![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 40. Go back in thread:
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
Posted by linkadge on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression » linkadge, posted by SLS on June 13, 2005, at 16:25:03
"I know. I was once given some magic pills. "
Perhaps you flew too close to the sun on wings of wax.
"I will state that exercise has no positive impact on my bipolar depression."
Try to think farther down the road.
"If you can't, your limitations are real and need not evoke feelings of guilt or inadequacy"
Baby steps.
"Exercise doesn't work for me"
What do you mean, doesn't work? Mood disorders can be neurodegenerative. In this sence even neuroprotection is active.
"refractory to exercise"
You're still trying to think too "magic bullit".
Linkadge
Posted by linkadge on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression » SLS, posted by linkadge on June 13, 2005, at 20:02:55
Don't get me wrong. I'm not trying to propose that exercise is going to fully cut it for everyone.
But I do think it is a good, multipurpose tool that is worth keeping in the toolchest.
Linkadge
Posted by SLS on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression » SLS, posted by linkadge on June 13, 2005, at 20:02:55
> > "I know. I was once given some magic pills. "
> Perhaps you flew too close to the sun on wings of wax.No, but I got a hell of a nice tan down in Jamaica at the time.
> > "I will state that exercise has no positive impact on my bipolar depression."
> Try to think farther down the road.I always do - just a different road, perhaps.
> > "If you can't, your limitations are real and need not evoke feelings of guilt or inadequacy"
> Baby steps.
Some people with depression can't walk. They can barely crawl.
> > "Exercise doesn't work for me"
> What do you mean, doesn't work?I think I'll leave you guessing on that one.
> Mood disorders can be neurodegenerative. In this sence even neuroprotection is active.
With depression, I sometimes think we are looking at atrophy and not neurodegeneration; a reversal occuring once the inactive tissue is utilized again when remission is attained. Just a thought.
> > "refractory to exercise"> You're still trying to think too "magic bullit".
I thank you for your concern regarding my unrealistic expectations. However, they are based in the reality I have seen all around me for the last 23 years. Sick people get very well with biological intervention. For each of these individuals, whatever got them that way is to them magic. I was fortunate enough once to have been awakened by such magic for 6 months. I intend to awaken again - this time for 6 decades. Actually, I might now be in the midst of that process without the benefit of exercise.
Go ahead and exercise your depression away, Linkadge. I dare you.
I'd be genuinely happy to see that happen.
- Scott
Posted by Jazzed on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression » Phillipa, posted by Phillipa on June 13, 2005, at 18:03:11
Wow, I'm impressed Phillipa, I've never gone that far!
(((((hugs))))) hope you're feeling better.
Jazzy
Posted by linkadge on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression » linkadge, posted by SLS on June 13, 2005, at 21:55:09
"Some people with depression can't walk. They can barely crawl."
Crawling's good
"atrophy and not neurodegeneration"
I don't think so. I think it is a truely a neurodegenerative process. Excess glutacortacoids can litterally punch holes in the brain through glutamate excitotoxitiy. Glutamate excitotoxicity kills the cell, no shrinkage. Much of Dr. Manjii's work into bipolar disorder is very suggestive of neurodengeration, and that's why he emphasizes preventitive neuroprotection. I'm not saying that atrophy cannot occur as well, but it is not all just atrophy.
I think atropy is more warm, and reassuring term, but not necessarily the case.
"Sick people get very well with biological intervention."
Great! I've seen well people get very sick with biological intervention!
Linkadge
Posted by SLS on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression, posted by linkadge on June 14, 2005, at 16:01:58
Hi Linkadge.
> > atrophy and not neurodegeneration
> I don't think so. I think it is a truely a neurodegenerative process. Excess glutacortacoids can litterally punch holes in the brain through glutamate excitotoxitiy. Glutamate excitotoxicity kills the cell, no shrinkage. Much of Dr. Manjii's work into bipolar disorder is very suggestive of neurodengeration, and that's why he emphasizes preventitive neuroprotection. I'm not saying that atrophy cannot occur as well, but it is not all just atrophy
Unfortunately, I agree with you. My heart sank when I first read Manji's papers. He is brilliant. He has been doing ground-breaking work at the NIMH since I was there 13 years ago. Damned time. It never stops.
I am still betting on the plasticity of the brain to get me out of this mess.
You neglected my challenge. Why don't you go ahead and exercise your depression away?
The worst thing that can happen is you improve your conditioning. The best thing that can happen is that you cure yourself. It's a no lose situation. Go for it!
Keep a running diary thread the way others have done with specific medications. Give us updates as to the protocol you are employing and the results. I think that would be pretty cool.
- Scott
Posted by Chairman_MAO on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression » Chairman_MAO, posted by gromit on June 13, 2005, at 17:22:28
I live in NJ and go to the University of Med and Denistry behavioral health clinic in New Brunswick, NJ. Despite being a public clinic, they have some of the most competent psychiatrists in the state, IMO. The mental health centers elsewhere in the state pale in comparison to this one. For instance, I was actually able to see a resident whose supervising physician used to be an anesthesiologist, is a coloniel in the US army, and isn't aversive to prescribing MAOIs for hard-to-treat patients. I suffered many years between attempting to self-medicate/drug addiction and incompetent shrinks, which reinforced my perceived need to self-medicate. Thank god I'm off the 3-year-long SSRI-go-round.
This doctor that I see routinely gives talks at addiction medicine forums about drug action, etc., and actually seems to know what he is talking about. This is good, since it is really hard for me to trust a doctor to Rx me medicine when I know more about the drugs than they do.
For the buprenorphine, I was referred out to a methadone clinic type place, but only because of the stupid federal 30-patient limit on sublingual buprenorphine. Otherwise, he just would've Rx'ed it himself.
Exercise has only become pleasant now that I take an MAOI, an opioid, and a dopamine agonist. Keep in mind that phenelzine or buprenorphine ALONE are both used for treatment resistant depression, but I only get good results taking BOTH, heh. Furthermore, augmentation with a DA agonist is generally only done for TRD as well, but I get optimal results using it to augment the other two. Oh, wait, most of life has become enjoyable, too. ;) This leads me to believe that most antidepressants on the market simply barely work or do not work at all.
I really envy those people who are biologically lucky enough to have things wired in their brains to allow for that sort of state of consciousness without taking three drugs.
Posted by Chairman_MAO on June 14, 2005, at 22:17:36
In reply to Re: Exercise for severe depression, posted by linkadge on June 13, 2005, at 15:48:51
"No magic pill in sight?"
I beg to differ. The effect I experience from the meds I am on now is truly magical. There aren't too many other words which describe it as adequately. I went from being pathaologically shy, amotivated, dysthymic, self-loathing, drug craving, hopeless, anergic, etc. to outgoing, more or less motivated to improve myself, life-loving, self-loving, having no problems using substances responsibly, hopeful, brimming with energy, etc. No, it is not Nirvana, but these drugs have woken me from a 23-year NIGHTMARE. I feel blessed by God to have access to them, and now know that I must get my act together and contribute something magnificent and useful to humanity because I have been given this profound gift of AN ABILITY TO ENJOY LIFE AND FEEL GENUINELY HAPPY AND FULFILLED.
The relationship between my parents and I has progressed further in the month I've been on these meds than it has since I turned 14. The only side effect that causes me a problem is anorgasmia, which isn't even all the time. With the cabergoline, the libido is adequate. No weight gain, acceptable sleep, etc. I am one of the lucky ones, but I must say, these pills are the closet thing to magic I've ever experienced in healing.
Posted by linkadge on June 14, 2005, at 22:17:37
In reply to Re: Exercise for severe depression » gromit, posted by Chairman_MAO on June 14, 2005, at 20:11:26
I too think they can do a lot, but I have my reserves about them. I have reserves about what they are really doing for your state. There's no doubt that they can bring subjective relief. But sometimes depression is just an outward manifestation of real problems. Ie, just because morphine releives pain, doesn't mean we should just keep popping morphine and keep our hand on the burner.
I think they can be lot of fluff. I think they can distract us from the truth about ourselves and our situation.
I think that depression has a lot more to do with our state that we want to admit.
I remember reading an article about a girl who was in university who was severely depressed. She tried absoluetley every treatment including multiple series of shock therapy.
After a few counselling sessions she was asked if she wanted to be in university or not. She responded that she did not want to be there and she hated it.
She left university and became a daycare worker. Since this she has not had a problem with depression, nor needed treatment in any form.
That story hit home *extremely* hard. I'd say the majority of people on AD's these days are people working 8 hours in a cubacle. That is a darned depressing situation.
I also think that the mind needs to find ways to incorperate medication into its life. I mean my mind would like me to believe that I was "ALWAYS" a basket case before depression, but that was not true. I remember the worst situations in picture form, and when I feel guilty or depressed about taking medication, I reasure myself by remembering these images.
The memory is state dependant. When you are well, you feel things have always been this way and always will. When things are bad you believe they are alwyas this way.
But honestly, what scared me the most about my situation were those times, that even when medicated to the brim, I would lapse back into that exact same person that I thought was eliminated by the medications.
I think to myself, all those horrable images and horrable times were simply related to low serotonin, and therefore they will never be again.
But, I threw out that theory a long time ago when I realized that even this new modified self, underneith all the layers, was still that same person.
Like I said before. We ****DESPARATELY**** want something to attribute all of our failures and all of our horrable feelings on. It is the only way we can get on with our lives.
Haven't you notices how when some new drug seems to work, your brain all of a sudden jumps into this mode where it concocts some crazy theory about how all the problems you have ever had was because of a defiency of a certain drug.
But, were all here for some reason, aren't we. We all keep coming back to this site. For some reason.
Its just like my mother. Even though sinequan put her into the hospital from mania psychosis etc, she would never dream of thinking that the drug was anything less than mana from heaven.
We all need our rabits feet.
Linkadge
Posted by linkadge on June 14, 2005, at 22:17:37
In reply to Re: Exercise for severe depression » gromit, posted by Chairman_MAO on June 14, 2005, at 20:11:26
Rabits feet with a buzz no less.
Linkadge
Posted by SLS on June 15, 2005, at 15:56:15
In reply to Re: Exercise for severe depression » Chairman_MAO, posted by linkadge on June 14, 2005, at 21:31:02
Dear Linkadge,
No hard feelings. Just a passionate difference of opinion.
I don't mean to be uncivil, but I invite you to look at the possibility that you might be overgeneralizing your own experiences with mental illness to that of the population as a whole. I believe you are.
- Scott
Go forward in thread:
Psycho-Babble Health | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.