Recovery

Dreaded Exercise

The catch is you have to do it.

I lace up my concrete running shoes and go out for my ten-minute jog that is uphill and against the wind both ways. If I ran any slower I'd be running backwards. I once broke 4:50 in the mile as a senior in high school, but my flashbacks are to my freshman year before I hit my growth spurt when I had to struggle in a world designed for the bigger, the faster, and the stronger.

Exercise for Depression and Bipolar Disorder

Why bother? I am literally running for my life, that's why. I nearly did not emerge from my last major depression, and the prospect of another is simply too horrible to contemplate. Make no mistake, exercise may be as effective as any antidepressant, plus you don't gain weight. The only catch is you have to go out and do it.

A 1999 Duke University study headed up by James Blumenthal PhD divided 150 participants with depression age 50 or more into three groups. One was put on an exercise regimen, another administered Zoloft, and a third given a combination of the two. Those in the exercise group worked out on a treadmill or stationary bicycle at 70 to 85 percent of their maximum heart rate for 30 minutes, three times a week.

At the end of four months, all three groups showed significantly lower rates of depression.

The big surprise came from a follow-up conducted six months later when it was discovered that those in the exercise group experienced significantly less relapse than those in the Zoloft or combination groups. Only eight percent of the exercise group had their depression return compared to 38 percent of the Zoloft group and 31 percent of the combination group.

As to why the combination group should fare worse than the exercise alone group, lead researcher James Blumenthal PhD speculated that: "The concurrent use of medication may undermine the psychological benefits of exercise ..."

He goes on to say: "The important conclusion is that the effectiveness of exercise seems to persist over time, and that patients who respond well to exercise and maintain their exercise have a much smaller risk of relapsing."

Moreover: "For each 50-minute increment of exercise, there was an accompanying 50 percent reduction in relapse risk."

At best, the study can claim that exercise is superior to a single random antidepressant. In the real world, patients get a second and third try at different antidepressants, so we cannot say that exercise tops antidepressant treatment. Nevertheless, it is clear that working out should be regarded as a major part of one's treatment regime, along with medications, diet, sleep, and other lifestyle choices.

More Exercise and Depression Studies

A 2002 study by Ron Duman PhD at Yale found exercise resulted in the growth of brain cells in the hippocampi of rats. Meanwhile in humans, a 2003 University of Illinois study of brain scans of 55 older adults found reductions in tissue densities in the frontal, parietal, and temporal cortices, but far less so among those who engaged in aerobic exercise.

The now-defunct Depression.com listed several studies:

* Researchers at the University of Illinois surveyed 401 adults and found that more exercise correlated with less depression, anxiety, and insomnia.
* Harvard University researchers put 16 moderately depressed individuals over age 60 on a weight-lifting regimen, and found that at the end of 10 weeks only two were still depressed compared to everyone in the control group.
* University of California-Berkeley researchers have been tracking 6,000 individuals since 1965, revealing strong associations between a sedentary lifestyle and depression and equally strong associations between physical activity and relief from depression.
* University of Nebraska researchers divided 180 college students into three groups - one that swam for an hour twice a week, another that did hour-long weight training twice a week, and the other that was the control group. Compared with the controls, both exercise groups were significantly less depressed.
* A LaTrobe Univerity (Australia) study found two months of tai chi beneficial for depression.

Why Exercise Works Against Depression

Exercise works against depression in a number of ways:

* By reducing the stress hormone cortisol, which is linked to depression.
* By restoring one's sleep and eating patterns, and raising energy levels, all critically important to feeling alive.
* By releasing endorphins, which are associated with good mood.
* By raising serotonin levels, according to one study.
* Finally, getting in shape improves self-esteem.
* By increasing brain cells in the hippocampus, according to a study done on rats.

Researchers at Nottingham Trent University (UK) claim the chemical phenylethylamine (PEA) to be a byproduct of exercise and the cause of the euphoric mood called "runner’s high." The researchers measured PEA levels in 20 men before and after exercise and discovered all but two had increased levels 24 hours later. The study’s author, Ellen Billett DPhil says that endorphins, previously thought to cause runner’s high, don’t penetrate the brain as easily as PEA does, though endorphins may still play a role. According to Hector Sabelli, MD, PhD of Rush University in an article in WebMD: "What we have seen is that PEA metabolism is reduced in people who are depressed. If you give PEA to people with depression, about 60 percent show an immediate recovery - very fast, a matter of half an hour."

Significantly, PEA is a key ingredient in chocolate, which along with fat and sugar is thought to account for the treat's feel-good effect. One can easily imagine humankind divided into two poles, all based on how we seek our PEA fix.

More on Exercise for Depression

There is no scientifically-proven exercise or type of exercise that is superior to the others. Dr Weil, the natural health guru, strongly advocates 30-minute aerobic workouts five times a week. Aerobics are what one associates with Jane Fonda workout tapes and prancing fitness instructors, but the term applies to nearly all physical activity that is not specifically strength-oriented, such as walking, jogging, bicycling, swimming, and tennis.

Suite101.com's Natural Health Editor, Traute Klein, describes how she sweated her way back from the abyss:

"I won a three months spa membership as a door prize and started to take part in aerobics classes on a regular basis. I was not able to keep up with the rest of the class but participated to the best of my ability. To my amazement, the sustained, regular exercise heightened my well-being more than anything else I had tried. Gradually I came to experience the occasional feeling of euphoria at the end of a class ... I soon found that for me a stationary bicycle produced the euphoric feeling more readily than aerobics and it was less stressful on my injuries. That exercise also allowed me to work out by myself at times when the contact with other people was just too strenuous.

"Since I have learned to communicate with people again, I have gone back to my favorite aerobic exercise, aquacising. It is the easiest on me, because it is the least aggravating on the physical injuries."

When considering an exercise regime, it pays to keep realistic goals in mind. If the body is not accustomed to activity, it is going to fight back and enlist your mind in the cause. Don't expect to run a marathon your first week. Walking for 30 minutes is perfectly acceptable, and represents a giant step forward for those who have been inactive. Don't expect your depression to begin lifting until at least a few weeks, and don't look forward to slacking off when you start feeling better. Working out should be a life-long commitment.

Older people need to be especially mindful, for they tend to engage in less physical activity as they age, making them easy prey for depression, which they experience in greater numbers.

Of course, the last thing any of us want to do when caught up in a killer depression is crawl out of the covers and try to win three gold medals. You will probably have to wait until the worst of your symptoms abate before you take the plunge. Even then, the prospect of taking one's body for a quick spin around the block seems daunting.

Okay, I need to come clean. I gave up my jogging routine. It was no fun. It was work. It sucked. I had set myself up to fail. These days, I'm living 3,500 feet up in the mountains in Southern California. I get in a good walk for about an hour a day. The skies are clear, the vista is splendid, and the experience of getting out of the house is both relaxing and enjoyable. On the weekends, I get in a few games of water volleyball. The point is I want to do these activities. I look forward to doing them. They play into my various personal inner needs.

By contrast, there's a whole industry based on the fact that we wind up using our home exercise machines as clothes racks and in not showing up at gyms that we shelled out our hard-earned cash for. Lesson: find something physical that you enjoy and make it part of your routine - ballroom dancing, nature walks, swimming, gardening, whatever. You may be one of the genetically blessed who gets an endorphin rush from jogging, so all power to you.

Published 2000, reviewed Feb 10, 2008