I’m a psychiatrist and a huge fitness enthusiast. It is gratifying to be able to incorporate exercise, something that I am passionate about in my personal life, as a powerful component in the treatment of my patients with depression.
Depression is a disease of the brain. It affects around 20 per cent of people men and women in their lifetime. It’s associated with a significant reduction in functioning and provides a large economic burden on society.
Most treatment consists of a combination of medicines and therapy. In addition to this conventional approach to depression, treatment can be supplemented or augmented with physical exercise with significant benefits. This is supported by my experience as a doctor treating depression and some evidence from scientific studies. The benefits of exercise in the treatment for depression are many:
Stress reduction: It’s been well documented in science that exercise improves the ability of the body to handle stress. Exercise acts to reset and strengthen the body’s ability to handle stress. In addition, I find personally that after a stressful day, fully immersing myself in a workout tends to bring me out of my head. While I’m working out I actually don’t even think about everything that was on my mind earlier in the day. After the workout, I use the calm to think through some of the problems that may have seemed without solution earlier in the day.
Improved self esteem: Many of my patients often have a negative view of themselves. They feel that they can’t do anything right. Regular exercise brings about improvements fairly rapidly. There are mental benefits of calm and stress reduction. Often there are improvements in body image or the joy of working through a progression and achieving a skill. Nothing boosts self esteem like being able to accomplish a goal through regular training.
Socialization: My depressed patients tell me they find it hard to leave the house. Some of them have significant social anxiety. Their world becomes closed in. Workouts rarely happen alone. Generally, people are going to the gym to begin to workout. Interaction with other people can occur at the gym. There are trainers who can provide help, group classes, and friends that can improve socialization. Even if the workouts are happening at home, often people will post their workouts on social media drawing support and encouragement through social media.
Improved Sleep: My depressed patients often have trouble falling asleep, or they wake up in the middle of the night and find it difficult to get back to sleep. It’s well known that regular exercise improves sleep hygiene. People begin to know and understand their bodies. If they stay up late watching TV, they won’t be able to perform optimally during their workouts the next day.
Elevated energy: It may seem backwards that you have to expend energy to get energy. In depression, patients have lost energy and motivation. The anergia (lack of energy) of depression kills motivation and people find themselves sleeping all day, staying up all night. Regular exercise improves the production of catecholamines (energy producers) in the body that help sustain energy throughout the day.
Mobility/Pain Reduction: Depression kills energy. Loss of energy leads to less movement. Once you stop moving, joints become stiff. Muscles ache. This leads to less movement and more pain. Movement loss leads to weight gain. The additional weight and pressure on the joints in the body, the low back, the knees, the hips compound pain. As you begin to exercise, mobility increases, reducing joint pain. As weight drops, pressure on the joints diminishes further reducing pain.
Improved eating habits: My depressed patients tell me they aren’t hungry, yet many of them are overweight or have gained weight. In a misguided attempt to improve mood, patients often turn to the wrong types of food: foods laden in sugar, salt and fat. The result is weight gain and further reduction in self-esteem. The journey to physical fitness is often accompanied by a change in diet. Very often people get interested in a diet that compliments their fitness regimen. Foods that fuel exercise are often healthier: fruits, vegetables and protein. Many of my patients cannot treat their depression strictly through exercise alone. Depression is a disease and many of my patients will need medicine in order to feel better. Unfortunately, a side effect of many of the medicines I prescribe for depression is weight gain. Some of the stronger medicines worsen glucose tolerance and can lead to problems in metabolism of fats leading to elevated cholesterol. If I could add exercise to their prescription I know I could lessen this effect.
Joy : Accompanying depression is something called anhedonia. Anhedonia is the inability to feel joy. It’s one of the core symptoms of depression. Depression not only saps your motivation but it also saps your ability to feel happiness. My patients often look at me incredulously when I encourage them to engage in more activities. The act of engaging in activities may be difficult at first, but as they begin to consistently add activity like exercise back into their lives, the emotional shackle of anhedonia starts to disappear. Regular exercise will aid in reclaiming the joy in life.
There are different levels and severity of depression. It is important to understand that exercise tends to work best in patients with mild to moderate depression. Severe depression is a very serious condition and should be treated under the care of a mental health professional. There is not much evidence to suggest that exercise is beneficial to patients in the midst of a severe depression.
Depression is a disease and while exercise can be a very effective treatment, it has its best effect when used as an addition to traditional treatments such as medicine and therapy.
The benefits of exercise listed above are not just seen in people in the grip of mild to moderate depression. Exercise is a powerful preventive strategy for mental health. It’s well known that regular exercisers are happier, have more energy, sleep better, have more sex and are better socialized then non-exercisers. We often focus on the physical transformation that exercise can bring – the mind and the body are connected and as the body improves so does the mind.
This week I am privileged to introduce Bradley Sadler, M.D. to the Strong Medicine community. Dr. Sadler is a Johns Hopkins trained psychiatrist as well as an avid student of physical culture. As a practicing psychiatrist he is in the clinical trenches daily, working tirelessly to improve the mental health of his patients. Anxiety and depression are huge public health problems and often are not addressed effectively due to social stigma and incorrect beliefs that they are products of mental weakness or some other type of character flaw.
It is hard for me to take seriously any recommendations for nutrition and exercise given by an out of shape physician who looks like he would be winded from walking up a flight of stairs. Dr. Sadler practices what he preaches. I think we can all take exercise recommendations seriously from a psychiatrist who is coming close to a legit front lever!
Dr. Sadler has constructed an excellent overview of the positive benefits of regular exercise for mental health. His article an example of excellent public health messaging. It is clear, concise, and easy to comprehend for the layperson.
Within his article are some very important concepts. Among these is the statement “Depression is a disease of the brain.” This is actually quite a profound point that is a departure from previous paradigms looking at depression as a “psychological” condition. Depression and anxiety are the end results of structural and functional changes within the brain. As we have a very sophisticated readership in the Dragon Door community, many of you will want to know what is going on “under the hood” in the brain with exercise and depression. I will team up with Dr. Sadler to write a future post covering the latest theories on the underlying mechanisms behind the observed benefits of exercise for mild to moderate depression. We will also take some of his points outlined above and put them in the context of concepts covered in the Strong Medicine book such as allostasis (“Stress Cup”), neuroplasticity, and chronic inflammation.
Depression has a profoundly negative impact on the quality of life for so many people and is seldom talked about openly. Many thanks to Dr. Sadler for contributing this post on a topic that is not often addressed effectively, and certainly not given the attention it deserves in public health discussions.