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Exercise as a treatment for depression: a meta-analysis (2016)

156 points by Luc 8y ago

reuters 8y ago
Good post. Thanks for sharing. Exercise is necessary.
rofo1 8y ago
From the summary: Exercise has a large and significant antidepressant effect in people with depression (including MDD). Our data strongly support the claim that exercise is an evidence-based treatment for depression. MDD I assume it means major depressive disorder From personal experience, being (extremely) fit made me feel better about myself. Just based on the fact that I can do a lot of things (sprint, hike, some cool gymnastic moves, solid flexibility, can run good distances) makes me feel better about myself. Also, once you get in a good shape, it's really not difficult to stay in it. Contrary to what anyone says. But you have to do it "the right way": change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice. I recommend anyone struggling with "bad thoughts" to at least consider this - give it a couple of months, see how it plays out.
- diminoten 8y ago
  Eh, it's always hard to get in and stay in shape, just like it's always hard to create and maintain any habit. Not all of us ever get "used" to a pattern of behavior, so there's always a fight to maintain anything resembling a pattern.
  - collyw 8y ago
    Personally I just cycle everywhere. It's the fastest way to get around the city where I live (if you are willing to bend the traffic rules a bit). I am aware that it won't work for everyone, but I am surprised at how few people cycle. There is a bit of a motivational hump to get over, but once you are over it (forcing yourself to cycle half an hour for as week maybe?) then it doesn't seem like a problem at all.
    - Insanity 8y ago
      Could be a regional thing. Where I live, cycling is for many people the standard way to go around. But then, most people are students around this city. There are quite a few cities in Belgium and the Netherlands that promote cycling though. :)
      - przmk 8y ago
        Only the northern part of Belgium though (Flanders). The rest of the country has quite poor infrastructure for cycling, especially when compared to the Netherlands. I would love to cycle to work in Brussels but I do not feel comfortable doing so.
        a_imho 8y ago
        I don't know about Brussels specifically, but if you are worried about the volume of the traffic you can probably try cycling in off hours, mainly at night, and/or using the pavements liberally to build up the routine.
        Insanity 8y ago
        I'd not like to cycle in Brussels either. Mostly cause of the (car) traffic there. Neither would I feel that comfortable at night in certain parts of Brussels :D
    - saiya-jin 8y ago
      I have rather unpopular opinion about biking in most cities (it doesn't cover bike friendly places like Netherlands/Belgium/Denmark, but your usual place where bikers share roads and sidewalks with rest of us) - bikers often behave like assholes, especially but not only to pedestrians. Aggressive, arrogant, utterly ignoring red lights, zooming fast through crowds walking on pedestrian crossings. I had few near-hits myself when biker went maybe 10cm from me, doing 30+kmh, not even slowing down although he saw me. Also have seen couple of incidents of biker hitting pedestrian hard only because biker was a total idiot and tried to get somewhere 5 seconds sooner. Fast bike hitting some old granny doesn't end well for her in any possible case. Fiancee who is a doctor had recently a case where biker hit pedestrian in same way, ignoring red light. Guy in his 40s was cca OK when brought to emergency room, but went into coma quickly due to internal bleeding in the brain. Dead within a week. Maybe its this idiotic childish 'french' culture that I am exposed to here in Geneva (when you see them drive in France you know what I mean), but it really seems biking in the city brings out the worst out of people. Biking elsewhere, in the nature, forests, unpaved roads, fields etc is something completely different, that I enjoy very much.
  - wjnc 8y ago
    There is a clear difference between becoming fit and staying fit, no? Overweight depressed and no prior sports history to fit can easily take a year of hard work. Maintaining basic fitness (not big gym bill or 21k in 90 min fit, but regular happy fit) and a healthy BMI is really just adapting lifestyle and not even having to work out. Walk to the groceries, walk during lunch and f.e. when calling with friends. All true that these last examples are all adaptations of a healthy lifestyle, which I expect to be harder to adapt to for those with mental health issues.
  - llamataboot 8y ago
    In my experience that's not true with a general level of fitness. I would say that if you get into reasonable shape and have a habit of moving daily that after 3-6 months it becomes hard /not/ to move. ie; you feel antsy and sluggish if you haven't moved for a few days and feel in need of a long walk, etc. The default state of humans is not sedentary.
    - diminoten 8y ago
      My point is your experience isn't universal, not everyone is like you. Some people simply don't have it as easy when forming and maintaining a habit.
- tapland 8y ago
  Getting 'fit' is very far away for a lot of people, MDD or not. That's not a reasonable aim for positive effects on depression. If we can get positive effects from regular exercise, it's great. If it requires patients to get 'fit', it's really not. > Also, once you get in a good shape, it's really not difficult to stay in it. Contrary to what anyone says. How old are you? This: "change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice" is one of the hardest things to do in life.
  - rofo1 8y ago
    > That's not a reasonable aim for positive effects on depression. If we can get positive effects from regular exercise, it's great. If it requires patients to get 'fit', it's really not. In my opinion, if you are not fit, then it won't have as good effect as it would otherwise. That might be.. jarring a little bit, but I don't think an obese person can workout 30 minutes and then call it a day, and believe he'll reap the benefits. Maybe I am wrong, but I don't think it is so. So the goal should always be to get in great shape, the best you can get (in your circumstances, I mean; age/cardiovascular fitness/joint health etc.) Our default mode should be being fit and everything else an abomination. > This: "change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice" is one of the hardest things to do in life. Sorry, I just fail to realize how can someone consciously think that this is one of the hardest thing in life. We have really way different view of life, then. To me, it takes some work, but it's not even hard. It's just something you do for couple of hours in your day, that's all. And the best part? There's no downside for you. Better health, mental and physical, longevity, mood, etc..
    - tapland 8y ago
      > That might be.. jarring a little bit, but I don't think an obese person can workout 30 minutes and then call it a day, and believe he'll reap the benefits. Then it's probably not helpful to treat depression though. At least not as a prescribed action. Send it back to "things everyone should do with rewards down the line". > We have really way different view of life, then. To me, it takes some work, but it's not even hard. It's just something you do for couple of hours in your day, that's all. Again. How old are you? This seems to just be a complete lack of experience being around depressed or unhealthy people, and a complete lack of understanding why anyone would find themselves in bad health. Weight issues and bad health are not only a result of people not wanting to put in effort. Just try looking at long term weight loss success rates or something. Your ideas are not based in reality here.
- arendtio 8y ago
  > But you have to do it "the right way": change your approach to exercising, eating, sleeping, etc. Regarding 'the right way', thinking in systems/implementations/solutions rather than goals/KPIs might help (at least it does for me): https://blog.dilbert.com/2013/11/18/goals-vs-systems/ https://blog.dilbert.com/2013/11/18/goals-vs-systems/
- dagaci 8y ago
  Not to mention that being extremely fit or just trying to be means that your mind is being occupied by being busy, people will act more positively around you and you will also tend to sleep better. Despite appearances we humans are much more animal than intellect, so that means the simple physical act will much more easily inform our mood and sentiment than just thinking alone. Extra care should be taken with diet and rest to avoid lowering the immune system by over stressing the body too quickly. You don't want to catch a cold and interrupt your momentum.
bayesian_horse 8y ago
In my opinion, motivational energy works a lot like financial investing. It grows and shrinks exponentially. You have to spend energy, to get more energy (or even conserve it) but the return is uncertain. The optimal strategy is to invest an amount relative to the energy I have, to avoid draining my reserves. To escape the effects of depression [alongside medical treatment] I have to invest my energy wisely, and ultimately I can (and have, in the past) achieve motivational abundance again. And I must adjust the investment strategy to my current capital. Exercise can be a very rewarding way of investing energy. But it can also be really hard at first.
llamataboot 8y ago
Exercise is probably one of the most robust treatments we have for a lot of mental health issues. Personal experience: I dealt with recurrent MDD for over a decade, and chronic fatigue/pain issues for many many years as well. There were years were exercise was impossible (I'd literally pass out on the gym floor after trying to work out). However, after I got well enough to move, regular movement helped wonders (I also think it helps get you into an embodied consciousness that contains less interpretation and more direct experience/awareness - esp somatic practices of moving meditation, yoga, contact improvisation) Also, once I started getting /serious/ about exercise - like actual cardio and weightlifting 5 days a week - my energy levels skyrocketed after about 2-3 months, but it did take a bit. -- Slightly off topic, but I'm convinced we'll also eventually have a lot of robust data that shows that alcohol, even in minor but regular amounts (2-3 drinks most days of the week, say) has large negative effects on mood/energy that build up over time. -- I don't have any problems with psychoactive drugs, SSRIs never helped me, nor tricyclics, (stimulants help mood/energy a lot but have significant negative effects)- but if someone wants to try them, by all means do! However, if someone came to me struggling with depression, I'd nearly 100% of the time encourage them to start exercising regularly, cut alcohol/eat better, and see a talk therapist or work through a self-help workbook and see where they are at in 3 months whether or not they also wanted to take anti-depressants.
- TheSpiceIsLife 8y ago
  In addition to all the mental health benefits, I like to point out that exercise important for body health and healing too because our lymphatic system doesn't have a pump! Everywhere there are blood vessels there are lymph vessels, they carry away the interstitial fluid our cells are bathed in. That fluid contains some of the waste products from our cells. The lymphatic system is also an immune organ in its own right. Often rest is the diametric opposite of what we need during convalescence or healing. Movement and exercise within our ability is vital.
  - throwaway66523 8y ago
    No idea why you are being downvoted, it's even interesting (and at worst offtopic).
duopixel 8y ago
Anecdota about depression and exercise: * It's not getting in shape what lifts depression, it is physical activity in itself. You generally feel better after exercise. It becomes much easier to hit the gym after realizing the reason to go is simply to feel better. Instead of thinking _I don't feel like going to the gym_ the correct cognition is _my medicine is there_. * There's a variety of options to exercise. Don't stick to running if you don't enjoy it (but you keep doing it because you feel better). There's a large menu of activities, at first try what is convenient, deliberately try many things and find what is more fulfilling to you. * With exercise nutrition follows quite naturally. It's difficult to navigate all the BS in nutrition, but in general eating fresh things closer to nature (leafs, fruit, veggies, nuts, lean meats) also has an impact on your wellbeing. * Often there are more issues other than lack of exercise. If you are socially isolated, if you are under constant stress, if your home situation is dire, exercise will help you cope with it but it's not getting at the root cause. Identify and work on the cause too.
- bonesss 8y ago
  Heavy weights also make an exceptional therapist. You can tell anything you want to a 200 pound loaded barbell, over and over again...
  - amelius 8y ago
    Some tips for beginners: - Make sure you don't overtrain, as it can make you feel burned out, which can last a week or longer, and certainly will not help a depression. It also will not make your muscles grow faster. It's better to start slowly. - If you can't do an exercise in a controlled manner, reduce the weight. - Also don't target the same muscle-group more than once a week. Your muscles need time to recover. - Muscles grow most if you load them (slowly) while they are being stretched. - Find a training buddy. - If you take supplements, be aware that they can have an effect on your mood. For example, L-glutamine and taurine (which are in many protein shakes) are known to affect neurotransmitters.
    - naasking 8y ago
raubtier 8y ago
Exercise is good for you. We've always known that. Also we know that eating properly is benificial, as your social situation and that you have a meaning in your life. Modern society rediscover this bit by bit. My guess is that the last part, meaning, will be discovered and accepted lastly. To bad, cause that's in my opinion the most important thing. If you believe in the evolution theory you can logically arrive at what is good for you. one can logically arrive at what is good for one. What is right is what evolution has adapted us to. So the task then is to try to make as qualified a guess as possible and then try to match our lifestyle against it. Some things are obvious, others are more difficult. Through evolutional history, what happend to individuals that didn't had any meaning, that did nothing that helped anyone, that was useless? Well, they died of.
aszantu 8y ago
my depression went away when I switched my diet from Standard German Diet to Keto, the anxiety went away when I made the switch to carnivore. Observed changes in mood and thought after consumtion of starch/plant food (The occurence of these effects takes about 4 days): Frozen non processed Spinach: Anxiety - Thoughts revolve around other people wanting to get me or steal from me or my friends. About one tablespoon of mashed potato and sauerkraut: depression - Suicidal wishes, low energy Thoughts and self talk are going in the direction of "everything is my fault, I deserve this suffering, I should be dead" A piece of apple without the skin every day for a week: Depression, laziness, don't want to get up, move, walk the dog, everything is too much, I'd rather just play games all day long. These effects keep going for about two to three days and then vanish suddenly and I can do my work and routine, workouts, clean my place, etc. I did depression comics/art when I was trying to fix it with meds, therapy and excercise, I'd be happy to cooperate if someone would like to help me market the stuff https://www.deviantart.com/aszantu/gallery/52706431/key-project https://www.deviantart.com/aszantu/gallery/52706431/key-proj...
- dan00 8y ago
  > Frozen non processed Spinach: Anxiety - Thoughts revolve around other people wanting to get me or steal from me or my friends. About one tablespoon of mashed potato and sauerkraut: depression Have you thought about histamine intolerance?
  - aszantu 8y ago
    Yes, I should get tested, but haven't gotten to it yet. The only other person I know who has Histamine Intolerance gets pimples all over his body
    - dan00 8y ago
      The symptoms of histamine intolerance can be quite different. I am not aware of any test that really gives a definite answer. You can only keep a diet and look if the symptoms get better and then after some time try again food rich on histamines and look if the symptoms come back.
_cerv 8y ago
Personal experience is that high intensity exercise mixed with a comforting ritual was what broke me out of a couple bouts of severe depression. When the streak was broken by an event or travel, and several days missing out on exercise followed, I would fall back into the depressive mood. The most recent depressive bout was probably the most extreme I've gone through, and required a couple close friends to jump in, but again, routine exercise with comfortable bits of a routine mixed in - like making a cup of tea, making sure I have a podcast queued up, a book to read, and a handful of songs I like - has seemed to help pull me from the brink. Now that I have eclipsed thirty years and I still am over 300 lbs, and some of the recent depression-like feelings, I am making a more of a cognisant action to keep working at this and to journal how I feel before, during, and after the routine. I look forward to seeing this kind of work being taken a little more seriously as a means to treat depression as opposed to only medication and therapy.
- ddorian43 8y ago
  Can you explain what you did with high intensity exercising ? Were you diagnosed by a professional psychiatrist ?
  - _cerv 8y ago
    I was diagnosed as a teenager and prescribed Zoloft. I hated the medication because intrusive thoughts would spiral from “what if I jumped infront of this car” to “what if I locked the doors of this grocery store and set it ablaze”. So I stopped taking it and got fat. As for high intensity, I’m sure that my use of the term isn’t correct, but I do something that raises my heart to 165+ for 30 seconds, keep my heart at 130, do something to spike it after 5 minutes and repeat until tired. I’ve been able to recently accomplish this reliably on an elliptical at the highest resistance level and maintain activity for 60 to 90 minutes. After longer sessions I feel pretty good and sometimes a bit euphoric.
- pfortuny 8y ago
  I only have to congratulate you for having "close friends" who "jump in". That is a great part of my keeping my mood stable lately (I have also a couple of friends who are not afraid to "jump in" and help me out). Hope you keep them and keep safe!
joantune 8y ago
this needs to be upvoted a bit more
tomhoward 8y ago
My own experience attempting to use exercise to reverse moderate depression was that it correlated with me crashing into more serious depression. It didn't make sense to me as I'd always heard that exercise was a solid remedy for mild depression. It was when I read this 2005 article on Kuro5hin (RIP) called Demystifying Depression [1], that it made sense. The section "The Role of Sports", with its explanation of the physiology behind the benefits and drawbacks of exercise for people with depression or burnout, is consistent with my own experience. These days, having done a huge amount of work over 10+ years, including emotion-based treatments, diet/nutrition, and some pharmaceutical treatment, I can and do often undertake intensive exercise without negative effects. But I still have to be careful - as the article says, listen to your body. As a general comment about this document: Anyone experiencing depression should seek professional help and should not make treatment decisions based on comments on internet discussion boards or online articles. But as a lay-person's summary of the mechanics underpinning depression, I've not found anything better than this in the 14 years since it was first published. If someone can recommend a better one, I'd be pleased to hear about it and will gladly start recommending it instead. [1] https://en.wikibooks.org/wiki/Demystifying_Depression/Print_version https://en.wikibooks.org/wiki/Demystifying_Depression/Print_...
- rygxqpbsngav 8y ago
  Ashwagandha works great. It is well studied too (check ksm-66). Prolonged use is safe and has no side effects. Depression is a result of hormonal imbalance which it corrects effectively along with aiding with deep sleep when taken at nights. Exercise raises few hormones like endorphin, serotonin and reduces cortisol (depending on the kind of exercise, like long walks), but I am not convinced if someone says it balances them.
  - tomhoward 8y ago
    > Ashwagandha works great I've used that at times, and it's been somewhat beneficial some of the time. But there's no silver bullet and no one-size-fits-all approach. The causes are complex and different from one person to another, so a complete recovery will require multiple forms of treatment and a tailored approach.
deleted 8y ago
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glastra 8y ago
From personal experience, having dealt with MDD/bipolar^, I can attest that exercise does help. However, exercise alone is not always sufficient. Daily meditation sessions help tremendously. But the icing on the cake (pun intended) is, in the end, nutrition. Our body (and thus our mind) works with what we put inside it. In fact, our body is made exclusively of what we, or our mother, ingested in the past. There is no escaping that fact, and most people seem to ignore it every single day. Personally, switching to a zero-carb ketogenic diet has done wonders for my overall health and well-being, including mental health. I am of course very biased in affirming this, but I honestly think sugar and most other plant substances (except perhaps some fruits and their oils) are there to harm us. The phytotoxin defense hypothesis really resonates with my experience. ^: I have had recurrent depressive episodes throughout most of my life, and antidepressants make me manic, but I otherwise experience no "natural" mania, only a mild hypomania.
zimpenfish 8y ago
Anecdotal counterpoint to the anecdotes posted here - I had a 200 day streak of >1km runs in 2015 and it didn't help my depression.
- alohomora2 8y ago
  In my also anecdotal experience 1 km is too short to have noticeable effects. I do >5 km at least 3 times per week with very positive effects on mood.
  - zimpenfish 8y ago
    Note that I did say ">1km". The total distance for those 200 days was 672km including one (1) marathon, six (6) halfs, seven (7) 10kms, etc. (Anecdotally, your 15km a week is only going to get you 428km in 200 days.)
- sridca 8y ago
  I wonder if all those anecdotes are placebo. The authors of this meta-analysis have links to rehabilitation and physiotherapy departments; so I'm not sure I see it as an exactly unbiased analysis. Unless it is clinical depression I find it hard to believe that someone can address their depression with mere physical movements without looking into the mental and emotional causes of it.
verasio 8y ago
Personal anecdote: During a bad depressive time I saw a psychiatrist who enthusiastically prescribed serious antidepressant medications like they were M&M's. One to lift me up, one to help me sleep, one to take the edge off, one just in case an anxious episode occurred during the day, etc, etc. That kind of thing. And he said to me "There is still nothing I can prescribe you that is as effective as exercise." Specifically, heavy weights.
- scottious 8y ago
  I have a similar anecdote! Except mine ends with me becoming a marathon runner. I'm kinda glad none of the pills worked or else I might not have discovered the best natural anti-depressant. The unfortunate thing is that often times when one is depressed, exercise is the the last thing on one's mind. And it also doesn't help that it can take a long time to have noticeable effects.
  - RankingMember 8y ago
    That's the most frustrating part of depression- You can have a nice protective mindset and habits carefully constructed and working great and then depression comes along and throws it all into darkness. You really have to work to keep pushing ahead and through it. I literally visualize putting one foot in front of the other to get through the hardest days.
    - philwelch 8y ago
      I had a similar mindset change the last time I had a prolonged depressive episode. Usually, I would be either happy and productive and feel on top of the world, or I would feel like shit and do nothing. My recent epiphany is a lot like "putting one foot in front of the other". It's mostly a change in values--instead of worrying so damn much about my own happiness, I just kind of thought, "I don't have to ENJOY being a high-functioning human being, but at least I can BE a high-functioning human being." Grim determination isn't really that much fun, but at least it breaks the part of the depressive spiral where you feel useless and your obligations continue to pile up.
karpodiem 8y ago
Looking good naked cures all ills. I know that won't play well among the Rain Man comment section here, but the material you are woven out proves this to be true. Among nearly all western countries there has been a decrease in testosterone levels, higher BMIs, and lower birthrates. Go read Chateau Heartiste.
- RankingMember 8y ago
  It's weird you felt you needed to make a nerdy straw man to rail against when the comments here mostly agree with your general thesis. Why the acidic tone?
  - your-nanny 8y ago
    too much tomato juice probably.
  - karpodiem 8y ago
    I wish someone would have impressed this upon me years ago like I'm doing now.
- dang 8y ago
  Please don't post nasty swipes to HN. Dissing the community you're participating in is in bad taste, and breaks the site guideline against shallow dismissals. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
bufferout 8y ago
For those of us who loathe excercise for the sake of excercise, may I suggest metalworking? You get the distraction of a project / learning to make cool things and it's a surprisingly physical process to inflict your will on such dense objects.
- gameswithgo 8y ago
  some other fun alternatives: mountain biking is amazing and there may bw great places to do it in your town that you arent aware of yet. no cars to run you over and modern bikes let you go anywhere in comfort. rock climbing in an indoor gym is safe and low impact and programmers often enjoy the mental aspect of it. it incentivizes you strongly to keep weight down as well.
  - g45y45 8y ago
    climbing walls or being stuck in the wilderness with a bike don't sound like fun at all. pointless. I don't think your suggestion is helpful for people that have depression. The metal working suggestion from parent is far more helpful, as you are actually making something.
    - maccam94 8y ago
      Rock climbing is like solving a puzzle with your body. You can't just go straight up. You have to analyze all of the differently shaped holds and walls and figure out how to position your body to maximize your grip while minimizing the amount of energy you need to expend. There's also a difficulty rating system, so you feel rewarded when you manage to finish a new level. But if you're not motivated by leveling or puzzle solving, it's probably not for you.
      - g45y45 8y ago
        I'm motivated by solving real problems, not artificial climbing wall problems, sorry.
- davemp 8y ago
DanBC 8y ago
A lot of people in this thread giving their personal experience, but failing to realise they're doing exactly the same as people who promote crystal healing or homeopathy. Depression is an umbrella term and it covers a wide range of experience. Some people will recover even if you do nothing to treat them; others will recover if you do anything (such as providing homeopathy) to treat them. Correcting for this is difficult, which is why respected organisations disagree about whether exercise works or not. Felipe suggest that publication bias explains why other analyses don't show benefit of exercise as a treatment, but that doesn't make much sense. The only reason he sees such large effect sizes is because he includes huge amounts of low quality research. When you restrict the analysis to good quality research the effect reduces and it's much harder to see any difference between no treatment and depression as treatment. It's not particularly suprising that physiotherapists and sports therapists think what they do works. What is somewhat suprising is that HN routinely falls for it.
- EForEndeavour 8y ago
  > they're doing exactly the same as people who promote crystal healing or homeopathy. It's only exactly the same if you consider their formal argument in a vacuum, neglecting everything you know and reasonably believe about the world. An intervention with a plausible mechanism has a greater chance of being effective than an intervention with no conceivable scientific mechanism (healing crystals; homeopathy). Anecdotal evidence isn't high-quality scientific evidence, but it does work as a decision support method to think about what to study more carefully -- or what to stick with because it works for some reason and you don't have the resources to scientifically validate the effect. Furthermore, and this does overlap with the placebo effect as well as fraudulent medicine: if a specific person tests a mood-elevating intervention on themselves and perceives a benefit, nobody can contradict them. Not to defend ardent believers of nonsensical cures, but if it's stupid and it works, it's not stupid.
  - your-nanny 8y ago
    this is a reasonable point. we know exercise does lots of things. we don't know that about homeopathy. hence it is more reasonable to suspect that exercise has an effect on depression than it would be for crystals and homeopathy.
harshulpandav 8y ago
Vitamin D3 is essential to fight against depression. Low vitamin D levels is one the major contributors toward depression. Many of us work inside office with hardly any sunlight coming in. Going out under sun in the morning for 30 minutes will be helpful.
- callesgg 8y ago
  People say that but the drops and pills make zero difference. Sun sure does feel good, but the vitamin additives does not have the same effects. Based on that one could make the conclusion that it is not vitamin d but something else with sunlight that is beneficial.
  - naasking 8y ago
    Yes, recent studies have shown that Vitamin D is the marker that's associated with whatever process sun exposure induces. It's not the vitamin itself causing the benefits. Get some sun, just not too much.
  - Franciscouzo 8y ago
    Probably the light itself, light therapy has anti-depressive effects even on non-seasonal depression.
throwaway66523 8y ago
During a depressive episode after the suicide of a friend I compiled a check list of very basic things that I noticed had helped in everyday life. I wrote it down when I noticed that I couldn't remember the items reliably (or when it didn't occur to me to think of them). I carried it in my pocket for some while. It contained very basic things, like questions if I had eaten enough, slept enough, whether I spent time outdoors (fresh air/sun), had met friends recently or exercised recently and corrective actions for each item (and yes, "eat something" was on it). Some items were accompanied by comments like "exercise will only help for the next day or two, do not skip for longer than that". Another thing that helped surprisingly well was having a shower, shaving and dressing up. Basically the opposite of letting oneself go. And in really bad moments, jamming/DoS-ing my brain by some sort of meaningless meditation (sitting, breathing and counting so that no other thoughts appeared anymore) helped as well. The best thing is that I haven't had to use the list in a long time now and hopefully never will have to again.
- RankingMember 8y ago
  Your list of things reminds me of this: http://philome.la/jace_harr/you-feel-like-shit-an-interactive-self-care-guide/play http://philome.la/jace_harr/you-feel-like-shit-an-interactiv... Otherwise, your mention of the mood implications of dressing up reminded me of the many times I've noticed that, after waking up in the morning feeling depressed and shitty, sometimes just pushing through and eating breakfast/getting showered/dressed makes me feel significantly better. Something about getting that last shoe on and standing up and suddenly my brain flips a 180.
- dorchadas 8y ago
  I agree with the dressing up. A lot of times, I've found my depression helped simply by dressing nicely and going out, even if it's just to eat. It's a confidence boost and you do get some human interaction which can really help.
MatthiasP 8y ago
That exercise (especially endurance sports) is as effective as your typical SSRI is known for decades. The problem is getting a depressed person to exercise five days a week and holding up to that schedule for months and years.
- justinator 8y ago
  I guess one of the nice things about the modern world is that there's lots of different activities one can choose. Like basketball? Play basketball! Like Crossfit? Do some Crossfit. Like running? Go for a - OK - no one really likes running... All these activities have casual social groups attached to them you can join. If you miss a meetup, someone's gonna check in with ya. The initial bump to make it habit is hard, and it could take a few tries, but that's true for any positive habit.
- SketchySeaBeast 8y ago
  You don't have to exercise for 5 days a week though - that's an arbitrary choice. I've been going to the gym 3-4 times / week for 1-3 hours at a time for years and it's absolutely helped my mood. There's no magic to 5 days a week.
- throwaway66523 8y ago
  Absolutely. As I commented elsewhere here, I suffered from a depressive episode after a close friend committed suicide. The lack of energy is extraordinary and what I experienced must have been mild compared to what others with severe depression suffer from. Anecdote: a sliding door slipped from its rail because there was no stopper at the end of the rail and it had to be moved back in place. It is neither heavy nor difficult to do it. I gave up after the first attempt to fix it. Depression is nothing that I would ever wish on anyone, no matter how much I might hate that person.
qwsxyh 8y ago
Any sort of excercise has never made me feel anything other than shit. High intensity? I feel like shit instantly. Just miles of walking? I feel like shit throughout the entire process. I don't get any sort of "high" after doing it - everything aches, and I am tired, and I feel like shit. If a doctor told me to get more excercise, I would tell them to fuck off.
- Zolomon 8y ago
  It’s abnormal to feel like shit from walking. Sounds like something to investigate further. Hope you can find a long term fix!
- om3n 8y ago
  I have had the exact opposite experience. Prior to 2012 I was in college and was overweight/out of shape and always felt like crap. I decided to get into shape: did intense cardio and HIIT workouts, lifted weights, and got into excellent shape within a year. I lost 50 lbs, went from being able to do 0 pull ups to over 20, I ran a few Tough Mudders (12 mile obstacle course races), etc. I still run, lift weights, and keep my body fat % low, and if I can help it, I'll never go back. If I go days without exercise I start to feel terrible, foggy headed, lethargic. One 5 mile run will immediately make me feel great for the rest of the day.
  - qwsxyh 8y ago
    Thanks for the reply that clearly could've been a top comment. Also, if I was overweight I simply wouldn't bother with excercise for losing it - it's so inefficient. I'd just skip a day of eating every other day.
- asark 8y ago
  Aerobic exercise has always been like that for me. I get exactly none of the "euphoria" or whatever people talk about with it. The result of any serious amount, even back when I was pretty damn in shape and made myself do it somewhat frequently, is that I feel like I'm ill for a good long while after. I also happen to find it boring as hell, though put me in an aerobic sport and I'll run myself around to vomiting and love every second of it. Lifting weights feels pretty good though. Doesn't constantly leave me with injured-feeling levels of joint or muscle pain like running and friends do. Just the good kind of aches.
lifeformed 8y ago
How common is depression? It feels like in every depression thread every single comment is someone's experience with it.
- your-nanny 8y ago
  about sixteen percent of people experience one bout of major depression
- sdinsn 8y ago
  Estimates range from 5% - 15% per year of people experiencing depression. It's a hard thing to measure since most people hide it.
philwelch 8y ago
Does exercise treat depression effectively? Yes, of course! The only problem is when you're too depressed to work out. This is where SSRI's and other first-line treatments can be valuable: they can lift you up just enough to go get the rest of your life squared away.
- larrywright 8y ago
  There's a quote I like from Jordan Peterson (yes, I know he's a mixed bag) that goes something like: If you come to me to get help with serious depression, the first thing I will do is prescribe an anti-depressant. Not because it's the long-term solution to the problem, but because they work, and I can't treat you if you're dead.
  - philwelch 8y ago
    Jordan Peterson is very outspoken about lifestyle-centered treatments, i.e. the whole "clean your room"/"sort yourself out" stuff, but you definitely need to start somewhere and an anti-depressant can help.
exolymph 8y ago
Exercise for depression was a total nonstarter for me because I didn't have the energy or wherewithal to exercise when depressed.
mntmoss 8y ago
My personal experiences go something like this: * Strength training tends to be a long term benefit. It can be really draining if you put in a difficult workout every session. Copious logging matters to lock in the sweet spot of difficulty, and maximizing recovery rate matters just as much - I found that increasing vitamin D intake did the trick here. But I find that the strength isn't the beginning and end - it helps to have it as a barometer of progress, but it's only one thing. * Cardio-intensive activity helps my mood throughout the day. Last year I trained judo, which rewards all-around athleticism(though my desire to compete is limited) and it pushed me to take cardio more seriously. I got gifted a Fitbit last Christmas, and took up a jogging routine first thing out of bed by way of pleasing the hourly activity monitor. By focusing mostly on the technique and habit instead of pace, I've improved my form quite a bit, gotten my sleep schedule under control and also hit on another supplement that seems to get my anxiety down(magnesium citrate). However, this led me to something else which I'm still working on: * I would tend to finish my jog with a cup of coffee and I finally realized last week that I had been letting my caffeine consumption creep up, and this was throwing off a lot of other stuff. My gym numbers were still coming in, but my concentration was mostly shot, and finally at an event Thursday I had one of the free diet sodas and soon after found that I was unusually anxious and had developed an eye twitch. This is too much, I told myself. I had gone through phases of overconsuming and cutting back before, but I was tired of the cycle. So I decided later that night that I would cold turkey caffeined drinks. I'm still consuming a little bit of chocolate, but it's been an eye-opener. I started having bottled water instead of coffee so as to keep my other habits in the same place. Day one was the most difficult, but my sleep improved immediately and my focus already started getting better on the second day. By the third I realized that I was smiling and engaging with activities better than I had in a long time. My depressive spells never quite went away with the other things, but they seem to be gone after dropping the caffeine(although I'm still getting the eye twitch). So, yes, it's a lot of things. Sobering up from coffee is something that's helped by getting all my other habits together. If you're starting from a "sodas every day/no exercise/no gym experience" standpoint, this is roughly the path I've recommended to friends: * Get some resistance bands and start a program with those. They're some of the simplest and most accessible strength training around. Focus on developing some technique and logging your progress. * Get a fitness tracker and try to hit some of the goals. I like the hourly goals(even though they do not measure when I get up and do housework), others like daily steps. * Switch either from sugar + caffeine to just sugar or just caffeine. I shifted away from soda about a year into my first job(by - surprise surprise - overconsuming until I felt ill). Then work your way down from there by getting bottled water more often. * Research supplements. This is not easy with so many options, but there are usually common ones that come up with respect to certain sports and activities.

156 points by Luc 8y ago

Good post. Thanks for sharing. Exercise is necessary.

From the summary: Exercise has a large and significant antidepressant effect in people with depression (including MDD). Our data strongly support the claim that exercise is an evidence-based treatment for depression. MDD I assume it means major depressive disorder From personal experience, being (extremely) fit made me feel better about myself. Just based on the fact that I can do a lot of things (sprint, hike, some cool gymnastic moves, solid flexibility, can run good distances) makes me feel better about myself. Also, once you get in a good shape, it's really not difficult to stay in it. Contrary to what anyone says. But you have to do it "the right way": change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice. I recommend anyone struggling with "bad thoughts" to at least consider this - give it a couple of months, see how it plays out.

diminoten 8y ago
Eh, it's always hard to get in and stay in shape, just like it's always hard to create and maintain any habit. Not all of us ever get "used" to a pattern of behavior, so there's always a fight to maintain anything resembling a pattern.
- collyw 8y ago
  Personally I just cycle everywhere. It's the fastest way to get around the city where I live (if you are willing to bend the traffic rules a bit). I am aware that it won't work for everyone, but I am surprised at how few people cycle. There is a bit of a motivational hump to get over, but once you are over it (forcing yourself to cycle half an hour for as week maybe?) then it doesn't seem like a problem at all.
  - Insanity 8y ago
    Could be a regional thing. Where I live, cycling is for many people the standard way to go around. But then, most people are students around this city. There are quite a few cities in Belgium and the Netherlands that promote cycling though. :)
    - przmk 8y ago
      Only the northern part of Belgium though (Flanders). The rest of the country has quite poor infrastructure for cycling, especially when compared to the Netherlands. I would love to cycle to work in Brussels but I do not feel comfortable doing so.
      - a_imho 8y ago
        I don't know about Brussels specifically, but if you are worried about the volume of the traffic you can probably try cycling in off hours, mainly at night, and/or using the pavements liberally to build up the routine.
        Insanity 8y ago
        I'd not like to cycle in Brussels either. Mostly cause of the (car) traffic there. Neither would I feel that comfortable at night in certain parts of Brussels :D
  - saiya-jin 8y ago
    I have rather unpopular opinion about biking in most cities (it doesn't cover bike friendly places like Netherlands/Belgium/Denmark, but your usual place where bikers share roads and sidewalks with rest of us) - bikers often behave like assholes, especially but not only to pedestrians. Aggressive, arrogant, utterly ignoring red lights, zooming fast through crowds walking on pedestrian crossings. I had few near-hits myself when biker went maybe 10cm from me, doing 30+kmh, not even slowing down although he saw me. Also have seen couple of incidents of biker hitting pedestrian hard only because biker was a total idiot and tried to get somewhere 5 seconds sooner. Fast bike hitting some old granny doesn't end well for her in any possible case. Fiancee who is a doctor had recently a case where biker hit pedestrian in same way, ignoring red light. Guy in his 40s was cca OK when brought to emergency room, but went into coma quickly due to internal bleeding in the brain. Dead within a week. Maybe its this idiotic childish 'french' culture that I am exposed to here in Geneva (when you see them drive in France you know what I mean), but it really seems biking in the city brings out the worst out of people. Biking elsewhere, in the nature, forests, unpaved roads, fields etc is something completely different, that I enjoy very much.
- wjnc 8y ago
  There is a clear difference between becoming fit and staying fit, no? Overweight depressed and no prior sports history to fit can easily take a year of hard work. Maintaining basic fitness (not big gym bill or 21k in 90 min fit, but regular happy fit) and a healthy BMI is really just adapting lifestyle and not even having to work out. Walk to the groceries, walk during lunch and f.e. when calling with friends. All true that these last examples are all adaptations of a healthy lifestyle, which I expect to be harder to adapt to for those with mental health issues.
- llamataboot 8y ago
  In my experience that's not true with a general level of fitness. I would say that if you get into reasonable shape and have a habit of moving daily that after 3-6 months it becomes hard /not/ to move. ie; you feel antsy and sluggish if you haven't moved for a few days and feel in need of a long walk, etc. The default state of humans is not sedentary.
  - diminoten 8y ago
    My point is your experience isn't universal, not everyone is like you. Some people simply don't have it as easy when forming and maintaining a habit.
tapland 8y ago
Getting 'fit' is very far away for a lot of people, MDD or not. That's not a reasonable aim for positive effects on depression. If we can get positive effects from regular exercise, it's great. If it requires patients to get 'fit', it's really not. > Also, once you get in a good shape, it's really not difficult to stay in it. Contrary to what anyone says. How old are you? This: "change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice" is one of the hardest things to do in life.
- rofo1 8y ago
  > That's not a reasonable aim for positive effects on depression. If we can get positive effects from regular exercise, it's great. If it requires patients to get 'fit', it's really not. In my opinion, if you are not fit, then it won't have as good effect as it would otherwise. That might be.. jarring a little bit, but I don't think an obese person can workout 30 minutes and then call it a day, and believe he'll reap the benefits. Maybe I am wrong, but I don't think it is so. So the goal should always be to get in great shape, the best you can get (in your circumstances, I mean; age/cardiovascular fitness/joint health etc.) Our default mode should be being fit and everything else an abomination. > This: "change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice" is one of the hardest things to do in life. Sorry, I just fail to realize how can someone consciously think that this is one of the hardest thing in life. We have really way different view of life, then. To me, it takes some work, but it's not even hard. It's just something you do for couple of hours in your day, that's all. And the best part? There's no downside for you. Better health, mental and physical, longevity, mood, etc..
  - tapland 8y ago
    > That might be.. jarring a little bit, but I don't think an obese person can workout 30 minutes and then call it a day, and believe he'll reap the benefits. Then it's probably not helpful to treat depression though. At least not as a prescribed action. Send it back to "things everyone should do with rewards down the line". > We have really way different view of life, then. To me, it takes some work, but it's not even hard. It's just something you do for couple of hours in your day, that's all. Again. How old are you? This seems to just be a complete lack of experience being around depressed or unhealthy people, and a complete lack of understanding why anyone would find themselves in bad health. Weight issues and bad health are not only a result of people not wanting to put in effort. Just try looking at long term weight loss success rates or something. Your ideas are not based in reality here.
arendtio 8y ago
> But you have to do it "the right way": change your approach to exercising, eating, sleeping, etc. Regarding 'the right way', thinking in systems/implementations/solutions rather than goals/KPIs might help (at least it does for me): https://blog.dilbert.com/2013/11/18/goals-vs-systems/ https://blog.dilbert.com/2013/11/18/goals-vs-systems/
dagaci 8y ago
Not to mention that being extremely fit or just trying to be means that your mind is being occupied by being busy, people will act more positively around you and you will also tend to sleep better. Despite appearances we humans are much more animal than intellect, so that means the simple physical act will much more easily inform our mood and sentiment than just thinking alone. Extra care should be taken with diet and rest to avoid lowering the immune system by over stressing the body too quickly. You don't want to catch a cold and interrupt your momentum.

bayesian_horse 8y ago

In my opinion, motivational energy works a lot like financial investing. It grows and shrinks exponentially. You have to spend energy, to get more energy (or even conserve it) but the return is uncertain. The optimal strategy is to invest an amount relative to the energy I have, to avoid draining my reserves. To escape the effects of depression [alongside medical treatment] I have to invest my energy wisely, and ultimately I can (and have, in the past) achieve motivational abundance again. And I must adjust the investment strategy to my current capital. Exercise can be a very rewarding way of investing energy. But it can also be really hard at first.

llamataboot 8y ago

Exercise is probably one of the most robust treatments we have for a lot of mental health issues. Personal experience: I dealt with recurrent MDD for over a decade, and chronic fatigue/pain issues for many many years as well. There were years were exercise was impossible (I'd literally pass out on the gym floor after trying to work out). However, after I got well enough to move, regular movement helped wonders (I also think it helps get you into an embodied consciousness that contains less interpretation and more direct experience/awareness - esp somatic practices of moving meditation, yoga, contact improvisation) Also, once I started getting /serious/ about exercise - like actual cardio and weightlifting 5 days a week - my energy levels skyrocketed after about 2-3 months, but it did take a bit. -- Slightly off topic, but I'm convinced we'll also eventually have a lot of robust data that shows that alcohol, even in minor but regular amounts (2-3 drinks most days of the week, say) has large negative effects on mood/energy that build up over time. -- I don't have any problems with psychoactive drugs, SSRIs never helped me, nor tricyclics, (stimulants help mood/energy a lot but have significant negative effects)- but if someone wants to try them, by all means do! However, if someone came to me struggling with depression, I'd nearly 100% of the time encourage them to start exercising regularly, cut alcohol/eat better, and see a talk therapist or work through a self-help workbook and see where they are at in 3 months whether or not they also wanted to take anti-depressants.

TheSpiceIsLife 8y ago
In addition to all the mental health benefits, I like to point out that exercise important for body health and healing too because our lymphatic system doesn't have a pump! Everywhere there are blood vessels there are lymph vessels, they carry away the interstitial fluid our cells are bathed in. That fluid contains some of the waste products from our cells. The lymphatic system is also an immune organ in its own right. Often rest is the diametric opposite of what we need during convalescence or healing. Movement and exercise within our ability is vital.
- throwaway66523 8y ago
  No idea why you are being downvoted, it's even interesting (and at worst offtopic).

duopixel 8y ago

Anecdota about depression and exercise: * It's not getting in shape what lifts depression, it is physical activity in itself. You generally feel better after exercise. It becomes much easier to hit the gym after realizing the reason to go is simply to feel better. Instead of thinking _I don't feel like going to the gym_ the correct cognition is _my medicine is there_. * There's a variety of options to exercise. Don't stick to running if you don't enjoy it (but you keep doing it because you feel better). There's a large menu of activities, at first try what is convenient, deliberately try many things and find what is more fulfilling to you. * With exercise nutrition follows quite naturally. It's difficult to navigate all the BS in nutrition, but in general eating fresh things closer to nature (leafs, fruit, veggies, nuts, lean meats) also has an impact on your wellbeing. * Often there are more issues other than lack of exercise. If you are socially isolated, if you are under constant stress, if your home situation is dire, exercise will help you cope with it but it's not getting at the root cause. Identify and work on the cause too.

bonesss 8y ago
Heavy weights also make an exceptional therapist. You can tell anything you want to a 200 pound loaded barbell, over and over again...
- amelius 8y ago
  Some tips for beginners: - Make sure you don't overtrain, as it can make you feel burned out, which can last a week or longer, and certainly will not help a depression. It also will not make your muscles grow faster. It's better to start slowly. - If you can't do an exercise in a controlled manner, reduce the weight. - Also don't target the same muscle-group more than once a week. Your muscles need time to recover. - Muscles grow most if you load them (slowly) while they are being stretched. - Find a training buddy. - If you take supplements, be aware that they can have an effect on your mood. For example, L-glutamine and taurine (which are in many protein shakes) are known to affect neurotransmitters.
  - naasking 8y ago

raubtier 8y ago

Exercise is good for you. We've always known that. Also we know that eating properly is benificial, as your social situation and that you have a meaning in your life. Modern society rediscover this bit by bit. My guess is that the last part, meaning, will be discovered and accepted lastly. To bad, cause that's in my opinion the most important thing. If you believe in the evolution theory you can logically arrive at what is good for you. one can logically arrive at what is good for one. What is right is what evolution has adapted us to. So the task then is to try to make as qualified a guess as possible and then try to match our lifestyle against it. Some things are obvious, others are more difficult. Through evolutional history, what happend to individuals that didn't had any meaning, that did nothing that helped anyone, that was useless? Well, they died of.

aszantu 8y ago

my depression went away when I switched my diet from Standard German Diet to Keto, the anxiety went away when I made the switch to carnivore. Observed changes in mood and thought after consumtion of starch/plant food (The occurence of these effects takes about 4 days): Frozen non processed Spinach: Anxiety - Thoughts revolve around other people wanting to get me or steal from me or my friends. About one tablespoon of mashed potato and sauerkraut: depression - Suicidal wishes, low energy Thoughts and self talk are going in the direction of "everything is my fault, I deserve this suffering, I should be dead" A piece of apple without the skin every day for a week: Depression, laziness, don't want to get up, move, walk the dog, everything is too much, I'd rather just play games all day long. These effects keep going for about two to three days and then vanish suddenly and I can do my work and routine, workouts, clean my place, etc. I did depression comics/art when I was trying to fix it with meds, therapy and excercise, I'd be happy to cooperate if someone would like to help me market the stuff https://www.deviantart.com/aszantu/gallery/52706431/key-project https://www.deviantart.com/aszantu/gallery/52706431/key-proj...

dan00 8y ago
> Frozen non processed Spinach: Anxiety - Thoughts revolve around other people wanting to get me or steal from me or my friends. About one tablespoon of mashed potato and sauerkraut: depression Have you thought about histamine intolerance?
- aszantu 8y ago
  Yes, I should get tested, but haven't gotten to it yet. The only other person I know who has Histamine Intolerance gets pimples all over his body
  - dan00 8y ago
    The symptoms of histamine intolerance can be quite different. I am not aware of any test that really gives a definite answer. You can only keep a diet and look if the symptoms get better and then after some time try again food rich on histamines and look if the symptoms come back.

_cerv 8y ago

Personal experience is that high intensity exercise mixed with a comforting ritual was what broke me out of a couple bouts of severe depression. When the streak was broken by an event or travel, and several days missing out on exercise followed, I would fall back into the depressive mood. The most recent depressive bout was probably the most extreme I've gone through, and required a couple close friends to jump in, but again, routine exercise with comfortable bits of a routine mixed in - like making a cup of tea, making sure I have a podcast queued up, a book to read, and a handful of songs I like - has seemed to help pull me from the brink. Now that I have eclipsed thirty years and I still am over 300 lbs, and some of the recent depression-like feelings, I am making a more of a cognisant action to keep working at this and to journal how I feel before, during, and after the routine. I look forward to seeing this kind of work being taken a little more seriously as a means to treat depression as opposed to only medication and therapy.

ddorian43 8y ago
Can you explain what you did with high intensity exercising ? Were you diagnosed by a professional psychiatrist ?
- _cerv 8y ago
  I was diagnosed as a teenager and prescribed Zoloft. I hated the medication because intrusive thoughts would spiral from “what if I jumped infront of this car” to “what if I locked the doors of this grocery store and set it ablaze”. So I stopped taking it and got fat. As for high intensity, I’m sure that my use of the term isn’t correct, but I do something that raises my heart to 165+ for 30 seconds, keep my heart at 130, do something to spike it after 5 minutes and repeat until tired. I’ve been able to recently accomplish this reliably on an elliptical at the highest resistance level and maintain activity for 60 to 90 minutes. After longer sessions I feel pretty good and sometimes a bit euphoric.
pfortuny 8y ago
I only have to congratulate you for having "close friends" who "jump in". That is a great part of my keeping my mood stable lately (I have also a couple of friends who are not afraid to "jump in" and help me out). Hope you keep them and keep safe!

joantune 8y ago

this needs to be upvoted a bit more

tomhoward 8y ago

My own experience attempting to use exercise to reverse moderate depression was that it correlated with me crashing into more serious depression. It didn't make sense to me as I'd always heard that exercise was a solid remedy for mild depression. It was when I read this 2005 article on Kuro5hin (RIP) called Demystifying Depression [1], that it made sense. The section "The Role of Sports", with its explanation of the physiology behind the benefits and drawbacks of exercise for people with depression or burnout, is consistent with my own experience. These days, having done a huge amount of work over 10+ years, including emotion-based treatments, diet/nutrition, and some pharmaceutical treatment, I can and do often undertake intensive exercise without negative effects. But I still have to be careful - as the article says, listen to your body. As a general comment about this document: Anyone experiencing depression should seek professional help and should not make treatment decisions based on comments on internet discussion boards or online articles. But as a lay-person's summary of the mechanics underpinning depression, I've not found anything better than this in the 14 years since it was first published. If someone can recommend a better one, I'd be pleased to hear about it and will gladly start recommending it instead. [1] https://en.wikibooks.org/wiki/Demystifying_Depression/Print_version https://en.wikibooks.org/wiki/Demystifying_Depression/Print_...

rygxqpbsngav 8y ago
Ashwagandha works great. It is well studied too (check ksm-66). Prolonged use is safe and has no side effects. Depression is a result of hormonal imbalance which it corrects effectively along with aiding with deep sleep when taken at nights. Exercise raises few hormones like endorphin, serotonin and reduces cortisol (depending on the kind of exercise, like long walks), but I am not convinced if someone says it balances them.
- tomhoward 8y ago
  > Ashwagandha works great I've used that at times, and it's been somewhat beneficial some of the time. But there's no silver bullet and no one-size-fits-all approach. The causes are complex and different from one person to another, so a complete recovery will require multiple forms of treatment and a tailored approach.

deleted 8y ago

[deleted]

glastra 8y ago

From personal experience, having dealt with MDD/bipolar^, I can attest that exercise does help. However, exercise alone is not always sufficient. Daily meditation sessions help tremendously. But the icing on the cake (pun intended) is, in the end, nutrition. Our body (and thus our mind) works with what we put inside it. In fact, our body is made exclusively of what we, or our mother, ingested in the past. There is no escaping that fact, and most people seem to ignore it every single day. Personally, switching to a zero-carb ketogenic diet has done wonders for my overall health and well-being, including mental health. I am of course very biased in affirming this, but I honestly think sugar and most other plant substances (except perhaps some fruits and their oils) are there to harm us. The phytotoxin defense hypothesis really resonates with my experience. ^: I have had recurrent depressive episodes throughout most of my life, and antidepressants make me manic, but I otherwise experience no "natural" mania, only a mild hypomania.

zimpenfish 8y ago

Anecdotal counterpoint to the anecdotes posted here - I had a 200 day streak of >1km runs in 2015 and it didn't help my depression.

alohomora2 8y ago
In my also anecdotal experience 1 km is too short to have noticeable effects. I do >5 km at least 3 times per week with very positive effects on mood.
- zimpenfish 8y ago
  Note that I did say ">1km". The total distance for those 200 days was 672km including one (1) marathon, six (6) halfs, seven (7) 10kms, etc. (Anecdotally, your 15km a week is only going to get you 428km in 200 days.)
sridca 8y ago
I wonder if all those anecdotes are placebo. The authors of this meta-analysis have links to rehabilitation and physiotherapy departments; so I'm not sure I see it as an exactly unbiased analysis. Unless it is clinical depression I find it hard to believe that someone can address their depression with mere physical movements without looking into the mental and emotional causes of it.

verasio 8y ago

Personal anecdote: During a bad depressive time I saw a psychiatrist who enthusiastically prescribed serious antidepressant medications like they were M&M's. One to lift me up, one to help me sleep, one to take the edge off, one just in case an anxious episode occurred during the day, etc, etc. That kind of thing. And he said to me "There is still nothing I can prescribe you that is as effective as exercise." Specifically, heavy weights.

scottious 8y ago
I have a similar anecdote! Except mine ends with me becoming a marathon runner. I'm kinda glad none of the pills worked or else I might not have discovered the best natural anti-depressant. The unfortunate thing is that often times when one is depressed, exercise is the the last thing on one's mind. And it also doesn't help that it can take a long time to have noticeable effects.
- RankingMember 8y ago
  That's the most frustrating part of depression- You can have a nice protective mindset and habits carefully constructed and working great and then depression comes along and throws it all into darkness. You really have to work to keep pushing ahead and through it. I literally visualize putting one foot in front of the other to get through the hardest days.
  - philwelch 8y ago
    I had a similar mindset change the last time I had a prolonged depressive episode. Usually, I would be either happy and productive and feel on top of the world, or I would feel like shit and do nothing. My recent epiphany is a lot like "putting one foot in front of the other". It's mostly a change in values--instead of worrying so damn much about my own happiness, I just kind of thought, "I don't have to ENJOY being a high-functioning human being, but at least I can BE a high-functioning human being." Grim determination isn't really that much fun, but at least it breaks the part of the depressive spiral where you feel useless and your obligations continue to pile up.

karpodiem 8y ago

Looking good naked cures all ills. I know that won't play well among the Rain Man comment section here, but the material you are woven out proves this to be true. Among nearly all western countries there has been a decrease in testosterone levels, higher BMIs, and lower birthrates. Go read Chateau Heartiste.

RankingMember 8y ago
It's weird you felt you needed to make a nerdy straw man to rail against when the comments here mostly agree with your general thesis. Why the acidic tone?
- your-nanny 8y ago
  too much tomato juice probably.
- karpodiem 8y ago
  I wish someone would have impressed this upon me years ago like I'm doing now.
dang 8y ago
Please don't post nasty swipes to HN. Dissing the community you're participating in is in bad taste, and breaks the site guideline against shallow dismissals. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

bufferout 8y ago

For those of us who loathe excercise for the sake of excercise, may I suggest metalworking? You get the distraction of a project / learning to make cool things and it's a surprisingly physical process to inflict your will on such dense objects.

gameswithgo 8y ago
some other fun alternatives: mountain biking is amazing and there may bw great places to do it in your town that you arent aware of yet. no cars to run you over and modern bikes let you go anywhere in comfort. rock climbing in an indoor gym is safe and low impact and programmers often enjoy the mental aspect of it. it incentivizes you strongly to keep weight down as well.
- g45y45 8y ago
  climbing walls or being stuck in the wilderness with a bike don't sound like fun at all. pointless. I don't think your suggestion is helpful for people that have depression. The metal working suggestion from parent is far more helpful, as you are actually making something.
  - maccam94 8y ago
    Rock climbing is like solving a puzzle with your body. You can't just go straight up. You have to analyze all of the differently shaped holds and walls and figure out how to position your body to maximize your grip while minimizing the amount of energy you need to expend. There's also a difficulty rating system, so you feel rewarded when you manage to finish a new level. But if you're not motivated by leveling or puzzle solving, it's probably not for you.
    - g45y45 8y ago
      I'm motivated by solving real problems, not artificial climbing wall problems, sorry.
davemp 8y ago

DanBC 8y ago

A lot of people in this thread giving their personal experience, but failing to realise they're doing exactly the same as people who promote crystal healing or homeopathy. Depression is an umbrella term and it covers a wide range of experience. Some people will recover even if you do nothing to treat them; others will recover if you do anything (such as providing homeopathy) to treat them. Correcting for this is difficult, which is why respected organisations disagree about whether exercise works or not. Felipe suggest that publication bias explains why other analyses don't show benefit of exercise as a treatment, but that doesn't make much sense. The only reason he sees such large effect sizes is because he includes huge amounts of low quality research. When you restrict the analysis to good quality research the effect reduces and it's much harder to see any difference between no treatment and depression as treatment. It's not particularly suprising that physiotherapists and sports therapists think what they do works. What is somewhat suprising is that HN routinely falls for it.

EForEndeavour 8y ago
> they're doing exactly the same as people who promote crystal healing or homeopathy. It's only exactly the same if you consider their formal argument in a vacuum, neglecting everything you know and reasonably believe about the world. An intervention with a plausible mechanism has a greater chance of being effective than an intervention with no conceivable scientific mechanism (healing crystals; homeopathy). Anecdotal evidence isn't high-quality scientific evidence, but it does work as a decision support method to think about what to study more carefully -- or what to stick with because it works for some reason and you don't have the resources to scientifically validate the effect. Furthermore, and this does overlap with the placebo effect as well as fraudulent medicine: if a specific person tests a mood-elevating intervention on themselves and perceives a benefit, nobody can contradict them. Not to defend ardent believers of nonsensical cures, but if it's stupid and it works, it's not stupid.
- your-nanny 8y ago
  this is a reasonable point. we know exercise does lots of things. we don't know that about homeopathy. hence it is more reasonable to suspect that exercise has an effect on depression than it would be for crystals and homeopathy.

harshulpandav 8y ago

Vitamin D3 is essential to fight against depression. Low vitamin D levels is one the major contributors toward depression. Many of us work inside office with hardly any sunlight coming in. Going out under sun in the morning for 30 minutes will be helpful.

callesgg 8y ago
People say that but the drops and pills make zero difference. Sun sure does feel good, but the vitamin additives does not have the same effects. Based on that one could make the conclusion that it is not vitamin d but something else with sunlight that is beneficial.
- naasking 8y ago
  Yes, recent studies have shown that Vitamin D is the marker that's associated with whatever process sun exposure induces. It's not the vitamin itself causing the benefits. Get some sun, just not too much.
- Franciscouzo 8y ago
  Probably the light itself, light therapy has anti-depressive effects even on non-seasonal depression.

throwaway66523 8y ago

During a depressive episode after the suicide of a friend I compiled a check list of very basic things that I noticed had helped in everyday life. I wrote it down when I noticed that I couldn't remember the items reliably (or when it didn't occur to me to think of them). I carried it in my pocket for some while. It contained very basic things, like questions if I had eaten enough, slept enough, whether I spent time outdoors (fresh air/sun), had met friends recently or exercised recently and corrective actions for each item (and yes, "eat something" was on it). Some items were accompanied by comments like "exercise will only help for the next day or two, do not skip for longer than that". Another thing that helped surprisingly well was having a shower, shaving and dressing up. Basically the opposite of letting oneself go. And in really bad moments, jamming/DoS-ing my brain by some sort of meaningless meditation (sitting, breathing and counting so that no other thoughts appeared anymore) helped as well. The best thing is that I haven't had to use the list in a long time now and hopefully never will have to again.

RankingMember 8y ago
Your list of things reminds me of this: http://philome.la/jace_harr/you-feel-like-shit-an-interactive-self-care-guide/play http://philome.la/jace_harr/you-feel-like-shit-an-interactiv... Otherwise, your mention of the mood implications of dressing up reminded me of the many times I've noticed that, after waking up in the morning feeling depressed and shitty, sometimes just pushing through and eating breakfast/getting showered/dressed makes me feel significantly better. Something about getting that last shoe on and standing up and suddenly my brain flips a 180.
dorchadas 8y ago
I agree with the dressing up. A lot of times, I've found my depression helped simply by dressing nicely and going out, even if it's just to eat. It's a confidence boost and you do get some human interaction which can really help.

MatthiasP 8y ago

That exercise (especially endurance sports) is as effective as your typical SSRI is known for decades. The problem is getting a depressed person to exercise five days a week and holding up to that schedule for months and years.

justinator 8y ago
I guess one of the nice things about the modern world is that there's lots of different activities one can choose. Like basketball? Play basketball! Like Crossfit? Do some Crossfit. Like running? Go for a - OK - no one really likes running... All these activities have casual social groups attached to them you can join. If you miss a meetup, someone's gonna check in with ya. The initial bump to make it habit is hard, and it could take a few tries, but that's true for any positive habit.
SketchySeaBeast 8y ago
You don't have to exercise for 5 days a week though - that's an arbitrary choice. I've been going to the gym 3-4 times / week for 1-3 hours at a time for years and it's absolutely helped my mood. There's no magic to 5 days a week.
throwaway66523 8y ago
Absolutely. As I commented elsewhere here, I suffered from a depressive episode after a close friend committed suicide. The lack of energy is extraordinary and what I experienced must have been mild compared to what others with severe depression suffer from. Anecdote: a sliding door slipped from its rail because there was no stopper at the end of the rail and it had to be moved back in place. It is neither heavy nor difficult to do it. I gave up after the first attempt to fix it. Depression is nothing that I would ever wish on anyone, no matter how much I might hate that person.

qwsxyh 8y ago

Any sort of excercise has never made me feel anything other than shit. High intensity? I feel like shit instantly. Just miles of walking? I feel like shit throughout the entire process. I don't get any sort of "high" after doing it - everything aches, and I am tired, and I feel like shit. If a doctor told me to get more excercise, I would tell them to fuck off.

Zolomon 8y ago
It’s abnormal to feel like shit from walking. Sounds like something to investigate further. Hope you can find a long term fix!
om3n 8y ago
I have had the exact opposite experience. Prior to 2012 I was in college and was overweight/out of shape and always felt like crap. I decided to get into shape: did intense cardio and HIIT workouts, lifted weights, and got into excellent shape within a year. I lost 50 lbs, went from being able to do 0 pull ups to over 20, I ran a few Tough Mudders (12 mile obstacle course races), etc. I still run, lift weights, and keep my body fat % low, and if I can help it, I'll never go back. If I go days without exercise I start to feel terrible, foggy headed, lethargic. One 5 mile run will immediately make me feel great for the rest of the day.
- qwsxyh 8y ago
  Thanks for the reply that clearly could've been a top comment. Also, if I was overweight I simply wouldn't bother with excercise for losing it - it's so inefficient. I'd just skip a day of eating every other day.
asark 8y ago
Aerobic exercise has always been like that for me. I get exactly none of the "euphoria" or whatever people talk about with it. The result of any serious amount, even back when I was pretty damn in shape and made myself do it somewhat frequently, is that I feel like I'm ill for a good long while after. I also happen to find it boring as hell, though put me in an aerobic sport and I'll run myself around to vomiting and love every second of it. Lifting weights feels pretty good though. Doesn't constantly leave me with injured-feeling levels of joint or muscle pain like running and friends do. Just the good kind of aches.

lifeformed 8y ago

How common is depression? It feels like in every depression thread every single comment is someone's experience with it.

your-nanny 8y ago
about sixteen percent of people experience one bout of major depression
sdinsn 8y ago
Estimates range from 5% - 15% per year of people experiencing depression. It's a hard thing to measure since most people hide it.

philwelch 8y ago

Does exercise treat depression effectively? Yes, of course! The only problem is when you're too depressed to work out. This is where SSRI's and other first-line treatments can be valuable: they can lift you up just enough to go get the rest of your life squared away.

larrywright 8y ago
There's a quote I like from Jordan Peterson (yes, I know he's a mixed bag) that goes something like: If you come to me to get help with serious depression, the first thing I will do is prescribe an anti-depressant. Not because it's the long-term solution to the problem, but because they work, and I can't treat you if you're dead.
- philwelch 8y ago
  Jordan Peterson is very outspoken about lifestyle-centered treatments, i.e. the whole "clean your room"/"sort yourself out" stuff, but you definitely need to start somewhere and an anti-depressant can help.

exolymph 8y ago

Exercise for depression was a total nonstarter for me because I didn't have the energy or wherewithal to exercise when depressed.

mntmoss 8y ago

My personal experiences go something like this: * Strength training tends to be a long term benefit. It can be really draining if you put in a difficult workout every session. Copious logging matters to lock in the sweet spot of difficulty, and maximizing recovery rate matters just as much - I found that increasing vitamin D intake did the trick here. But I find that the strength isn't the beginning and end - it helps to have it as a barometer of progress, but it's only one thing. * Cardio-intensive activity helps my mood throughout the day. Last year I trained judo, which rewards all-around athleticism(though my desire to compete is limited) and it pushed me to take cardio more seriously. I got gifted a Fitbit last Christmas, and took up a jogging routine first thing out of bed by way of pleasing the hourly activity monitor. By focusing mostly on the technique and habit instead of pace, I've improved my form quite a bit, gotten my sleep schedule under control and also hit on another supplement that seems to get my anxiety down(magnesium citrate). However, this led me to something else which I'm still working on: * I would tend to finish my jog with a cup of coffee and I finally realized last week that I had been letting my caffeine consumption creep up, and this was throwing off a lot of other stuff. My gym numbers were still coming in, but my concentration was mostly shot, and finally at an event Thursday I had one of the free diet sodas and soon after found that I was unusually anxious and had developed an eye twitch. This is too much, I told myself. I had gone through phases of overconsuming and cutting back before, but I was tired of the cycle. So I decided later that night that I would cold turkey caffeined drinks. I'm still consuming a little bit of chocolate, but it's been an eye-opener. I started having bottled water instead of coffee so as to keep my other habits in the same place. Day one was the most difficult, but my sleep improved immediately and my focus already started getting better on the second day. By the third I realized that I was smiling and engaging with activities better than I had in a long time. My depressive spells never quite went away with the other things, but they seem to be gone after dropping the caffeine(although I'm still getting the eye twitch). So, yes, it's a lot of things. Sobering up from coffee is something that's helped by getting all my other habits together. If you're starting from a "sodas every day/no exercise/no gym experience" standpoint, this is roughly the path I've recommended to friends: * Get some resistance bands and start a program with those. They're some of the simplest and most accessible strength training around. Focus on developing some technique and logging your progress. * Get a fitness tracker and try to hit some of the goals. I like the hourly goals(even though they do not measure when I get up and do housework), others like daily steps. * Switch either from sugar + caffeine to just sugar or just caffeine. I shifted away from soda about a year into my first job(by - surprise surprise - overconsuming until I felt ill). Then work your way down from there by getting bottled water more often. * Research supplements. This is not easy with so many options, but there are usually common ones that come up with respect to certain sports and activities.