercise is the hard part. Maybe you can find an exercise partner to help motivate you.
maxime
> I was wondering if a few of you could weigh in on exercise as it relates to serious depression. I have always heard people say that exercise helps depression, but I almost have to laugh when this is brought up. The only thing I can gather is that it helps in light to moderate cases. Maybe I'm much sicker than others I've heard of, but I am rarely able to engage in physical exercise because of my depression, and on the infrequent occasions when I could, instead of making me feel better, I have some sort of strage rebound type effect that makes my problems significantly worse in the ensuing days, if not immediately. I've never been able to figure out why the counterintuitive effect occurs, seemingly contradicting a large body of evidence and advice I've come across over the years.
Posted by Maximus on August 8, 2006, at 11:07:00
In reply to Exercise and depression, posted by Bob on August 5, 2006, at 17:00:55
Hi,
Exercices are very very good, indeed. But i find it not useful for the melancholic component.
Bye.
Posted by bassman on August 8, 2006, at 11:07:01
In reply to Exercise and depression, posted by Bob on August 5, 2006, at 17:00:55
My experience has been the same as yours: when I've been very depressed, exercise is very tiring and doesn't seem to help-I just feel dizzy during and after. When the depression is milder, exercise works very well with medication-to the point that sometimes I feel "normal". But I've found it takes 1-2 hours exercise/day for there to be a really big effect. That's a big time committment-but worth it when it is working well.
Posted by linkadge on August 8, 2006, at 11:07:01
In reply to Exercise and depression, posted by Bob on August 5, 2006, at 17:00:55
As many people know, I am a proponent of exercise for depression, even severe depression.
There is a wealth of information relating to the effects of physical activity on depression. However, you must make note that almost all studies that conclude an antidepressant effect relate to aerobic exercise like running, and not weightlifiting etc. Although other forms of exercise may help mood, they do not have the reseach to support it.
The effects of exercise on depression include multiple factors. Like many antidepressant treatments, the full effects can take a long time to manifest. One cannot conclude based on a few short sessions that exercise will not help their depression. It usually takes a month or so, of consistent exercise, to conclude if it works or not.
Exercise produces many biochemical changes identical to antidepressant treatment. Exercise does more than any one antdiepressant, however.
Some of the main effects of long term exercise are:
Increased BDNF expression (brain growth factor)
Increased GDNF expression (brain growth factor)
Increased NGF expression (brain growth factor)
Increased NT-3 expression (brain growth factor)
Reduced Cortisol excretion
HPA axis regulation
Endorphen Release
Phenylethylamine Increase (with possable subsequent reductions in norepinephrine transporter exprssion)
Downregulated serotonin autoreceptors,
Increased 5-ht1a receptor expression
Neuropeptide Y increase
Improvement in sleep archetecture
Positive changes in EEG patterns
Enhancement of hippocampal neurogenesis
Increased brain bloodflow
Downregulated beta adrenergic receptors.
Improved cognition.The effect of exercise on mild to moderate depression is well documented. There are some studies that show similar effects in more severe cases. Some studies have shown that exercise programs reduce relapse and improve overall condition (long term) better than drugs do.
The only thing standing against the case of exercise for severe deprsson is the relative lack of trials. Most people with severe depression do not want to participate in such trials. This does not mean that exercse would not have an effect on these individuals.
People tell me that exercise does not help their depression and its not really for me to judge. Understandably it is easier for some than others, but I would challange anyone to dedicate time each day to try and work up to 45 minaues or so, of some type of vigorous aerobic exercise.
If they can do that for a month, and still say it has zero effect, then I will believe them.
Regards.
Linkadge
Posted by linkadge on August 8, 2006, at 11:07:01
In reply to Re: Exercise and depression, posted by linkadge on August 5, 2006, at 19:55:54
I put them at the bottom
Increased BDNF expression (brain growth factor)
Increased GDNF expression (brain growth factor)
Increased NGF expression (brain growth factor)
Increased NT-3 expression (brain growth factor)
Reduced Cortisol excretion
HPA axis regulation
Endorphen Release
Phenylethylamine Increase (with possable subsequent reductions in norepinephrine transporter exprssion)
Downregulated serotonin autoreceptors,
Increased 5-ht1a receptor expression
Neuropeptide Y increase
Improvement in sleep archetecture
Positive changes in EEG patterns
Enhancement of hippocampal neurogenesis
Increased brain bloodflow
Downregulated beta adrenergic receptors.
Improved cognition
Activation of the endocannabanoid system
FGF-2 increase (brain growth factor)
GAP-43 increase (brain growth factor)
Linkadge
Posted by Phillipa on August 8, 2006, at 11:07:01
In reply to forgot a few items, posted by linkadge on August 5, 2006, at 20:30:42
Link I know you're to young to remember but when I was in my late 20's there was a doc who treated his patients while they ran. And they all improved. This was before the SSRI's.
I ride my bike without gears daily 7.5-l2miles daily. If it wasn't for this I'd go crazy. I make it a point to go up steep hills. Going down feels great free like a bird. Oh yes it increses endorphins. Love Phillipa
Posted by rod on August 8, 2006, at 11:07:02
In reply to Exercise and depression, posted by Bob on August 5, 2006, at 17:00:55
>.. on the infrequent occasions when I could, instead of making me feel better, I have some sort of strage rebound type effect that makes my problems significantly worse in the ensuing days, if not immediately. I've never been able to figure out why the counterintuitive effect occurs, seemingly contradicting a large body of evidence and advice I've come across over the years.
Hi Bob!
Well, the same happens to me! All docs etc. tell me to do some exercise, but even mild physical exercise makes me worse. I dont know why! My only guess is that exercise can lower blood pressure, and isnt blood pressure partly controlled by the catecholamines? So maybe it lowers the activity of some of them? just guessing..
Do you sweat easily? I wondered about losing minerals via sweat.. dunno
I sweat very easily.I am tapping in the dark here...
anyway
bye
Posted by ciaolavida on August 8, 2006, at 11:07:02
In reply to Exercise and depression, posted by Bob on August 5, 2006, at 17:00:55
I am bipolar and sometimes when I have tried to exercise in depressive episode I have just ended up in tears, or unable to move. When you can hardly get out of bed it's very hard to exercise.
Posted by linkadge on August 8, 2006, at 11:07:04
In reply to Re: Exercise and depression » Bob, posted by rod on August 5, 2006, at 21:58:42
Its possable too, that it is a "feel worse before you feel better" type of situation.
Sometimes people feel significantly worse the first little while on an antidepressant. This is probably because the drug induces placticity in parts of the brain which works bring resolution to the things that are depressing you. Its possable that you are activating parts of the brain that have been dormant for a while, and in doing so you may create some sort of internal conflict. It may induce placticity in parts of the brain that may be critical for an antidepressant effect, but in the short term produce dysphoria.
For instance. If I've had a bad day at work where I feel that my boss is always over my head and pissing me off. When I start to jog, it is like the day goes in reverse. My brain starts trying to undoe the things that it doesn't like (ie confronting the issues that are depressing me). So instead of being depressed, and accepting it, I start to feel a bit more agressive. I look for ways to regain my normal feeling of self control. Some people think I'm crazy, jogging along, cursing to the air. Eventually as I keep exercising I feel myself transcending the anger. I feel more objective. I start to think about why this jerk has no better a life than to take out his anger on his employees. I start to think about other options I have for other jobs, I start to think about ways I can keep him occupied and off my back. I think about ways to get him fired, I think about ways I can suck up, I think about ways I can make his job easier and perhaps put him in a better mood. And no, after all of this, I don't always come up with the *concrete* answer that I am looking for, but I at least feel better that I have adressed the issue, and that I am thinking about it.
It depends of course on where you're at, but exercising is not just like popping a tranquilier, its can be a very active. Just like hitting the punching bag, you start, and you may start to trigger the release of things you've been bottling up. Exercise can sometimes bring the crappy stuff to the forefront.
This is just my experience though.
Linkadge
Posted by linkadge on August 8, 2006, at 11:07:04
In reply to Re: Exercise and depression, posted by ciaolavida on August 5, 2006, at 23:49:55
It is really about doing what you can do.
Baby steps.
Starting any one treatment at 1000 miles an hour will always result in disaster.
Linkadge
Posted by linkadge on August 8, 2006, at 11:07:04
In reply to Re: Exercise and depression, posted by linkadge on August 6, 2006, at 1:01:57
Another thing is that people can become a little defensive when told to exercise, and I can totally understand that. Nobody likes being told what to do. It can totally come across as sounding like a punitive type of requiest...
"Eat your vegetables!"People are buisy these days, I can understand that too. I guess all I am asking is that people give it a fair trial. If after that you still contend there is no positive effect, then feel free to drop it.
Linkadge
Posted by SLS on August 8, 2006, at 11:07:05
In reply to Re: Exercise and depression, posted by linkadge on August 6, 2006, at 1:00:09
I wonder if bipolar depression and non-bipolar depression respond differently to exercise.
My bipolar depression does not seem to be penetrable by either aerobic or anaerobic exercise. I must admit, though, that I have not persisted with an intense aerobic regimen for more than a month or so. It was a very long time ago.
- Scott
Posted by linkadge on August 8, 2006, at 11:07:05
In reply to Re: Exercise and depression, posted by SLS on August 6, 2006, at 5:52:45
A month seems like a fair trail to me.
The main improvement I saw was in sleep, anxiety, and concentration.
Different symptoms may respond differently.
Not trying to say everbody will respond. Just because it has worked for me doesn't mean it will for everbody.
That being said, I do think that even in the absence of a robust effect, the brain could still benifit from a preventitive or maintainance effects from it.
Exercise seems to significantly slow the progression of both Huntintons and Parkinsons diseases.
Exercising mice seem to be almost completely immune to the destructive effects of the potent neurotoxin MTPT, which is proposed to be a result of the elevated levels of the neuroprotective/neurotrophic protein BDNF.
Linkadge
Posted by Meri-Tuuli on August 8, 2006, at 11:07:05
In reply to Re: Exercise and depression » SLS, posted by linkadge on August 6, 2006, at 6:10:36
Hello Link!
I was just wondering what your exercise regime would be to prevent/treat depression? Say 45 aerobic activity 5 times a week, for instance??? How 'hard' would the aerobic activity have to be?
I totally believe exercise is good for depression. In fact, I think there have been times when I've managed to delay a depressive episode with exercise. Of course, the depression came out when I stopped exercising.
Kind regards
Meri
Posted by wacky on August 8, 2006, at 11:07:05
In reply to Re: Exercise and depression, posted by linkadge on August 6, 2006, at 1:00:09
There is no question in my mind as to the benefits of exercise. The tough part is that the more depressed one becomes, the less likely they have enough motivation to do it.
I am an avid dressage rider. I typically ride 4-5 days a week. Contrary to popular belief, riding a big moving dressage horse is VERY aerobic. There have been times when I've gotten on my horse, especially when no one is around, and I start bawling. So I tend to agree with Linkage and her assessment that before it gets better - it feels worse. At other times, when I'm done riding (usually around 45 minutes), I feel better.
One way I know I'm getting into trouble (depression coming on) is that I lose interest in riding - which for me is not a hobby - but a passion. So, if I have a passion that I have difficulty forcing myself to do, it must require an enormous amount of willpower/effort to get a depressed person to start a new exercise program. Frankly, when I recall how hard it has been for me to ride, I don't see how someone without such a passion can do it at all.
Now that I am on the upside of the depression (this one anyway), when I ride I get that eurphoric feeling that I haven't felt in a long time.
If there was anything I could do to help a depressed person to get out and do something, I would.
Posted by Crazy Horse on August 8, 2006, at 11:07:05
In reply to Re: Exercise and depression, posted by linkadge on August 5, 2006, at 19:55:54
I even notice when i exercise my meds work better. Exercise is just plain good for you..it's that simple. Especially when one has depressive/mental disorders. Endorphins and other "feel good" chemicals are released during and after exercise that have a positive effect on mood.
The biggest problem i have w/exercise is when i go into see my pdoc feeling HORRIBLE/DEEPLY DEPRESSED and he asks me to exercise. Yea, like i Fu*kin' feel life exercising when i can barely get out of bed. Even though, i know this is when i need it the most!
MJ
Posted by SFY on August 8, 2006, at 11:07:06
In reply to Re: Exercise and depression, posted by Crazy Horse on August 6, 2006, at 11:54:19
Though I've exercised regularly for the past few years, I've never noticed anything specifically mood-elevating (i.e., an endorphin rush) from it. But I think it's one thing that helps raise the floor on my depression and keeps the lows manageable.
Even a brisk walk can help as Dr. Ivan Goldberg points out in his tips on recovering from depression:
Posted by Karen44 on August 8, 2006, at 11:07:07
In reply to Re: Exercise and depression, posted by SFY on August 6, 2006, at 12:36:03
> Though I've exercised regularly for the past few years, I've never noticed anything specifically mood-elevating (i.e., an endorphin rush) from it. But I think it's one thing that helps raise the floor on my depression and keeps the lows manageable.
>
> Even a brisk walk can help as Dr. Ivan Goldberg points out in his tips on recovering from depression:
>
> http://www.psycom.net/depression.central.hints.htmlBefore there was such a thing as antidepressants, one of the things they noticed at Menninger's (and this goes back to the 20's even) is that exercise, working in a garden, going for walks helped patients who were depressed. When I was there in the early 1980's, I was profoundly depressed and did not want to get out of bed. I was on a variety of antidepressan medications until they found Parnate worked - dangerous as I was extremely suicidal at the time and tried to kill myself at times that I was not even aware of what I was doing. In any case, I was told that the best activities for me would be the volleyball activity (okay) and wood chopping - with a sledge hammer and wedge. I hated that activity, but it was so strenuous, it did work to some extent to get the endorphns going. I think in the long run it helped
Posted by Maximus on August 8, 2006, at 11:07:07
In reply to Re: Exercise and depression, posted by linkadge on August 5, 2006, at 19:55:54
Wow! Thanks for that exhaustive list. Good work buddy.
In a not-offensive tone at all (<- is it in English?), i still wonder why you put so much energy to demonstrate the use of alternative treatments? Do you try to convince yourself of something?
"On paper" excercise is very amazing. Helas, that's different in practice. A much weaker effect on depression can be noticed.
But i do believe in sports for others reasons, spirit team, mainly. I force myself and my 2 sons to practice 2 differents sports during the year. I can observe a better concentration, memory and sleep.
Bye.
Posted by Bob on August 8, 2006, at 11:07:08
In reply to Re: Exercise and depression, posted by bassman on August 5, 2006, at 17:54:48
> My experience has been the same as yours: when I've been very depressed, exercise is very tiring and doesn't seem to help-I just feel dizzy during and after. When the depression is milder, exercise works very well with medication-to the point that sometimes I feel "normal". But I've found it takes 1-2 hours exercise/day for there to be a really big effect. That's a big time committment-but worth it when it is working well.
One to two hours per day? Wow. I don't think I will ever be able to get to such an intense regimen.
Posted by Bob on August 8, 2006, at 11:07:09
In reply to Re: forgot a few items » linkadge, posted by Phillipa on August 5, 2006, at 21:47:42
> Link I know you're to young to remember but when I was in my late 20's there was a doc who treated his patients while they ran. And they all improved. This was before the SSRI's.
>
> I ride my bike without gears daily 7.5-l2miles daily. If it wasn't for this I'd go crazy. I make it a point to go up steep hills. Going down feels great free like a bird. Oh yes it increses endorphins. Love Phillipa
7.5 to 12 miles daily?!! Damn! I must be much, much sicker than I ever imagined, cause I don't think I will ever be able to do that. When I was younger (early twenties) I loved biking, and went on long bike rides often, but then my mind started to malfunction, and as much as I hate to say it, the meds were the nail in the coffin. They just brought a crippling physical unhealthiness with them that has festered over the years. I am now a physical mess, but of course none of it show up in the tests at the doctor's office. I think I must be one of the statistical minority that performs very badly with these drugs.
Posted by Bob on August 8, 2006, at 11:07:10
In reply to Re: Exercise and depression » Bob, posted by rod on August 5, 2006, at 21:58:42
> >.. on the infrequent occasions when I could, instead of making me feel better, I have some sort of strage rebound type effect that makes my problems significantly worse in the ensuing days, if not immediately. I've never been able to figure out why the counterintuitive effect occurs, seemingly contradicting a large body of evidence and advice I've come across over the years.
>
> Hi Bob!
>
> Well, the same happens to me! All docs etc. tell me to do some exercise, but even mild physical exercise makes me worse. I dont know why! My only guess is that exercise can lower blood pressure, and isnt blood pressure partly controlled by the catecholamines? So maybe it lowers the activity of some of them? just guessing..
>
> Do you sweat easily? I wondered about losing minerals via sweat.. dunno
> I sweat very easily.
>
> I am tapping in the dark here...
>
> anyway
>
> bye
I sweat like a pig and having breathing problems as well as muscle weakness on many psych meds. Off of them, all these things seem to lessen or go away, but then my mind collapses, and my body simply runs out of energy and motivation.
Posted by Bob on August 8, 2006, at 11:07:10
In reply to Re: Exercise and depression, posted by wacky on August 6, 2006, at 9:13:33
> One way I know I'm getting into trouble (depression coming on) is that I lose interest in riding - which for me is not a hobby - but a passion. So, if I have a passion that I have difficulty forcing myself to do, it must require an enormous amount of willpower/effort to get a depressed person to start a new exercise program. Frankly, when I recall how hard it has been for me to ride, I don't see how someone without such a passion can do it at all.
>
> Now that I am on the upside of the depression (this one anyway), when I ride I get that eurphoric feeling that I haven't felt in a long time.
>
>
>
>I think this hits at the crux of the issue. I have always loved being active, particularly sports like biking, softball, volleyball, running, or just working out at the gym. My mental health and the drug side effects eventually took away all of that and I lament it greatly. If there were any way to be physically active on a regular basis, I certainly would, but it is virtually impossible.
Posted by Bob on August 8, 2006, at 11:07:10
In reply to Re: Exercise and depression, posted by Crazy Horse on August 6, 2006, at 11:54:19
> I even notice when i exercise my meds work better. Exercise is just plain good for you..it's that simple. Especially when one has depressive/mental disorders. Endorphins and other "feel good" chemicals are released during and after exercise that have a positive effect on mood.
>
> The biggest problem i have w/exercise is when i go into see my pdoc feeling HORRIBLE/DEEPLY DEPRESSED and he asks me to exercise. Yea, like i Fu*kin' feel life exercising when i can barely get out of bed. Even though, i know this is when i need it the most!
>
> MJI can honestly say that my p-doc has never told me to exercise - I wonder if he knows something we don't. I have however had many friends and relati ves tell me to exercise, take vitamins, do accupuncture, or go on a special diet like absolutely no suger, or all vegetables. Then when I balk, I'm like the recalcitrant lazy patient who doesn't know if it would have helped 'cause I didn't try it. I know I'm a little defensive, but if there's one thing that bothers me, it's someone making a casual suggestion about a treatment that is often quite difficult to implement.
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