3 ms·

Exercise is often pushed as a treatment for depression on HN, but the evidence is surprisingly weak. Many of the studies aren't very good; most of the studies h

by DanBC 8y ago

Exercise is often pushed as a treatment for depression on HN, but the evidence is surprisingly weak. Many of the studies aren't very good; most of the studies have inclusion criteria that exclude people with major depression or people who've had in-patient treatment. This means that the studies have included a bunch of people who had sponteneous remission, or who would have recovered no matter what intervention you gave them. This study only looked at people who were recruited from inpatient or outpatient MH services; it excluded people who had other long term physical problems; and it found similar effects for solo or group exercise, and for exercise that used or didn't use equipment.

astazangasta 8y ago
Look, the evidence is always surprisingly weak. This isn't necessarily because these things don't work, its because the epistemology used is terrible at evaluating these sorts of questions, when someone has bothered to look in the first place. See here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/ Anecdotally my life experience is that exercise is the best possible way to combat depression. The other day I was crushingly depressed and had been for a week. I went and hit my heavy bag for twenty minutes and came out feeling fine. The effect was profound and easily felt. I don't need a study to convince me further; my lived experience is a superior epistemic method here.
- massivecali 8y ago
  Severe depression leads to isolating behaviors. If you're not so depressed that you are able to leave the house and go somewhere, you're ahead of the game and excercise is just icing on the cake.
  - astazangasta 8y ago
    The floor is always available for pushups, but the social benefits of exercise are also worthwhile in combatting depression. Severe depression is another story, but most depressed people are not severely depressed.
  - leib 8y ago
    When I was younger I think I was depressed. It got to the stage where people would talk to me and I wouldn't talk back, I'd just stare; I'd lie in bed doing nothing; I let my hair grow long because I didn't want to go outside or talk to a barber. I'm much better now, and I think exercise was one of the key things that improved my general mood. It was a constant sturggle though for a while. YMMV, of course, and I was never diagnosed or anything.
  - HeyLaughingBoy 8y ago
    That still doesn't mean that he wasn't depressed though. I've experienced the same thing. I struggled with depression in my 20's but I found that if I was able to drag myself out of the house and get on my bike, I'd feel better within minutes. However, the huge struggle was getting out of bed and walking outside in the first place.
- astura 8y ago
  Anecdotally, for me, when I was in the mist of severe clinical depression exercise did absolutely nothing for me except make me feel much worse and made me vomit... a lot. Of course, I was suffering from severe clinical depression not "feeling terrible for a week" level "depression." That's really key, severe clinical depression profoundly affects your response to stimuli in pathological ways. Another example for me is severe clinical depression (of which I've suffered two episodes of in my life) makes me unable to taste food.
  - rleigh 8y ago
    If exercise is making you vomit, I think you're doing it wrong. What did you have to do to get that reaction? Did you try backing off the intensity to a level where you could simply cope and enjoy it?
    - tempguy9999 8y ago
      > If exercise is making you vomit, I think you're doing it wrong. Good point. I'm interested in their answer on that. > [...] and enjoy it? Fuck me :) That was amusing! No offence but you really don't get it. Exercise in that state we use as a coping mechanism. I guess he, like me, overdid it hence the vomiting (just a guess though - love to hear the answer). There is no enjoying it because there's little if anything to enjoy if you're hurting inside. To repeat: exercise is a coping mechanism. It's not 'fun'.
      - astura 8y ago
        Didn't overdo it or anything, if anything I underdid it, my workouts, depressed or not depressed, are not particularity intense and the depression takes the intensity down, since I'm feeling so shitty. Vomiting is simply my body's response to stress while disfunctioned by severe depression. During that timeframe, I was sitting in a room with coworkers discussing specifics of a project and that was just so completely overwhelming to me that I had to run out of the room and go vomit. Later that week I had to take an extended leave of absence from work because I could just no longer function at work.
    - 8y ago
- DanBC 8y ago
  The context is people being given treatment by the state, sometimes against their will, sometimes when they've been deprived of their liberty. Given that context it's important that we don't force people to do anything unless we know it works, and the previous evidence didn't tell us that. I'm glad exercise works for you, and I always support people finding out what works for them.
  - atomical 8y ago
    Is exercising harming them? Why apply such a high standard to something is healthy especially when western populations are sedentary? I think there should be a measured approach.
    - kaybe 8y ago
      Exercise usually hurts more that lying around, even when you're not depressed. So yes, I think it can harm.
      - atomical 8y ago
        https://www.cnn.com/2017/05/15/politics/donald-trump-exercise/index.html https://www.cnn.com/2017/05/15/politics/donald-trump-exercis... > Trump believed the human body was like a battery, with a finite amount of energy, which exercise only depleted. So he didn't work out.
        chillwaves 8y ago
        The link only demonstrates the absurdity of your previous statement. Unless that's what you are going for?
        sctb 8y ago
        We've asked you countless times to stop posting unsubstantive, trollish, or flamebait comments, and since there's no sign of abatement we're about ready to ban the account. Could you please review the guidelines and stop? https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- ced 8y ago
  That article is glorious, thank you for posting!
- zdragnar 8y ago
  N=1, but exercise was not useful for me. If anything, the cool-down period afterwards just encouraged me to avoid doing anything, and the pain of strenuous exrrcise also added to the misery index. I did, however, find a medicine that worked wonders. Since then, I have worked out 30-45 minutes 5 days a week, but I certainly don't notice a difference in mood from before and after i started working out again. Edit: I want to make clear that this is not a rebuttal of what worked for you, but a point to consider when discussing with others who may be suffering. If you speak in absolutes about what works, and they find that it does not work for them, they may end up feeling even more hopeless.
- tempguy9999 8y ago
  Agreed with @astura here. > The other day I was crushingly depressed and had been for a week In my regrettably extensive experience, if you feel bad for a week then you can count yourself very, very lucky. I can't see what you describe as being depression, although of course people are very different (had GFs who had it bad for a week or so at a time every month). > I [...] hit my heavy bag for twenty minutes and came out feeling fine Depression made me exercise compulsively, to the point of damaging myself. It never made me feel better so I don't know why I did it, but I had to, and I understand this is common. Twenty minutes of exercise and you felt better? It's impossible to equate that in any sense with what I had. There's a big difference between feeling really crappy and knowing you'd literally be better of dead, and being in that state for years continuously. That kind of things hurts inside, worse than physical pain (I know both). > my lived experience is a superior epistemic method here Hmm. Good for you.
  - 0815test 8y ago
    > Twenty minutes of exercise and you felt better? High-intensity exercise, seems plausible. Aerobic exercise is an annoying timesink by comparison, even though it does nevertheless play an important role in building up cardio endurance.
  - tempguy9999 8y ago
    [edit] Replying to myself: I'll go a little further. Past few years have been extremely hard for me, haven't been able to concentrate for ~6 months to the point of not mentally being able to work (had to sign off sick (am in the UK)) and just starting to get back to work next week 1 day a week, unpaid. I can just about keep my clothes clean, and mostly keep my flat clean. I'm mentally very unwell to the point of being unable to go to the pub and socialise as I used to. I was unwell to the point of being a danger to other people (am over that now, thank god. Yes, I did talk to the doc). I am coping, barely. I have no current interest in life, music, little interest in other people etc. I'm abusing drugs and alcohol as a way of coping, though in the long term I know that's a bad idea (and I draw a clear distinction between drug use/drug abuse, entirely independent from what's legal/illegal). Point is, I feel justifiably terrible but I'm not clinically depressed. For sure I'm down, but I'm nowhere near the utter destructive blackness that is real depression, and I'm bloody grateful for it. So I can't see what you describe as depression in any way that I can comprehend. (NB, life sucks but any sympathy you can shove up your arse. I'd much prefer you took the piss, at least in a nice way. At least I'd get a laugh out of it).
chapium 8y ago
Sometimes just doing something for yourself that you know is beneficial helps slow down the downward spiral. I find exercise reduces stress, and that helps one cope with the day to day setbacks. If you are depressed, this should help. Of course this doesn't apply to all depression, but I can give this anecdotally an HN comment, unsourced.
jdietrich 8y ago
I broadly agree with you on the weakness of the evidence, but I'd strongly recommend exercise to everyone anyway. The overall health benefits are immense, even if it turns out that it doesn't do much for depression. Higher physical activity in the general population is likely to have a significant preventative effect on depression, because chronic physical illness is one of the most significant risk factors for developing a depressive illness and exercise has a strong preventative effect on chronic physical illness.
GordonS 8y ago
In the UK, my guess is that this is pushed because it's comparatively cheap. Interestingly, it's also pushed on those with CFS, despite evidence that it actually causes harm. IIRC, there is a NICE review going on at present, but recommendations are going to be made for a while yet. Sometimes the speed at which the NHS works is literally painful!
nswest23 8y ago
would you expect broad studies on something that only makes money for personal trainers and LA Fitness?
emit_time 8y ago
Anecdotally, I notice a large improvement in my mood within a week when I start exercising after not having done so in a while. This has happened to me on multiple occasions.

by DanBC 8y ago

astazangasta 8y ago

Look, the evidence is always surprisingly weak. This isn't necessarily because these things don't work, its because the epistemology used is terrible at evaluating these sorts of questions, when someone has bothered to look in the first place. See here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/ Anecdotally my life experience is that exercise is the best possible way to combat depression. The other day I was crushingly depressed and had been for a week. I went and hit my heavy bag for twenty minutes and came out feeling fine. The effect was profound and easily felt. I don't need a study to convince me further; my lived experience is a superior epistemic method here.

massivecali 8y ago
Severe depression leads to isolating behaviors. If you're not so depressed that you are able to leave the house and go somewhere, you're ahead of the game and excercise is just icing on the cake.
- astazangasta 8y ago
  The floor is always available for pushups, but the social benefits of exercise are also worthwhile in combatting depression. Severe depression is another story, but most depressed people are not severely depressed.
- leib 8y ago
  When I was younger I think I was depressed. It got to the stage where people would talk to me and I wouldn't talk back, I'd just stare; I'd lie in bed doing nothing; I let my hair grow long because I didn't want to go outside or talk to a barber. I'm much better now, and I think exercise was one of the key things that improved my general mood. It was a constant sturggle though for a while. YMMV, of course, and I was never diagnosed or anything.
- HeyLaughingBoy 8y ago
  That still doesn't mean that he wasn't depressed though. I've experienced the same thing. I struggled with depression in my 20's but I found that if I was able to drag myself out of the house and get on my bike, I'd feel better within minutes. However, the huge struggle was getting out of bed and walking outside in the first place.
astura 8y ago
Anecdotally, for me, when I was in the mist of severe clinical depression exercise did absolutely nothing for me except make me feel much worse and made me vomit... a lot. Of course, I was suffering from severe clinical depression not "feeling terrible for a week" level "depression." That's really key, severe clinical depression profoundly affects your response to stimuli in pathological ways. Another example for me is severe clinical depression (of which I've suffered two episodes of in my life) makes me unable to taste food.
- rleigh 8y ago
  If exercise is making you vomit, I think you're doing it wrong. What did you have to do to get that reaction? Did you try backing off the intensity to a level where you could simply cope and enjoy it?
  - tempguy9999 8y ago
    > If exercise is making you vomit, I think you're doing it wrong. Good point. I'm interested in their answer on that. > [...] and enjoy it? Fuck me :) That was amusing! No offence but you really don't get it. Exercise in that state we use as a coping mechanism. I guess he, like me, overdid it hence the vomiting (just a guess though - love to hear the answer). There is no enjoying it because there's little if anything to enjoy if you're hurting inside. To repeat: exercise is a coping mechanism. It's not 'fun'.
    - astura 8y ago
      Didn't overdo it or anything, if anything I underdid it, my workouts, depressed or not depressed, are not particularity intense and the depression takes the intensity down, since I'm feeling so shitty. Vomiting is simply my body's response to stress while disfunctioned by severe depression. During that timeframe, I was sitting in a room with coworkers discussing specifics of a project and that was just so completely overwhelming to me that I had to run out of the room and go vomit. Later that week I had to take an extended leave of absence from work because I could just no longer function at work.
  - 8y ago
DanBC 8y ago
The context is people being given treatment by the state, sometimes against their will, sometimes when they've been deprived of their liberty. Given that context it's important that we don't force people to do anything unless we know it works, and the previous evidence didn't tell us that. I'm glad exercise works for you, and I always support people finding out what works for them.
- atomical 8y ago
  Is exercising harming them? Why apply such a high standard to something is healthy especially when western populations are sedentary? I think there should be a measured approach.
  - kaybe 8y ago
    Exercise usually hurts more that lying around, even when you're not depressed. So yes, I think it can harm.
    - atomical 8y ago
      https://www.cnn.com/2017/05/15/politics/donald-trump-exercise/index.html https://www.cnn.com/2017/05/15/politics/donald-trump-exercis... > Trump believed the human body was like a battery, with a finite amount of energy, which exercise only depleted. So he didn't work out.
      - chillwaves 8y ago
        The link only demonstrates the absurdity of your previous statement. Unless that's what you are going for?
      - sctb 8y ago
        We've asked you countless times to stop posting unsubstantive, trollish, or flamebait comments, and since there's no sign of abatement we're about ready to ban the account. Could you please review the guidelines and stop? https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
ced 8y ago
That article is glorious, thank you for posting!
zdragnar 8y ago
N=1, but exercise was not useful for me. If anything, the cool-down period afterwards just encouraged me to avoid doing anything, and the pain of strenuous exrrcise also added to the misery index. I did, however, find a medicine that worked wonders. Since then, I have worked out 30-45 minutes 5 days a week, but I certainly don't notice a difference in mood from before and after i started working out again. Edit: I want to make clear that this is not a rebuttal of what worked for you, but a point to consider when discussing with others who may be suffering. If you speak in absolutes about what works, and they find that it does not work for them, they may end up feeling even more hopeless.
tempguy9999 8y ago
Agreed with @astura here. > The other day I was crushingly depressed and had been for a week In my regrettably extensive experience, if you feel bad for a week then you can count yourself very, very lucky. I can't see what you describe as being depression, although of course people are very different (had GFs who had it bad for a week or so at a time every month). > I [...] hit my heavy bag for twenty minutes and came out feeling fine Depression made me exercise compulsively, to the point of damaging myself. It never made me feel better so I don't know why I did it, but I had to, and I understand this is common. Twenty minutes of exercise and you felt better? It's impossible to equate that in any sense with what I had. There's a big difference between feeling really crappy and knowing you'd literally be better of dead, and being in that state for years continuously. That kind of things hurts inside, worse than physical pain (I know both). > my lived experience is a superior epistemic method here Hmm. Good for you.
- 0815test 8y ago
  > Twenty minutes of exercise and you felt better? High-intensity exercise, seems plausible. Aerobic exercise is an annoying timesink by comparison, even though it does nevertheless play an important role in building up cardio endurance.
- tempguy9999 8y ago
  [edit] Replying to myself: I'll go a little further. Past few years have been extremely hard for me, haven't been able to concentrate for ~6 months to the point of not mentally being able to work (had to sign off sick (am in the UK)) and just starting to get back to work next week 1 day a week, unpaid. I can just about keep my clothes clean, and mostly keep my flat clean. I'm mentally very unwell to the point of being unable to go to the pub and socialise as I used to. I was unwell to the point of being a danger to other people (am over that now, thank god. Yes, I did talk to the doc). I am coping, barely. I have no current interest in life, music, little interest in other people etc. I'm abusing drugs and alcohol as a way of coping, though in the long term I know that's a bad idea (and I draw a clear distinction between drug use/drug abuse, entirely independent from what's legal/illegal). Point is, I feel justifiably terrible but I'm not clinically depressed. For sure I'm down, but I'm nowhere near the utter destructive blackness that is real depression, and I'm bloody grateful for it. So I can't see what you describe as depression in any way that I can comprehend. (NB, life sucks but any sympathy you can shove up your arse. I'd much prefer you took the piss, at least in a nice way. At least I'd get a laugh out of it).

chapium 8y ago

Sometimes just doing something for yourself that you know is beneficial helps slow down the downward spiral. I find exercise reduces stress, and that helps one cope with the day to day setbacks. If you are depressed, this should help. Of course this doesn't apply to all depression, but I can give this anecdotally an HN comment, unsourced.

jdietrich 8y ago

I broadly agree with you on the weakness of the evidence, but I'd strongly recommend exercise to everyone anyway. The overall health benefits are immense, even if it turns out that it doesn't do much for depression. Higher physical activity in the general population is likely to have a significant preventative effect on depression, because chronic physical illness is one of the most significant risk factors for developing a depressive illness and exercise has a strong preventative effect on chronic physical illness.

GordonS 8y ago

In the UK, my guess is that this is pushed because it's comparatively cheap. Interestingly, it's also pushed on those with CFS, despite evidence that it actually causes harm. IIRC, there is a NICE review going on at present, but recommendations are going to be made for a while yet. Sometimes the speed at which the NHS works is literally painful!

nswest23 8y ago

would you expect broad studies on something that only makes money for personal trainers and LA Fitness?

emit_time 8y ago

Anecdotally, I notice a large improvement in my mood within a week when I start exercising after not having done so in a while. This has happened to me on multiple occasions.