![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by linkadge on June 14, 2005, at 22:17:34
In reply to Re: tramadol, posted by Jakeman on June 12, 2005, at 14:12:09
There are quite a number of studies that show that exercise is very effective even in severe depression.
I have been on almost everything. I agree that exercise is extremely hard to do when severely depressed, but I don't doubt its effacacy even in severe depression.
All drugs have pooped out on me, but exercise has never pooped out.
I suppose some say it doesn't work for them. I say throw away the rubber bands, and bump up the intensity.
If the end target of AD treatment is enhanced neurotrophin expression, then exercise has pharmacudicals beat hands down.Shock - 200% increase BDNF in hippocampus
Exercise - 90-120% increase in BDNF (at 1.5 hours)
Parnate - 40% increase in BDNF in hippocampus
Another intresting thing is that the more exercise, the more BDNF, up to about 8 hours of exercise (at least in rats). I agree 8 hours is not tangable though.
Linkadge
Posted by SLS on June 14, 2005, at 22:17:34
In reply to Exercise for severe depression, posted by linkadge on June 12, 2005, at 15:35:34
> There are quite a number of studies that show that exercise is very effective even in severe depression.
"Quite a number of studies"?These study teams are probably no less biased towards confirming their own hypotheses than any other group in the study of mental illness seems to be. This, indeed, seems to be quite a number. If they were to have used me in their experiments as n=1, they all would have resulted in confirming the null hypothesis.
"very effective"?What is very?
"even in severe depression"?How is severe defined?
This scenario of having exercise be very effective in treating depression does not reflect my own experience with it. Neither 60 minutes of intense anaerobic exercise four days a week nor 60 minutes of aerobic exercise a day has had any impact on my condition. My bodybuilding regime had no positive effect on my condition - which is bipolar depression. Perhaps exercise is more effective for other types of depression.I would not disuade anyone from exercising. It is a habit that yields positive effects in many ways. For some, it might even bring them into remission from whatever depression they were suffering from. However, I recommend to anyone for whom exercise does not help that they do not think less of themselves or in some way feel lazy or inadequate. You are simply an exercise non-responder.
- Scott
Posted by Chairman_MAO on June 14, 2005, at 22:17:34
In reply to Re: Exercise for severe depression, posted by SLS on June 12, 2005, at 16:48:33
I tried for years and years to exercise in order to feel better. Even when I was merely "dysthymic as usual" (forget about in a state of "double depression), I found myself barely able to do crunches without losing track of where I was in the set and staring up at the ceiling. At the very best, I could sustain an hour on an elliptial trainer at minimal resistance, but when I'd up the resistance, I wouldn't be able to sustain the effort. Moreover, the social phobia was always too bad to get to a gym, and I couldn't even bring myself to care anyway, as I never felt that "exercise euphoria" or any kind of sustained good feeling afterward that everyone reports. I suspect that even if I'd had access to real gym equipment, I wouldn't have been able to sustain any kind of program for very long, as it was always hard to bring myself to care about anything for a long period of time unless it was immediately gratifying or something that I otherwise couldn't tear myself away from. Again, that is dysthymia, or, as I prefer to look at it, a "reward deficiency syndrome".
After getting on Nardil, buprenorphine, and cabergoline (though I could possibly do this without the cabergoline), I _WANTED_ to start an exercise program IMMEDIATELY. I started waking up at 6am on VACATION to use the GYM at the hotel! When I got back to my parents' house (upon which they were astounded and speechless at what a different person I seemed to be), I joined a gym. I now wake up at 5am (When on no meds I prefer to sleep until noon and go to bed at 5am) beaming with energy and literally CAN'T WAIT to get to the gym and work out for TWO HOURS. It now is HARD _NOT_ to go to the gym on the days that I have to rest, even though I go 4-5 days in a row before the rest. I simply feel so good afterward, I almost fear I am becoming addicted to it. I believe its quite possibly the bupe enhancing/"normalizing" opioid receptors that allows me to actually feel the exercise "high" now.I must emphasize that I was always strongly aversive to and disinterested in any kind of atheltic activity for over 24 years of my 25-year life. Within weeks of switching to Nardil (I was on 16mg/day of bupe at this point), out of nowhere I wanted to exercise, clean up after myself, take care of unopened envelopes on my desk, etc. But this exercise thing is amazing. I do at least 20 minutes of cardio and 1.5 hours of weight training 5x/wk. I already see results, and I may be buff within a month or two from now. I never would've been able to even CONCEIVE of what this state of mind is like before the meds. I am lately tempted to taper down on the buprenorphine due to anorgasmia that would not be there if I weren't on it or on such a high dose, but I am wary of doing that without at least talking to my prescribing Dr. about it. The old me would've just gone ahead and did it, because I never would've been in a state of mind I felt I wished to preserve. This one is infinitely precious.
Perhaps exercise works for you--you are lucky. Exercise only works for me if I am on the right medication.
Now I am starting to conquer the ultimate difficulty: procrastination of schoolwork. This has a more behavioral component than most of my problems. Even though I am now well, I am still finding it hard to get started on my make-up work. PErhaps that's because my school just dismissed me (kicked me out) for a low GPA within weeks of finally getting well--because of a year of classes that I attempted to pass while pretty much out of my gourd (although the tranylcypromine worked brilliantly for a time for social phobia and depression, it would "poop out" for a while and then work again without explanation. It also didn't give me near full remission, but I didn't know because it was so much better than anything else I'd taken previously). I hope I can get back in due to my condition with some Dr's notes, etc. I probably can, but I am so scared I Find myself smoking pot again lately to escape; this is not good. Before finding this out, I had not used any mind-altering substance except socially or to sleep since the Nardil kicked in.
But I digress here (perhaps I am just calling out for help because I am really confused and scared about school and my recent upswing in drug use (Even though it is only like 3-4 *tiny* hits max per day when I used to smoke 1 grams per day or more, it is more than I Want to be doing). The point of this post: I am wired in such a way that when not on meds, exercise does nothing for me, no matter how hard I try. :(
I would much rather exercise than take all of these meds (especially from a sex dysfunction POV) but that simply is not in the cards for me. To continue the card analogy, we all must play the hand we're dealt. :)
Posted by ed_uk on June 14, 2005, at 22:17:34
In reply to Exercise for severe depression, posted by linkadge on June 12, 2005, at 15:35:34
Dear Link,
Exercise is good but.............when I'm depressed I can barely get out of bed let alone exercise. I find it hard enough to exercise when I'm not depressed.
~Ed
Posted by linkadge on June 14, 2005, at 22:17:34
In reply to Re: Exercise for severe depression » linkadge, posted by ed_uk on June 12, 2005, at 17:21:08
Like I said, thats the catch. It is easier to pop a pill then get exercise. The problem is that depression never happens over night.
Yes, medications do give that quick boost, but like many others on this page, have found they poop out, and leave me needing to augment with this or that.
Clearly, I have not thrown medications out the window, but it was intereting to note that even though exercise does not give such reinforcement, it got me eating and sleeping, and back to enjoying things during the day.
I felt absolutely worst, when I said: "forget exercise" and "let meds do everything"
Linkadge
Posted by Phillipa on June 14, 2005, at 22:17:34
In reply to Re: Exercise for severe depression, posted by linkadge on June 12, 2005, at 17:31:17
Excercise does nothing for me anymore. I used to get high from jogging when I was younger. My meds just aren't working and my life situation is making it worse. I go through the motions. Walk lift light weights but I don't feel any better. Fondly, Phillipa
Posted by linkadge on June 14, 2005, at 22:17:34
In reply to Re: Exercise for severe depression, posted by Phillipa on June 12, 2005, at 18:22:49
Unfortunately it is only vigorous aerobic exercise that has been shown to have any use in severe depression.
Some of the effects are immediate, and others may take many weeks to occur.
One rat study showed that only after 3 weeks of daily wheel running did a significant reduction in the expression of inhibitory serotonin autoreceptors occur.
There are *many* studies that have shown a possative link, and not just small studies.
(ie pay no attention to synical people :) )http://biopsychiatry.com/exerdep.htm
It is really an instinctual reaction to become defensive when exercise is suggested. It seems, sometimes to point the finger back at us, and try to blame our depression on some kind character flaw or personal weakness.
If you believe, like me, that depression is a whole brain disease, and not just this neurotransmitter or that, then the neuroprotective and neurorestorative effects of exercise far exceed that of any pharmacudical.
Ie, we have almost no drugs that enhance GDNF (glial derived neurotrophic factor) not even lithium, but exercise doubles it quite nicely.Alright, I will stop now, as I am starting to sound like a motivational speaker, or an infomercial spokesperon.
Linkadge
Posted by Jakeman on June 14, 2005, at 22:17:34
In reply to Re: Exercise for severe depression, posted by linkadge on June 12, 2005, at 19:19:29
> Alright, I will stop now, as I am starting to sound like a motivational speaker, or an infomercial spokesperon.
>
> LinkadgeYou've convinced me. I've decided to not back out of that 10k I had promised to run. BTW, I saw a guy yesterday riding a bike while smoking a cigarette.
Posted by linkadge on June 14, 2005, at 22:17:34
In reply to Re: Exercise for severe depression, posted by Jakeman on June 12, 2005, at 19:31:41
Hey, I always found those runs killed me. Not the run itself, but I was competitive, and that added stress.
Linkadge
Posted by 4WD on June 14, 2005, at 22:17:34
In reply to Re: Exercise for severe depression, posted by linkadge on June 12, 2005, at 19:19:29
> Unfortunately it is only vigorous aerobic exercise that has been shown to have any use in severe depression.
>
> Some of the effects are immediate, and others may take many weeks to occur.
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> One rat study showed that only after 3 weeks of daily wheel running did a significant reduction in the expression of inhibitory serotonin autoreceptors occur.
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> There are *many* studies that have shown a possative link, and not just small studies.
> (ie pay no attention to synical people :) )
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> http://biopsychiatry.com/exerdep.htm
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> It is really an instinctual reaction to become defensive when exercise is suggested. It seems, sometimes to point the finger back at us, and try to blame our depression on some kind character flaw or personal weakness.
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> If you believe, like me, that depression is a whole brain disease, and not just this neurotransmitter or that, then the neuroprotective and neurorestorative effects of exercise far exceed that of any pharmacudical.
> Ie, we have almost no drugs that enhance GDNF (glial derived neurotrophic factor) not even lithium, but exercise doubles it quite nicely.
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> Alright, I will stop now, as I am starting to sound like a motivational speaker, or an infomercial spokesperon.
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> Linkadge
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Linkadge, I agree with you. I hate going to the gym but when I make myself go, four days a week, and spend 35-40 minutes on the treadmill at a fast pace with an incline, I feel so much better for th rest of the day. It doesn't work if you stroll, or go kind of in between. You have to get your heart rate up to about 75% and keep it there most of the time.Marsha
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Posted by JenStar on June 14, 2005, at 22:17:35
In reply to Exercise for severe depression, posted by linkadge on June 12, 2005, at 15:35:34
For myself,
I find that exercise DOES help me with anxiety, usually. It's especially helpful when I exercise regularly and consistently. Depression is not my biggest issue, but I know that i seem to be more upbeat and positive when I exercise.It's hard to quantify, but it's definitely "real."
JenStar
Posted by SLS on June 14, 2005, at 22:17:35
In reply to Re: Exercise for severe depression, posted by linkadge on June 12, 2005, at 19:19:29
> Unfortunately it is only vigorous aerobic exercise that has been shown to have any use in severe depression.
I've been there, man. I've been there. I put in more time than the rats studied.
> One rat study showed that only after 3 weeks of daily wheel running did a significant reduction in the expression of inhibitory serotonin autoreceptors occur.I think it is important to separate out pure research from clinical research. The BDNF is nice and all, but if people in real life don't respond to a stimulus, they just don't respond. We both know how incredibly complex the body is. Looking at one physiological process and trying to extrapolate that to the entirety neglects the gestault and emergent properties.
I think the potential for exercise to produce dramatic improvements in mood is dependent on the physiology of the mood illness itself and not on the generic presentation of what people label as depression.
> There are *many* studies that have shown a possative link, and not just small studies.> (ie pay no attention to synical people :) )
It seems that we both need to learn how to spell that word properly. :-)
> It is really an instinctual reaction to become defensive when exercise is suggested. It seems, sometimes to point the finger back at us, and try to blame our depression on some kind character flaw or personal weakness.
This was one of the more important points I made in my last post. It is sabotage to believe that if exercise doesn't work, it is because we are not working hard enough and are thus lazy and inadequate.
> If you believe, like me, that depression is a whole brain disease,
Exactly! Please see above.
> ...the neuroprotective and neurorestorative effects of exercise far exceed that of any pharmacudical.
Perhaps (I question this), but even so, since when are neuroprotection and neurotrophism putative mechanisms by which antidepressant exert their therapeutic effects - or even exercise? They are not.
> Ie, we have almost no drugs that enhance GDNF (glial derived neurotrophic factor) not even lithium, but exercise doubles it quite nicely.
Exercise doesn't work for the majority of people posting here. It is as simple as that. In this population, empirically, excercise does very little to treat "severe" depression. It serves no purpose to declare otherwise.
By all means, exercise! For some people who are depressed, it will work wonders. I just don't know if we should be so optimistic for people who suffer with true MMD and BP.
The study you cited on the Hedonistic Imperative website fails to demonstrate cause and effect. The more depressed a person is, the less intense will be the exercise they perform. Bad study. It is retrospective and not prospective and without controls.
Don't confuse cynicism with scrutiny.
- Scott
Posted by SLS on June 14, 2005, at 22:17:35
In reply to Re: Exercise for severe depression » linkadge, posted by SLS on June 13, 2005, at 8:27:16
After I exercise, I temporarily feel more energetic and upbeat. The same thing occurs when I become animated during a conversation that I am interested in. However, the magnitude of this effect is relatively small, and it is qualitatively NOT a TRUE antidepressant effect.
However, I find the following sentence misleading.
"There are quite a number of studies that show that exercise is very effective even in severe depression."
1. *quite* a number
2. *very* effective
3. *severe* depressionExercise should be particularly effectve for people whose depressions are situational or psychogenic. Not all "depression" involves a brain anomaly. MDD atypical type might be affected positively by exercise in a significant way if they tend to be mood reactive in the first place. However, if mood reactivity is absent, and they experience severe vegetative symptoms, I doubt exercise will be of much use to treat it.
Exercise is a good thing. I am hoping that it helps extend for me the life of a healthy body so that I will have more years ahead of me to enjoy a remission from my illness when that occurs. I am just beginning to exercise again. This has become possible because I am experiencing an improvement in anergia and vegetative symptoms. Without medication, regular exercise would not be possible. For severe anergic depression, exercising becomes a Catch-22 situation.
- Scott
Posted by emme on June 14, 2005, at 22:17:35
In reply to Exercise for severe depression, posted by linkadge on June 12, 2005, at 15:35:34
Sorry Link, but unfortunately I'm one of the folks who don't get a sustained AD response from aerobic exercise. My brother said the same applies for him. But if I'm anxious, it dispels some nervous energy and it feels good physically (at least when I'm done).
I drag myself to the gym for some fairly strenuous classes. The social aspects can help my mood.
I'm glad working out benefits you reliably.
em
Posted by Jazzed on June 14, 2005, at 22:17:35
In reply to Re: Exercise for severe depression » linkadge, posted by emme on June 13, 2005, at 12:48:57
I exercise a lot, but I don't know how anyone who's depressed can do it. I"m not currently depressed, but have been. My hat's off to anyone who gets out there despite their depression!I do feel worlds better because I exercise, it keeps my head clear, I have more focus, and I'm less restless. Right now my routine is getting to the gym by 6 AM, swimming 60 laps, then biking 10 miles, then at home some weights, and if I can get to it, "run" 30 minutes, and then I usually walk 3-5 miles. It's a lot, but the morning stuff I can get done before anyone wakes up.
Btw, in case anyone thinks I'm a fanatic or a jock, I"m not. I'm overweight despite all that I do, but I feel better and better about myself because of it.
Jazzed
Posted by linkadge on June 14, 2005, at 22:17:35
In reply to Re: Exercise for severe depression » linkadge, posted by SLS on June 13, 2005, at 8:27:16
I would certainly *not* say that exercise does not "work" for the majority of people here.
There are a few posts above of people for whom it does have an effect. And, yes in this devistating illness, (with no magic pill in sight), we must learn to settle for an effect, an improvement.
Think of it this way. My father, who has realized that he no longer needs to get off the couch since the Crestor takes care of is cholesterol quite nicely.Fine, truthfully perhaps, there are people out there whoose cholseterol does not lower sufficiantly with diet and exercise, and for them medication is a must. But I have yet to find a doctor who will give you the go ahead to toss the healthy diet and the exercise. No it may not bring those fast, hardcore digit dropping results that drug companies will kill to achieve.
So what do you think is the cure for depression. Surely you are not still stuck on the second messanger signalling cascade theory. If you are, then you'd better drop the zyrexa, since olanzapine will be sure that your PKC will never see the light of day.
We know that ECT is probably the best antidepressant we have. Show me a study that shows ECT activates second messanger transcripts.
We do know that ECT dramatically increase NT-3, BDNF and NGF. We also know that a single injection of BDNF or NT-3 into the VTA, has a very potent AD effect in animal depression models.
I am very doubtfull that there is a single case where exercise would not offer even the "smallest benefit" over the long term.Linkadge
Posted by linkadge on June 14, 2005, at 22:17:35
In reply to Re: Exercise for severe depression, posted by Jazzed on June 13, 2005, at 13:19:27
"After I exercise, I temporarily feel more energetic and upbeat. The same thing occurs when I become animated during a conversation that I am interested in. However, the magnitude of this effect is relatively small, and it is qualitatively NOT a TRUE antidepressant effect."
-------------------------------------------------
What is a "true antidepressant effect"?? Yes the temporary mood improvement of exercise is probably related to the maximization of endogenious endorphin release PEA etc, but the research seems to suggest that the benefits of exercise seem to extend much further beyond the short term boost it offers.
Adults who carried a consistant exercise routeen into retirement had much denser hippocampii than did equivilantly aged persons with no exercise routeen.Exerciseing adults with other neurodegenerative disorders (parkinson's, HD, etc) do dramatically better when they continue with exercise.
Exercise regulates endorphen release, serotonin release, neurotrophins. It regulates the genes that express CRH. It increases the number of post synaptic 5-ht1a receptors that are much lower in depressed and panic disorder patients, increases PEA, promotes neurogenesis in hippocampus and frontal cortex (most AD's only increase hippocampal neurogenesis). Desnesitieses dopamine autoreceptors and serotonin autoreceptors. Suports the glia.
Sorry, but I'd say that exemption to a benefit, is only granted to the catatonic.Linakdge
Posted by SLS on June 14, 2005, at 22:17:35
In reply to Re: Exercise for severe depression, posted by linkadge on June 13, 2005, at 15:48:51
> And, yes in this devistating illness, (with no magic pill in sight), we must learn to settle for an effect, an improvement.
I ain't settlin' for nothin'. YES - THERE ARE MANY MAGIC PILLS if you are fortunate to respond robustly to them and attain remission. It happens. I know. I was once given some magic pills. Unfortunately, my doctor at the time removed them prematurely, and I have not responded to them in the same way since. To be honest, it looks like Trileptal will be a magic pill for me (added to what I was already taking).
Fr*g the science. Give me my magic pills and let me get the hell out of here.
And yes, I do think that there *might* be a problem in gene expression as a result of anomolies in G-protein coupled adenylyl cyclase second messenger systems that control receptor numbers.
Since I can only speak for myself, I will state that exercise has no positive impact on my bipolar depression. I am n=1. That's all I care about.
I have still not seen a single person here suffering from a severe endogenous depression claim that exercise has brough them into full remission. For all of the people who have posted that exercise helps them, why are they still describing themselves as being depressed?
Just a reminder: Exercise is good (usually). If you can, just do it. If you can't, your limitations are real and need not evoke feelings of guilt or inadequacy.
Mental illness is a nightmare.
I have often exercised...
my option not to exercise.
It has been an exercise...
in futility to even try.I refuse to allow anyone to tell me differently. Exercise doesn't work for me. Am I unique? I really don't care if I'm the only one here refractory to exercise. I know myself and I know my illness. I doubt I am unique. However, I probably should not have generalized so much regarding the population here at Psycho-Babble. I never took a poll. Even polls can be skewed. I'll just worry about myself right now. Tomorrow might be a different story.
- Scott
Posted by Jakeman on June 14, 2005, at 22:17:35
In reply to Re: Exercise for severe depression, posted by linkadge on June 13, 2005, at 16:02:46
Often times my exercising is partly an effort to work off the agitating/energizing effect of Wellbutrin. If the exercise is regular I gain some of the cumulative anti-depressive effects. But then there are those black hole depressions in which it's a major effort just to speak or write something on an internet message board.
~Jake
endogenious endorphin release PEA
Posted by ed_uk on June 14, 2005, at 22:17:35
In reply to Re: Exercise for severe depression, posted by linkadge on June 13, 2005, at 15:48:51
Hi Link,
I'm going to go for a walk tomorrow. I can't run so that's not an option. I'm only 20 and I get breathless walking up the stairs. I'm sick of being so unfit. It all started when I was depressed - I hardly got out of bed for a year. I've never regained my fitness, it's so hard - even small amounts of exercise are exhausting. Geez, I used to be quite fit, I went climbing and did gymnastics when I was yonger.
~Ed
Posted by Phillipa on June 14, 2005, at 22:17:35
In reply to Re: Exercise for severe depression » linkadge, posted by ed_uk on June 13, 2005, at 16:53:19
Well, I may be older now and no longer able to job due to bone crunching and fear of doing more harm. But I do go to the gym most weeks three times and lift weights controlled by machines. And I do try and walk on the beach and walk my dog. But I really don't feel better anymore. Just tired. Fondly, Phillipa
Posted by gromit on June 14, 2005, at 22:17:35
In reply to Re: Exercise for severe depression » SLS, posted by Chairman_MAO on June 12, 2005, at 17:10:18
First I have to ask, where roughly do you live? I want to see your doctor. And I admire you, 1 hr on the elliptical machine! We have one at home and I can go maybe 10 minutes before I want to claw my eyes out from boredom.
When I was younger I used to train hard, jogging every other day, weights/sprints the other days. I've never in my life felt this mythical runner's high. Even after a few years, running say 5 miles I would get done and just feel ill, go right to sleep. I can't imagine exercising in the morning.
I looked good but still felt like a pile of cr*p mentally. It doesn't work for everybody.
Rick
Posted by Jazzed on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression » linkadge, posted by ed_uk on June 13, 2005, at 16:53:19
> Hi Link,
>
> I'm going to go for a walk tomorrow. I can't run so that's not an option. I'm only 20 and I get breathless walking up the stairs. I'm sick of being so unfit. It all started when I was depressed - I hardly got out of bed for a year. I've never regained my fitness, it's so hard - even small amounts of exercise are exhausting. Geez, I used to be quite fit, I went climbing and did gymnastics when I was yonger.
>
> ~Ed
Take it one day at a time Ed, you'll get there. And don't be too hard on yourself. It's good that you want your stamina back.Jazzed
Posted by Jazzed on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression, posted by Phillipa on June 13, 2005, at 17:04:58
Posted by Phillipa on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression, posted by Phillipa on June 13, 2005, at 17:04:58
Thanks, I guess that's for just trying. My altime best was when I lived in Connecticut. It was New Years Day. There was snow and ice on the road. I ran l3 miles! Did I ever feel good about myself! I wasn't depressed then either. I was working and married to a man who took me all over Europe. We stayed in a different castel every day. Until we went to his Mother's in Switzerland. Then we stayed with her. We traveled daily to Guyere, St Moritz, all the rich and famous places. His sister was a millionaire and so was her second husband. Life used to be so good! Fondly, Phillipa
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