HOW EXERCISE WORKS AS AN ANTIDEPRESSANT 

Most of us know that exercise is good for our physical health. It helps maintain strength and flexibility as we age, improves weight control, lowers blood pressure, reduces the risk of diabetes and heart disease, and improves immunity.

Few of us realize, though, that exercise is just as important for preserving mental health. For those of us who currently struggle or have struggled in the past with depression, exercise can take on a whole new role as part of our mental health treatment plan.

Exercise – as a treatment? Absolutely!

The first large scale research study on the antidepressant effects of exercise was done in the US in the 1990’s, by Dr. Jim Blumenthal. The study took 156 patients with a diagnosis of clinical depression, and assigned them randomly to treatment with either Zoloft (a common prescription antidepressant) or exercise. You might think that for an exercise regimen to be effective against depression, it would need to be very intense. Strenuous, bathed-in-sweat, “feel the pain” sessions of vigorous activity for an hour or two at a time, likely every day.

Exercise intense

Ready for some great news?

All Dr. Blumenthal had his patients do was take a brisk half-hour walk three times a week. That’s it. No marathon running sessions, no grueling make-your-neck-veins-bulge weight lifting. Just walking. (Most of the patients involved in the study were middle-aged and quite out of shape – so they likely couldn’t have completed an intense regimen anyway!)

In the study, this relatively low ”dose” of exercise was shown to be more effective than Zoloft in the longer term! The two treatments actually had about equal in effectiveness for the first several months, but by ten months into the study, the exercisers were much more likely that the medicine-takers to be depression-free. And since this first landmark study, many other clinical trials have shown exercise to be an effective treatment for depression.

If the research isn’t enough to convince you, how about the opinion of an associate professor of psychiatry at Harvard Medical School? This is what Dr. John Ratey, author of SPARK: The Revolutionary New Science of Exercise and the Brain, says about exercise:

“It is simply one of the best treatments we have for most psychiatric problems.”

Exercise is not just a helpful little adjunct, something to possibly add on to a “real” treatment program. It is a powerful treatment in and of itself. Wow!

What does exercise do in the brain that makes it so powerful?

Exercise changes the levels and activity of key brain chemicals and hormones. By doing that, it changes brain function. Think of it this way: it has the same effects as psychopharmacological medication. Really, exercise IS medicine. Except that this medicine has side effects that anyone would be happy to accept: weight loss, prevention and better management of diabetes and heart disease, and greater strength and endurance.

Let’s just look at one amazing effect of exercise in detail.

Exercise prompts the production of a compound called BDNF (brain derived neurotrophic factor). This powerful protein is a growth hormone produced by nerve cells. Dr. Ratey calls it “Miracle-Gro for the brain”, because it literally acts like fertilizer. BDNF stimulates the growth of brain cells, and increases the number of connections between them (scientists call these processes neurogenesis and neuroplasticity). These functions allow our brains to grow and change throughout our whole lives.

Depression causes levels of BDNF to plummet. With longer lasting depression some parts of the brain – for example the hippocampus, which is involved with memory – will actually start to shrink. Learning and memory will be impaired. Exercise combats this effect, by reversing the trend and actually increasing BDNF production. This revitalizes the brain in a way nothing else can.

So, would you like to use exercise to get more refreshing sleep, improve your concentration and memory, and boost your mood?

Here’s the exercise prescription:

  • Choose an aerobic activity (the aim is to do repetitive movements with large muscle groups, which increases your heart rate)
  • Do this activity for at least 30 minutes, three times a week

Hopefully this is already a lot more understandable than the hieroglyphics your doctor may scribble on a prescription pad, but let’s clarify a few points for good measure.

Common choices of aerobic activities would be walking (the absolute winner, as it is doable just about anywhere, by anyone), jogging, biking or swimming. The key thing is it has to be continuous activity – not stop and go. For exercise to be effective, your heart rate has to get up and stay up steadily for at least 30 minutes. So unfortunately, taking a leisurely walk your dog and pausing repeatedly for the “sniff and sprinkle” doesn’t count.

You may be wondering how high your heart rate really needs to be. First, I’ll address those who like numbers and technical definitions. Aerobic means that your pulse is 60 to 90% of your maximum heart rate. (Your maximum heart rate is the number 220 minus your age). Obviously, if you’re just starting out with an exercise routine, aim for the low end of the spectrum. Then as your body gets used to the activity, you can nudge the intensity higher.

For those who aren’t into numbers, graphs of target heart rates, and digital gizmos, here’s a simple way to assess your workout:  With aerobic exercise, you want to be able to speak, but feel it’s a little “choppy”. If you can speak in long sentences – or sing! – push yourself a little harder. On the other hand, if you can’t speak at all because you’re gasping for breath, tone it down.

Remember to start small, and work up gradually – especially if you haven’t done any regular exercise for a while. But hang in there, and you’ll see the benefits! At the 30 minutes, three times a week level, most people with depression start feeling better within a few weeks.

Trust me, I was a long-standing couch potato, a confirmed nerdy bookworm who was never involved with sports even as a teenager. The most physical activity I ever did regularly as a young adult was Hungarian folk dancing (and that was greatly influenced by the fact that a certain good-looking, single young man was in the dance group. He now happens to be my husband.)

Now, having found a combination of activities that I feel comfortable doing, and recognizing the powerful effects on my well-being, I make it part of my routine to have 4-5 hours of physical activity a week. It is crucial in controlling my diabetes, helping me lose weight (over 60 pounds to date), and preventing a relapse of depression.

So, anyone up for a walk?

Blessings!

 

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Focus on Causes, Not Symptoms

 

Doesn’t getting to the root of a problem just make sense? Here’s a story to illustrate.

One day, in a small community that was built up around a river, a young man heard wailing. He noticed a baby floating downstream in the river. He quickly jumped in, swam out in the strong current, and grabbed the infant. Luckily it was still alive and saved by his heroic effort.

The next day as the man was working in his yard, he again heard a pitiful cry. Shockingly, there was another baby floating down towards him! Again, he braved the dangerous waters and saved the infant from sure death.

In the following days and weeks, more and more infants came bobbing down the river. The young man, worried that he wouldn’t always be able to hear the cries, set up a monitor at the water’s edge, with an amplifier that would sound in his barn and house. He organized watches, recruiting others in the community to take turns being available to make the bold rescues. Families were found to take in the babies and nurture them.

Finally one day, an amazing story appeared in the paper. An evil worker in the orphanage just a mile upstream from them had been arrested by police. He had been trying to solve their over-crowding challenges by getting rid of some of the newest arrivals.

Now, I sincerely hope that nothing like this has ever happened or will happen in real life. But it brings about the obvious point: Why didn’t anyone in the heroic community that was trying to save all the babies ask, “Where are those babies coming from? How are they getting in the river in the first place?”

As my son would say, “Well, duh!”

We can see some of this misguided emphasis in the approach to depression treatment. Even though science has shown that clinical depression is not caused by low levels of serotonin and other neurotransmitters, what is actually known to contribute is not being publicized. Approaches that have been proven to work, are extremely safe and are relatively inexpensive are not – by and large – being actively supported by conventional medicine.

So, here comes “Depression Causes 101”.

What all medical organizations will admit and actually do have in their texts, literature, and websites – although it may take some searching to find it – is that depression causes can be grouped into three broad classes: biological, psychological and social. This is called the bio-psycho-social model of depression. (I know, I know, the medical community just loves its fancy jargon).

Some more holistically-minded professionals might even include a fourth area: the spiritual. I believe, though, that a more Biblical way of looking at life is to consider one’s faith as foundational. An easy way to picture it is to think of the spiritual life as the ground, and the basic areas needed for mental wellness (the biological, psychological and social) as the three legs of a stool. Sure, each leg has to be strong, and they all have to be equal in length or balanced for our mental functioning to be stable. However, if the stool isn’t on a firm, level foundation the seat isn’t going to be steady no matter how you perch on it!

3-leggedstool-unstable

 

Let’s look at these three categories in greater depth.

When considering biological causes, I know I used to automatically think of genetics. Perhaps it was an implication that came with the chemical imbalance theory: certain people just have an inherited tendency for depression. The DNA coding for the manufacture of brain hormones was just faulty.

Yet in the great deal of research that has been done, no specific genes have been isolated that are linked to depression. I’ve heard opinions that only about 20 per cent of depression is truly genetic. For the rest, while there may be a genetic susceptibility, outside factors determine whether the illness actually comes about.

But what about the many instances we see where multiple generations in a family are all suffering from depression? Isn’t that proof that genetics are heavily involved?

What investigators say is that there is a much greater influence from learned behaviour – the old nurture versus nature issue. Many of the skills learned from our family are greatly involved with our vulnerability to depression. Things like communication and relationship skills, problem solving, even a basic attitude of optimism versus pessimism.

The other aspect to consider is the epidemic rise in depression in the last two generations. This is an illness that has gone from relatively uncommon in our grandparents’ era (with a prevalence of about 1 in 100 people) to now extremely common (a prevalence of about 1 in 10 in the general population). A tenfold increase in such a short span of time strongly implies outside influences – our genes just don’t change that fast!

There are many other factors, though, in the biological category besides genetics. If we think of our body as being a chemical environment – consider the exact pH and oxygen levels, precise glucose quantities, and all the hormones and needed to keep our body and brain functioning – it becomes easier to see how many things in our physical world can affect our mental state.

The four major factors that physically influence our brain, are nutrition, exercise, sleep, and sunlight exposure. All of these factors have direct effects on the supply of vital building blocks needed for our tissues, our energy, and levels of hormones that regulate essential functions.

Who doesn’t remember his or her mom’s simple advice to “eat right, get enough rest, and go outside and play”? I could say moms are always right, but being one myslef I might be biased! It’s just good, sound, basic healthy living.

In later posts, I’ll look at more specifics of how each of the other factors in the biological category affect depression, and how we can influence them.

The second category, psychological, may seem a little intimidating. How many of us have any idea of how our thought processes operate? Yet there are some basic concepts that can help a great deal. The average person is estimated to have sixty thousand thoughts a day. I have no idea how psychologists came up with that number – the main point is that we have have A LOT of thoughts.

Psychological research reveals that our thoughts directly affect our emotions, and in turn our emotions affect how we behave.

Because of the effects of thoughts on our emotions and behaviour, certain types of psychotherapy can be very effective in helping deal with depression. Please note, however, that I said certain types of psychotherapy. Some models of psychotherapy (for example, the humanistic model) are founded on unbiblical principles. The distinctions between the various common types and the ways one can use basic concepts to help in day to day life will be the topic of one of my next posts.

The third major category of depression causes is social. God designed man for relationship – with Him, and with each other. In relationships, we need to consider both the quantity and quality of our interactions. Spending both quality and quantity time with the Lord is vital, and I’d encourage everyone to seek out a church with good Biblical teaching that emphasizes a relationship with Jesus.

The same principles apply to our human relationships. Obviously, if we allow ourselves to become so rushed and overscheduled that we rarely have time to spend others, that’s not good. And making sure we have good fellowship with brothers and sisters in Christ is crucial. It’s no surprise that there are many exhortations in the scriptures about fellowship. In Hebrews 10: 24-25 we are commanded to “consider one another in order to stir up love and good works, not forsaking the assembling of ourselves together…”

 

However, consider also the quality of your interactions. This is determined to a great extent by your social skills. The term social skills implies that human relationship is an area that can be developed. That one realization can cause a profound shift in perspective. For my whole life up to my late thirties, I considered myself shy and awkward around people. I literally told myself, “That’s just the way I am.” Telling myself that, as well as adding to it the natural conclusion, “So that’s the way I’ll always be,” made me completely closed to any possibilities for improving my skills.

The foundational keys for healthy relationships are all in the Bible. In the future I will share here how I was able to become more comfortable in my interactions. If this is an area of concern for you, allow yourself to meditate on the idea that change can happen (are we not told that with God all things are possible? Matt 19:26). Be open to guidance from the Word and the Holy Spirit.

While the key concepts as presented here are basically simple, I also realize that making changes and incorporating them into everyday life is far from easy. It is why I am involved with peer support groups, including a program called Mood Mastery, which is a ten week workshop hosted periodically by at a few Christian churches in Calgary. If a group seems too overwhelming, consider ‘buddying up’ with someone, and doing a study of the book The Depression Cure, by Dr. Stephen Ilardi.

Praying that you will become open to new possibilities for managing your mental health,

Blessings!