6 ms·

Exercise has 'similar effect' to therapy, study on depression shows

104 points by PaulHoule 9mo ago

cindyllm 9mo ago
[dead]
joe_mamba 9mo ago
How to solve most cases of depression, make sure to get all these (if you can): - good diet with no junk food, alcohol, drugs and stimulants - regular exercise and outdoor time - good sleep hygiene - regular healthy social interactions - eliminate environmental stressors (job/financial stress, relationship stress, noise pollution, etc) Of course, not everyone can have everything and some of those aren't 100% under your control, but ultimately it becomes your responsibility to try fix them if you want your situation to improve, since nobody else will.
- xnorswap 9mo ago
  The trouble is, this reads like "Just don't be depressed", since this is almost effectively a list of (anti-) symptoms of depression.
  - jdiff 9mo ago
    And the ones that aren't simply "don't be depressed" are a lottery for anyone, even those not suffering depression. In the US, current projections are for 300 new jobs per state per month this year. Even accounting for retirees and deaths, last I looked at the numbers, there have been 2M more new additions to the workforce (people turning 18) than there are new jobs for those new additions, all competing with the large unemployed and laid off populations. It's similarly often not easy to solve relationship stressors or noise pollution.
    - weatherlite 9mo ago
      I agree we are headed into very unstable times, all the more reason for people to exercise. The stress relief effect is magical, and if you do it outside you get some fresh air and vitamin D. Exercise isn't a magic cure to make everyone honkey dorey but I do believe it should be seen as one of the best (and free) tools we have to maintain mental health.
  - joe_mamba 9mo ago
    No, it isn't like "Just don't be depressed", I know it's very difficult for people to get all of those combined, that's what I said you should strive to get all of them if you want to cure your depression. SSRIs or exercise won't make your financial or relationship issues go away so you'll still be depressed unless you can fix all the issues bothering you.
    - Sharlin 9mo ago
      The problem is that depression by definition makes it 100x harder to do any of those things.
      - joe_mamba 9mo ago
        Well yeah, but you gotta start somewhere, and it's not gonna get better if you drink cola, beer everyday and stay up until 2AM watching netflix.
        rincebrain 9mo ago
        I think GP's point is that "just do it" shows a lack of understanding that an inability to "just do X" is often a symptom of depression that leads to people not talking about it, because people who haven't experienced it think you must be lying about having decided to do something and not actually then doing it. Consider: there was a study about a guy who was paralyzed from the waist down, who got an implant to bypass the injury, and with a year+ of walking with the implant, could eventually walk to a limited extent without the implant.[1] This suggests walking can be used to treat loss of ability to walk. Unfortunately, there's a catch-22 there... ...and so too with inability to make yourself do anything. [1] - https://www.nature.com/articles/s41586-023-06094-5 https://www.nature.com/articles/s41586-023-06094-5
        deleted 9mo ago
        [deleted]
        jmye 9mo ago
        > Well yeah, but you gotta start somewhere Wait, I thought those things solved depression? Why are you hedging now? Did your initial analysis suck, and you're just now realizing it? Are you figuring out that maybe this is slightly more complex than "just be happy" and that maybe you're not the only person on the planet who's ever thought about this?
  - taneq 9mo ago
    This is always what leaps out at me with this kind of “live better be happier” article. Yeah, if you’re sleeping well, eating well, working out regularly, spending quality time with friends, and have a healthy work life balance, you probably aren’t depressed. Might there be some possibility, perchance, that this is because any single one of those factors is almost impossible when in the pit of despair, let alone all of them at once? It’s like saying glasses cause short sightedness because hey, you almost never see someone with good eyesight wearing glasses.
- bananaflag 9mo ago
  > good diet with no junk food, alcohol, drugs and stimulants How does one get rid of the excitement of the expectation of eating chips or drinking cola etc?
  - adrian_b 9mo ago
    Hard?
  - celeritascelery 9mo ago
    GLP-1
  - joe_mamba 9mo ago
    You stop buying them during your weekly grocery shopping.
  - megaloblasto 9mo ago
    It sounds like you're saying that low will power leads to depression.
  - coffeefirst 9mo ago
    You replace the thing you want to quit with a better thing. Try tea and seltzers, not because they’re healthy but because they’re interesting. There’s an infinite range of teas. And learning to cook changed my life. I get annoyed with almost all delivery now because I can do better.
    - bananaflag 9mo ago
      I started drinking herbal teas some years ago, I heavily enjoy hibiscus and ginger because of their strong taste, to a lesser degree also cinnamon, licorice and peppermint, but most teas seem very bland.
  - gowld 9mo ago
    You need to educate/brainwash yourself with operant conditioning that junk food makes you sick and good food makes you feel good. The problem with depression in particular, though, is that self-harm--seeking behaviors is also a symptom, so that brainwashing can backfire.
- staticassertion 9mo ago
  I think this is true, but oof that's a heavy list. For one thing, food, alcohol, drugs, and stimulants, all have addictive properties that are almost certainly comorbid with depression. Dropping those is rough. Exercise is perhaps one of the easier ones but, personally, I've found it incredible to reflect on how absolutely bad my childhood "gym" classes were. At no point did we actually... go to a gym. That was never normalized for us. We sort of just learned how to do jumping jacks when we were told to, that sort of thing, and it was all structured for us. There was no habit forming, no "how to do this once there's no one around to structure it for you". In my experience, people who go to the gym get "brought in" by someone in their life who can help them build that structure. For someone missing it, well, you're truly on your own in a rather stressful environment. Sleep hygiene is good but, again, I suspect tricky here. Regular social interactions, another heavy lift! What do you do to build up a network of people in your life? Social structures don't just magically appear, and once again, they're usually just handed to you for most of your life and once those fall away you're in quite a spot trying to recover or build anew. I think the environmental stressors may be the roughest, hard to say. Eliminating financial stress is something that can take decades. Noise pollution? That's really quite out of my control. All of these are great things to work on but I suppose my read of them is "wow, being depressed seems really fucking hard if you have to do these things to get out of it".
  - joe_mamba 9mo ago
    > "wow, being depressed seems really fucking hard if you have to do these things to get out of it". Yeah IT IS hard, I didn't say it's easy, I just said what you need to not be depressed. Whether everyone can get all those is another issue. The thing is that in the case when you don't have all of these, adding unhealthy habits on top, doesn't make your situation better.
    - staticassertion 9mo ago
      Yes, sorry, I think other posts are quite critical of yours so maybe you think this was me trying to be like "your post is bad". I think you're right (though I think that medication and therapy are often critical to help kickstart healthier habits, and it's worth noting how heavy a lift those things are), but it is just notable to me how hard those things are. I am not depressed, thankfully, because if I had to rebuild a social life or go to the gym to fix myself I'd be fucked.
- Aaargh20318 9mo ago
  I can't remember where I read it, but it always stuck with me: most cases of depression can be solved with a one-time deposit of $20 million in the patient's bank account. A lot of the time, what is diagnosed as depression is actually a very valid reaction to being in a shitty situation. I myself ended up at a psychiatrist due to being stuck in a shitty job with me being too exhausted and anxious to do anything about it. What eventually 'cured' me wasn't any of the sessions with the shrink but being laid off in a company restructuring with a nice severance package that allowed me to take a couple of months to decompress and look for a job that was a better fit.
  - joe_mamba 9mo ago
    >most cases of depression can be solved with a one-time deposit of $20 million in the patient's bank account. Yes, but actually not always. If you have someone overweight because they're only eating pizza, cheetos and cola everyday and you use a magic wand to give them Thor's physique, how long will their new physique last with their diet until they devolve back into a slug monster? Money tends to run out, very quickly for some people. If you aren't able to keep your life in order when you're poor, you'll probably squander it all quickly too if you win the lottery. Like a friend of mine said "Thank God nobody gave me a million dollars when I was a drug addict, I would have OD's in a day". People with self destructive tendencies don't need 20 million dollars, they need therapy, a stable job, and a loving caring community, something that fewer people have nowadays.
    - alphawhisky 9mo ago
      This is a pretty poor take. Everyone knows that it's easier to maintain fitness/muscle than build it. The same is true with money, it's much easier to coast or make moves financially when you have headroom. There's a type of financial self-sabotage people often commit when they're in an "unwinnable" situation called Doom Spending. I feel like the same psychological principles that convince a person in debt to finance their groceries also makes them lean into eating when overweight, lean into laziness when unemployed, etc. They always say that the hardest part is starting, but when it comes to money, fitness, employment, not everyone starts from the same place, and without being/having been at rock bottom you can't speak to the perspective of getting out of it. Agreed that a holistic approach is the only proper way though.
- deleted 9mo ago
  [deleted]
- wvh 9mo ago
  You just described causes of depression, like divorce, social isolation and being unemployed. I know there are people that can feel free in a place as horrible as a concentration camp, but most of us have some basic needs that have to be met to feel OK and have some hope. Some people have actual neurotransmitter imbalances, but many of us just have monkey brains that don't know how to deal with (real, abstract) modern-day stressors that trigger a fight-or-flight response.
- vrosas 9mo ago
  This is exactly the kind of list that is both not true (solving depression is not a checklist) and COMPLETELY unhelpful to anyone actually dealing with depression. It's like saying "just make more money" to someone with financial struggles.
  - weatherlite 9mo ago
    I see your point but I think there's nuance here First of all exercise should be seen as one of the first lines of defense against not only depression but chronic health problems (which also lead to depression). So you shouldn't wait until you are depressed to start exercising - ideally it is something you do all the time. Secondly - someone who's depressed is not keen on most things - including talking to a therapist , yet we still encourage them to do it. If you have the will power to pay hundreds of dollars a session to talk to a complete stranger, in theory you may have the willpower to walk birskly for 150 minutes a week. As a society we should simply encourage everyone no matter what age or state of mind to do that.
- goodpoint 9mo ago
  AKA "just don't be depressed"
- z3t4 9mo ago
  - lower your expectations If you set your goal too high you will be sad all the time. Choose a goal that you would be happy with but make sure it's a realistic goal!
- basisword 9mo ago
  Every time this comes up the comments are the same. Just don't eat crap, just go to the gym, just make sure you get good sleep. It shows a total lack of understanding of depression. Of course these things work - and if people weren't depressed they might be able to try and do them. But when you have severe depression you literally have zero motivation. None. You suddenly can't sleep. You can barely get yourself out of bed. That's why things like pills are useful because they can help you get to the point where you can take the steps necessary to get your life into a state where it's less conducive to depression. >> ultimately it becomes your responsibility to try fix them if you want your situation to improve, since nobody else will. No. This is why doctors and psychologists etc exist. Not everything is fixable by you. Sometimes you need help from other people and blaming the depressed person for being depressed is fucking idiotic.
- randusername 9mo ago
  > How to solve most cases of depression Tread carefully friend, I agree this is a good list to _prevent_ the most common forms of depression, but some will think you are framing major clinical depression as a personal failing. Some people slide into a hole of their own making. Others get thrown into the abyss by external factors. Grief, trauma, abuse, crises of repressed identity, poverty and poor prospects. Life can be brutal. I highly, highly recommend The Noonday Demon: An Atlas of Depression (Solomon) for anyone that is interested in a comprehensive view of depression.
  - joe_mamba 9mo ago
    >Some people slide into a hole of their own making Others get thrown into the abyss by external factors. Yes, true, a lot of the times it is from external factors (ask me how I know), but what people miss is that even in that case, it's still on you to get yourself out since SSRIs and therapy session won't fix the situation you fell into, nor will anyone else come to get you out, unless maybe you're lucky enough to have an incredible family, community or support network. It's still your responsibility to get yourself out even when your situation is not your fault. That's the sad truth about life, you have to play the hand you're dealt, instead of being depressed you've been dealt a bad hand. It's not fair, but that's how it works.
    - randusername 9mo ago
      From one internet stranger to another, both vaguely alluding to heavy things in our lived experience, I respectfully invite you to consider a "yes and". Yes, we all must accept responsibility in changing our circumstances. _And_ we all can accept responsibility for helping others do the same. Some people need to hear the first part that you shared. Others need to hear the the second part that I am sharing.
- jmye 9mo ago
  > How to solve most cases of depression What absurdly thoughtless, shallow nonsense. What, specifically, is your background in depression research, that leads you to believe you've completed solved it for everyone? I'll wait. I'm sure it's fucking extensive.
- Fricken 9mo ago
  One indicator that you might be falling in to depression is that you struggle to find the motivation to maintain those healthy practices.
- deleted 9mo ago
  [deleted]
- Insanity 9mo ago
  The last one you list is hardest to fix. And that in turn causes the others. For example, if you have a stressful job, you might: 1. Sleep less (job stress or long hours keeping you up) 2. Eat less healthy (coping mechanism for job stress, and it’s faster) 3. Have less time for the higher quality social interactions.
- tpoacher 9mo ago
  How to solve most cases of paraplegia: - Regular long walks at the park - Climb stairs whenever possible instead of using the lift - Good foot care - Engage in social exercise like running clubs - Wear good quality footwear, suitable for the activity that you're engaged in. Of course, not all paraplegics can use their feet, but ultimately it becomes your responsibility to try to improve leg strength to the point of overcoming paraplegia, by doing the things that would have helped in improving leg strength, if only you could walk. /s (tbf, not fully disagreeing per se, and all analogies are flawed, but the above sarcasm is to point out that this model is overly simplistic. And it can lead to hidden but very real unconscious bias and discrimination once words like "responsibility" is thrown into the mix)
- butlike 9mo ago
  I don't agree with the elimination of things. Removing things can be its own source of tribulation. I agree on all other parts, though
- GuB-42 9mo ago
  Sounds like a catch 22 to me. All of what you describe besides environmental stressors are symptoms of depression. So, to solve depression, you must first solve depression. And even the environmental stressors are something we could work with as a society though welfare, environment regulations, etc... But how people react to them is also a symptom. There are depressive people with the best of situations, and people who enjoy life in the worst of situations. What often strikes me in documentaries about warzones, places of repression and extreme poverty or crippling diseases is how "normal" people seem to be, they enjoy themselves as if everything was fine. So, while reducing environmental stressors work, it is not the end of it. The take may be that treating the symptoms of depression could work in treating the root cause, a positive feedback loop. But if done through lifestyle change, unfortunately, the treatment is coercion, you can't rely on the willpower of people who have none because of the disease.
- bulbar 9mo ago
  That's a dangerous take. People that suffer from a clinical depression oftentimes won't be able to do any of these things and this has nothing to do with responsibility and everything with suffering from a depression. From what I have learned from friends working in the field, meds often work as an enabler, allowing people to do some of the things that are known to improve their condition further. If you think you suffer from depression, don't keep trying to "just buckle up", don't keep trying to "just need to take responsibility". Go talk to professionals, therapists and/or psychiatrists. Mental disorders do things to a person outside of their control.
Eddy_Viscosity2 9mo ago
"Exercise has at least a "moderate impact" on symptoms "compared with no treatment or a control intervention," I mean, yes, but we already knew this. So good that this is a finding that passes replication.
pjerem 9mo ago
I don't get what's new ? It's a known fact that exercise and good lifestyle are good for the mental health. But isn't the inability to maintain a good lifestyle one of the first symptoms of depression ?
- Sharlin 9mo ago
  Exactly. Depression is defined in part as being the inability to effectively do those things.
  - jmye 9mo ago
    Why is this downvoted? It's literally two of the questions on the PHQ9, which is used to, you know, diagnose/measure depression. Maybe some of y'all should stick to the javascript threads and stop pretending to be experts in healthcare. Listen more, speak less, kids.
    - Sharlin 9mo ago
      Many people unfortunately think that depression is like somatic diseases such as influenza, where we deduce the presence of a pathogen, a root cause, based on presented symptoms. But for depression (and many other mental health issues) we don't currently know any root cause(s) – all we can do is give names to sets of often-comorbid symptoms.
- almost_usual 9mo ago
  You have to work on your will to live incrementally.
hmmmmmmmmmmmmmm 9mo ago
Vague reports like these are how you get people who drag themselves by the feet to go to gym and sit on a machine or do a random set of jumping jacks on the sled track. Taking up a sport and making it part of your lifestyle will be much more beneficial than telling people to do "moderate level exercise" because most people don't even know what that means and will never enjoy it. If you actually get into a sport there will be second order effects such as better diet and possibly finding others with interest in such activities as you will invest more time into it.
iammjm 9mo ago
lets get concrete with "Exercise": what is one unit of exercise? like exactly what type of movement, at what intensity and duration should be performed how frequently to be as effective as therapy? like should i run every day at 160bmp for 20 minutes? whats the minimum effective dose?
- esquivalience 9mo ago
  There are no units of exercise and no units of depression either. In my opinion the best measure of exercise is perceived effort. So while you're asking for objective answers, I think a lot of this is inherently subjective. The benchmark you're asking for is also ill-defined. For example: How frequently to be as effective as what type and what frequency of therapy?
- arethuza 9mo ago
  "what is one unit of exercise" Based on my own recent experience I would suggest the "dog".
  - taneq 9mo ago
    Addendum: if not a dog person, may I suggest ‘motorcycle’ as an alternative?
    - arethuza 9mo ago
      This chap certainly recommends it for his worries: https://www.youtube.com/watch?v=S83zwxkNio8 https://www.youtube.com/watch?v=S83zwxkNio8 Edit: A motorcycle that is, unless someone has created 200mph dogs...
- beezlebroxxxxxx 9mo ago
  If you take a "brisk" 20 minute walk every day, you'll meet the recommended weekly amount of aerobic exercise for Americans. (I think people should do more.) The actual amount you need to exercise, or the intensity, is not very big. The good thing with exercise is also that once you make it a habit to walk, say, 20 minutes a day, then walking 25 minutes a day becomes pretty trivial, and so on.
resoluteteeth 9mo ago
Exercise, therapy, and antidepressants have all been shown to have similar effect sizes for depression. It seems like some people take that to mean that therapy and antidepressants are pointless but unless there's some reason to think that the effects are mutually exclusive, a more reasonable interpretation is probably that it's good to try to do all of these things if possible if you are depressed.
- weli 9mo ago
  The problem is that people who are depressed often don't have the energy to change their lifestyle to start exercise, which requires significant effort. That's why psychiatrists will suggest antidepressants or Electroconvulsive therapy (in extreme cases of depression) because clients are unable to help themselves.
  - bobomonkey 9mo ago
    Happens for physical heath too. I jumpstarted progress with GLP-1 and Statins and now I probably don't need them because I enjoy exercising and eating well.
- nasir 9mo ago
  Mens sana in corpore sano Taking the antidepressant has become the dominant go to approach as it is more commercially profitable for the seller and easier to commit to for the taker.
  - jmye 9mo ago
    > Taking the antidepressant has become the dominant go to approach Cite?
  - graemep 9mo ago
    Its also cheaper. A lot cheaper. In the UK a GP can just lot prescribe an anti-depressant. There are waiting lists for NHS therapy and paying privately is expensive.
throw4847285 9mo ago
I've seen the exact same post on HN maybe a dozen times. The psychology of people posting this sort of advice is more interesting to me than the advice itself.
- giglamesh 9mo ago
  I hope this phenomenon is not limited to HN, but this is the only place I'm aware of where the comments are often more interesting and useful than the posts.
  - throw4847285 9mo ago
    I'm addicted to HN comments in a way that's almost certainly bad for me. I skim the articles (if that) and then hop into the comments section to pontificate about whatever topic is marginally related to the article I didn't read. Maybe my attention span has entirely eroded, or maybe I lack an outlet for the never-ending torrent of racing thoughts that keeps me up at night. But either way, here we are.
sublinear 9mo ago
This might sound strange, but a trick that got me off my ass was doing housework. It started to spill over into the rest of my life... If I'm sweating already and warmed up, I might as well take a walk to cool down. If I'm already walking and a good song comes on, I might as well jog. If I'm feeling sore already, I might as well lift some weights to gain some strength. To boost this all, I might as well eat more protein. If moving around is kinda making me feel nauseous sometimes, it's probably a vitamin thing so I go for more veggies. Hey veggies are slowly replacing bread and other empty carbs! Then my nerd brain kicked in and developed an obsession with cooking. On the other end of this, I was doing more housework because I was inviting people over more often and otherwise working from home. The mess became harder to avoid. I think we all did a little of that because of the cultural shift in the first half of this decade. That also meant entertaining more which meant trying to put out better food. All the incentives aligned to break me out of a cycle of bad habits for long enough that I genuinely can't go back. My life is objectively way better and I know exactly how it got that way, so there's nothing intimidating about it anymore. The level of effort also went down as all the new habits were streamlined into a coherent lifestyle. At the risk of sounding condescending, I think most of this is really just a matter of growing up anyway (I entered my 30s during this time period). I just wanted to share how it happened to me.
BenFranklin100 9mo ago
Reistance training — moreso than cardiovascular exercise — can improve sleep quality and duration. Both have significant effects on daytime mood and cognition. A good exercise program incorporates both resistance and cardiovascular exercise.
- weatherlite 9mo ago
  Thanks this is new to me (I'm mostly a cardio guy), didnt' know there was any difference in sleep quality/duration between cardio and lifting. They both help sleep btw it just turns out according to recent research resistance training helps more. Both are need though for a healthy lifestyle and I think cardio is actually more accessible for most people; I'm gonna count brisk walking as cardio for most people and that's the most accessible type of excercise everyone but the extremely debilitated can do.
  - BenFranklin100 9mo ago
    I don’t like anecdotal evidence, but for myself I was running regularly but still experiencing suboptimal sleep. I started resistance training again and my sleep immediately got better.
    - weatherlite 9mo ago
      I'm down with that , resistance training is clearly good. Cardio is also clearly good (both groups had better sleep than the group that didn't do any cardio). People should just do something, even walking birskly. We should all simply try to move and/or lift things.
- wvh 9mo ago
  It's important to keep cortisol low, and over-exercise can cause cortisol to spike – as does depression in general, hence the sleeping difficulties many depressed people experience. Likely that's why resistance training and HIIT are more helpful in this case as there is less built up of stress hormones. I've been diagnosed with moderate to severe depression, and I'm a trial runner and do CrossFit. It's a balancing act to find strength and feeling capable through sport without increasing insomnia and early waking, likely because of cortisol spikes. Sport does more for me than antidepressants, which have little effect than making me feel tired all the time. I've gone through a whole battery of them with little success and I've become quite critical of them. But I'm lucky to generally like sport and eat pretty healthily; I can imagine for others that can be an extra stressor they really don't need.
gowld 9mo ago
OP site is blogspam. Here's the paper: https://pubmed.ncbi.nlm.nih.gov/41500513/ https://pubmed.ncbi.nlm.nih.gov/41500513/ It's a review/summary of existing research, not anything new. The fundamental problem with studying alternatives to therapy is that "being in a study" may be as effective as therapy! It's a structural placebo effect. For a depressed person, "Exercise guided by a researcher" is different from "trying to make myself exercise". > Authors' conclusions: Exercise may be moderately more effective than a control intervention for reducing symptoms of depression. > Exercise appears to be no more or less effective than psychological or pharmacological treatments, though this conclusion is based on a few small trials. > Long-term follow-up was rare. Nothing new: > The addition of 35 RCTs (at least 2526 participants) to this update has had very little effect on the estimate of the benefit of exercise on symptoms of depression.
tpoacher 9mo ago
But only for "per protocol" analyses. "Intention to treat" analyses, now ... very different conclusions.
dsm4ck 9mo ago
Show me a disease with multiple unreliable treatment methods and I'll show you a disease that is not well understood
butlike 9mo ago
Nothing says "I can finally conquer my fears and anything that comes up" like a little strength in your back pocket.
gavinray 9mo ago
There's no money in telling people "You will feel better if you move around a little each day, and don't eat junk food." Plus, the grand of majority of people would rather NOT move around and continue to eat junk food regardless. Animals evolved to be lazy.
- thefz 9mo ago
  Waiting for the inevitable peak HN comment "we should distillate the chemicals released during exercise into a pill and give it to people so they don't need to move"
  - gavinray 9mo ago
    I've taken several of those, they're called "exercise mimetics". https://en.wikipedia.org/wiki/Exercise_mimetic https://en.wikipedia.org/wiki/Exercise_mimetic Unfortunately we've not invented one that can fully replace exercise yet.
_DeadFred_ 9mo ago
This is the worst thing about having long COVID (well other than no one believing it is a thing). I had worked for years working back to being fit, had gotten up to benching 245 for 3 sets of 10. Workouts kept helped keep me balanced. Now I can barely squat 100lbs 5 times. It's so frustrating. And no one believes it's real. Like I had the fortitude to spend years building back strength and then one day I just chose to stop.

104 points by PaulHoule 9mo ago

[dead]

How to solve most cases of depression, make sure to get all these (if you can): - good diet with no junk food, alcohol, drugs and stimulants - regular exercise and outdoor time - good sleep hygiene - regular healthy social interactions - eliminate environmental stressors (job/financial stress, relationship stress, noise pollution, etc) Of course, not everyone can have everything and some of those aren't 100% under your control, but ultimately it becomes your responsibility to try fix them if you want your situation to improve, since nobody else will.

xnorswap 9mo ago
The trouble is, this reads like "Just don't be depressed", since this is almost effectively a list of (anti-) symptoms of depression.
- jdiff 9mo ago
  And the ones that aren't simply "don't be depressed" are a lottery for anyone, even those not suffering depression. In the US, current projections are for 300 new jobs per state per month this year. Even accounting for retirees and deaths, last I looked at the numbers, there have been 2M more new additions to the workforce (people turning 18) than there are new jobs for those new additions, all competing with the large unemployed and laid off populations. It's similarly often not easy to solve relationship stressors or noise pollution.
  - weatherlite 9mo ago
    I agree we are headed into very unstable times, all the more reason for people to exercise. The stress relief effect is magical, and if you do it outside you get some fresh air and vitamin D. Exercise isn't a magic cure to make everyone honkey dorey but I do believe it should be seen as one of the best (and free) tools we have to maintain mental health.
- joe_mamba 9mo ago
  No, it isn't like "Just don't be depressed", I know it's very difficult for people to get all of those combined, that's what I said you should strive to get all of them if you want to cure your depression. SSRIs or exercise won't make your financial or relationship issues go away so you'll still be depressed unless you can fix all the issues bothering you.
  - Sharlin 9mo ago
    The problem is that depression by definition makes it 100x harder to do any of those things.
    - joe_mamba 9mo ago
      Well yeah, but you gotta start somewhere, and it's not gonna get better if you drink cola, beer everyday and stay up until 2AM watching netflix.
      - rincebrain 9mo ago
        I think GP's point is that "just do it" shows a lack of understanding that an inability to "just do X" is often a symptom of depression that leads to people not talking about it, because people who haven't experienced it think you must be lying about having decided to do something and not actually then doing it. Consider: there was a study about a guy who was paralyzed from the waist down, who got an implant to bypass the injury, and with a year+ of walking with the implant, could eventually walk to a limited extent without the implant.[1] This suggests walking can be used to treat loss of ability to walk. Unfortunately, there's a catch-22 there... ...and so too with inability to make yourself do anything. [1] - https://www.nature.com/articles/s41586-023-06094-5 https://www.nature.com/articles/s41586-023-06094-5
      - deleted 9mo ago
        [deleted]
      - jmye 9mo ago
        > Well yeah, but you gotta start somewhere Wait, I thought those things solved depression? Why are you hedging now? Did your initial analysis suck, and you're just now realizing it? Are you figuring out that maybe this is slightly more complex than "just be happy" and that maybe you're not the only person on the planet who's ever thought about this?
- taneq 9mo ago
  This is always what leaps out at me with this kind of “live better be happier” article. Yeah, if you’re sleeping well, eating well, working out regularly, spending quality time with friends, and have a healthy work life balance, you probably aren’t depressed. Might there be some possibility, perchance, that this is because any single one of those factors is almost impossible when in the pit of despair, let alone all of them at once? It’s like saying glasses cause short sightedness because hey, you almost never see someone with good eyesight wearing glasses.
bananaflag 9mo ago
> good diet with no junk food, alcohol, drugs and stimulants How does one get rid of the excitement of the expectation of eating chips or drinking cola etc?
- adrian_b 9mo ago
  Hard?
- celeritascelery 9mo ago
  GLP-1
- joe_mamba 9mo ago
  You stop buying them during your weekly grocery shopping.
- megaloblasto 9mo ago
  It sounds like you're saying that low will power leads to depression.
- coffeefirst 9mo ago
  You replace the thing you want to quit with a better thing. Try tea and seltzers, not because they’re healthy but because they’re interesting. There’s an infinite range of teas. And learning to cook changed my life. I get annoyed with almost all delivery now because I can do better.
  - bananaflag 9mo ago
    I started drinking herbal teas some years ago, I heavily enjoy hibiscus and ginger because of their strong taste, to a lesser degree also cinnamon, licorice and peppermint, but most teas seem very bland.
- gowld 9mo ago
  You need to educate/brainwash yourself with operant conditioning that junk food makes you sick and good food makes you feel good. The problem with depression in particular, though, is that self-harm--seeking behaviors is also a symptom, so that brainwashing can backfire.
staticassertion 9mo ago
I think this is true, but oof that's a heavy list. For one thing, food, alcohol, drugs, and stimulants, all have addictive properties that are almost certainly comorbid with depression. Dropping those is rough. Exercise is perhaps one of the easier ones but, personally, I've found it incredible to reflect on how absolutely bad my childhood "gym" classes were. At no point did we actually... go to a gym. That was never normalized for us. We sort of just learned how to do jumping jacks when we were told to, that sort of thing, and it was all structured for us. There was no habit forming, no "how to do this once there's no one around to structure it for you". In my experience, people who go to the gym get "brought in" by someone in their life who can help them build that structure. For someone missing it, well, you're truly on your own in a rather stressful environment. Sleep hygiene is good but, again, I suspect tricky here. Regular social interactions, another heavy lift! What do you do to build up a network of people in your life? Social structures don't just magically appear, and once again, they're usually just handed to you for most of your life and once those fall away you're in quite a spot trying to recover or build anew. I think the environmental stressors may be the roughest, hard to say. Eliminating financial stress is something that can take decades. Noise pollution? That's really quite out of my control. All of these are great things to work on but I suppose my read of them is "wow, being depressed seems really fucking hard if you have to do these things to get out of it".
- joe_mamba 9mo ago
  > "wow, being depressed seems really fucking hard if you have to do these things to get out of it". Yeah IT IS hard, I didn't say it's easy, I just said what you need to not be depressed. Whether everyone can get all those is another issue. The thing is that in the case when you don't have all of these, adding unhealthy habits on top, doesn't make your situation better.
  - staticassertion 9mo ago
    Yes, sorry, I think other posts are quite critical of yours so maybe you think this was me trying to be like "your post is bad". I think you're right (though I think that medication and therapy are often critical to help kickstart healthier habits, and it's worth noting how heavy a lift those things are), but it is just notable to me how hard those things are. I am not depressed, thankfully, because if I had to rebuild a social life or go to the gym to fix myself I'd be fucked.
Aaargh20318 9mo ago
I can't remember where I read it, but it always stuck with me: most cases of depression can be solved with a one-time deposit of $20 million in the patient's bank account. A lot of the time, what is diagnosed as depression is actually a very valid reaction to being in a shitty situation. I myself ended up at a psychiatrist due to being stuck in a shitty job with me being too exhausted and anxious to do anything about it. What eventually 'cured' me wasn't any of the sessions with the shrink but being laid off in a company restructuring with a nice severance package that allowed me to take a couple of months to decompress and look for a job that was a better fit.
- joe_mamba 9mo ago
  >most cases of depression can be solved with a one-time deposit of $20 million in the patient's bank account. Yes, but actually not always. If you have someone overweight because they're only eating pizza, cheetos and cola everyday and you use a magic wand to give them Thor's physique, how long will their new physique last with their diet until they devolve back into a slug monster? Money tends to run out, very quickly for some people. If you aren't able to keep your life in order when you're poor, you'll probably squander it all quickly too if you win the lottery. Like a friend of mine said "Thank God nobody gave me a million dollars when I was a drug addict, I would have OD's in a day". People with self destructive tendencies don't need 20 million dollars, they need therapy, a stable job, and a loving caring community, something that fewer people have nowadays.
  - alphawhisky 9mo ago
    This is a pretty poor take. Everyone knows that it's easier to maintain fitness/muscle than build it. The same is true with money, it's much easier to coast or make moves financially when you have headroom. There's a type of financial self-sabotage people often commit when they're in an "unwinnable" situation called Doom Spending. I feel like the same psychological principles that convince a person in debt to finance their groceries also makes them lean into eating when overweight, lean into laziness when unemployed, etc. They always say that the hardest part is starting, but when it comes to money, fitness, employment, not everyone starts from the same place, and without being/having been at rock bottom you can't speak to the perspective of getting out of it. Agreed that a holistic approach is the only proper way though.
deleted 9mo ago
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wvh 9mo ago
You just described causes of depression, like divorce, social isolation and being unemployed. I know there are people that can feel free in a place as horrible as a concentration camp, but most of us have some basic needs that have to be met to feel OK and have some hope. Some people have actual neurotransmitter imbalances, but many of us just have monkey brains that don't know how to deal with (real, abstract) modern-day stressors that trigger a fight-or-flight response.
vrosas 9mo ago
This is exactly the kind of list that is both not true (solving depression is not a checklist) and COMPLETELY unhelpful to anyone actually dealing with depression. It's like saying "just make more money" to someone with financial struggles.
- weatherlite 9mo ago
  I see your point but I think there's nuance here First of all exercise should be seen as one of the first lines of defense against not only depression but chronic health problems (which also lead to depression). So you shouldn't wait until you are depressed to start exercising - ideally it is something you do all the time. Secondly - someone who's depressed is not keen on most things - including talking to a therapist , yet we still encourage them to do it. If you have the will power to pay hundreds of dollars a session to talk to a complete stranger, in theory you may have the willpower to walk birskly for 150 minutes a week. As a society we should simply encourage everyone no matter what age or state of mind to do that.
goodpoint 9mo ago
AKA "just don't be depressed"
z3t4 9mo ago
- lower your expectations If you set your goal too high you will be sad all the time. Choose a goal that you would be happy with but make sure it's a realistic goal!
basisword 9mo ago
Every time this comes up the comments are the same. Just don't eat crap, just go to the gym, just make sure you get good sleep. It shows a total lack of understanding of depression. Of course these things work - and if people weren't depressed they might be able to try and do them. But when you have severe depression you literally have zero motivation. None. You suddenly can't sleep. You can barely get yourself out of bed. That's why things like pills are useful because they can help you get to the point where you can take the steps necessary to get your life into a state where it's less conducive to depression. >> ultimately it becomes your responsibility to try fix them if you want your situation to improve, since nobody else will. No. This is why doctors and psychologists etc exist. Not everything is fixable by you. Sometimes you need help from other people and blaming the depressed person for being depressed is fucking idiotic.
randusername 9mo ago
> How to solve most cases of depression Tread carefully friend, I agree this is a good list to _prevent_ the most common forms of depression, but some will think you are framing major clinical depression as a personal failing. Some people slide into a hole of their own making. Others get thrown into the abyss by external factors. Grief, trauma, abuse, crises of repressed identity, poverty and poor prospects. Life can be brutal. I highly, highly recommend The Noonday Demon: An Atlas of Depression (Solomon) for anyone that is interested in a comprehensive view of depression.
- joe_mamba 9mo ago
  >Some people slide into a hole of their own making Others get thrown into the abyss by external factors. Yes, true, a lot of the times it is from external factors (ask me how I know), but what people miss is that even in that case, it's still on you to get yourself out since SSRIs and therapy session won't fix the situation you fell into, nor will anyone else come to get you out, unless maybe you're lucky enough to have an incredible family, community or support network. It's still your responsibility to get yourself out even when your situation is not your fault. That's the sad truth about life, you have to play the hand you're dealt, instead of being depressed you've been dealt a bad hand. It's not fair, but that's how it works.
  - randusername 9mo ago
    From one internet stranger to another, both vaguely alluding to heavy things in our lived experience, I respectfully invite you to consider a "yes and". Yes, we all must accept responsibility in changing our circumstances. _And_ we all can accept responsibility for helping others do the same. Some people need to hear the first part that you shared. Others need to hear the the second part that I am sharing.
jmye 9mo ago
> How to solve most cases of depression What absurdly thoughtless, shallow nonsense. What, specifically, is your background in depression research, that leads you to believe you've completed solved it for everyone? I'll wait. I'm sure it's fucking extensive.
Fricken 9mo ago
One indicator that you might be falling in to depression is that you struggle to find the motivation to maintain those healthy practices.
deleted 9mo ago
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Insanity 9mo ago
The last one you list is hardest to fix. And that in turn causes the others. For example, if you have a stressful job, you might: 1. Sleep less (job stress or long hours keeping you up) 2. Eat less healthy (coping mechanism for job stress, and it’s faster) 3. Have less time for the higher quality social interactions.
tpoacher 9mo ago
How to solve most cases of paraplegia: - Regular long walks at the park - Climb stairs whenever possible instead of using the lift - Good foot care - Engage in social exercise like running clubs - Wear good quality footwear, suitable for the activity that you're engaged in. Of course, not all paraplegics can use their feet, but ultimately it becomes your responsibility to try to improve leg strength to the point of overcoming paraplegia, by doing the things that would have helped in improving leg strength, if only you could walk. /s (tbf, not fully disagreeing per se, and all analogies are flawed, but the above sarcasm is to point out that this model is overly simplistic. And it can lead to hidden but very real unconscious bias and discrimination once words like "responsibility" is thrown into the mix)
butlike 9mo ago
I don't agree with the elimination of things. Removing things can be its own source of tribulation. I agree on all other parts, though
GuB-42 9mo ago
Sounds like a catch 22 to me. All of what you describe besides environmental stressors are symptoms of depression. So, to solve depression, you must first solve depression. And even the environmental stressors are something we could work with as a society though welfare, environment regulations, etc... But how people react to them is also a symptom. There are depressive people with the best of situations, and people who enjoy life in the worst of situations. What often strikes me in documentaries about warzones, places of repression and extreme poverty or crippling diseases is how "normal" people seem to be, they enjoy themselves as if everything was fine. So, while reducing environmental stressors work, it is not the end of it. The take may be that treating the symptoms of depression could work in treating the root cause, a positive feedback loop. But if done through lifestyle change, unfortunately, the treatment is coercion, you can't rely on the willpower of people who have none because of the disease.
bulbar 9mo ago
That's a dangerous take. People that suffer from a clinical depression oftentimes won't be able to do any of these things and this has nothing to do with responsibility and everything with suffering from a depression. From what I have learned from friends working in the field, meds often work as an enabler, allowing people to do some of the things that are known to improve their condition further. If you think you suffer from depression, don't keep trying to "just buckle up", don't keep trying to "just need to take responsibility". Go talk to professionals, therapists and/or psychiatrists. Mental disorders do things to a person outside of their control.

Eddy_Viscosity2 9mo ago

"Exercise has at least a "moderate impact" on symptoms "compared with no treatment or a control intervention," I mean, yes, but we already knew this. So good that this is a finding that passes replication.

pjerem 9mo ago

I don't get what's new ? It's a known fact that exercise and good lifestyle are good for the mental health. But isn't the inability to maintain a good lifestyle one of the first symptoms of depression ?

Sharlin 9mo ago
Exactly. Depression is defined in part as being the inability to effectively do those things.
- jmye 9mo ago
  Why is this downvoted? It's literally two of the questions on the PHQ9, which is used to, you know, diagnose/measure depression. Maybe some of y'all should stick to the javascript threads and stop pretending to be experts in healthcare. Listen more, speak less, kids.
  - Sharlin 9mo ago
    Many people unfortunately think that depression is like somatic diseases such as influenza, where we deduce the presence of a pathogen, a root cause, based on presented symptoms. But for depression (and many other mental health issues) we don't currently know any root cause(s) – all we can do is give names to sets of often-comorbid symptoms.
almost_usual 9mo ago
You have to work on your will to live incrementally.

hmmmmmmmmmmmmmm 9mo ago

Vague reports like these are how you get people who drag themselves by the feet to go to gym and sit on a machine or do a random set of jumping jacks on the sled track. Taking up a sport and making it part of your lifestyle will be much more beneficial than telling people to do "moderate level exercise" because most people don't even know what that means and will never enjoy it. If you actually get into a sport there will be second order effects such as better diet and possibly finding others with interest in such activities as you will invest more time into it.

iammjm 9mo ago

lets get concrete with "Exercise": what is one unit of exercise? like exactly what type of movement, at what intensity and duration should be performed how frequently to be as effective as therapy? like should i run every day at 160bmp for 20 minutes? whats the minimum effective dose?

esquivalience 9mo ago
There are no units of exercise and no units of depression either. In my opinion the best measure of exercise is perceived effort. So while you're asking for objective answers, I think a lot of this is inherently subjective. The benchmark you're asking for is also ill-defined. For example: How frequently to be as effective as what type and what frequency of therapy?
arethuza 9mo ago
"what is one unit of exercise" Based on my own recent experience I would suggest the "dog".
- taneq 9mo ago
  Addendum: if not a dog person, may I suggest ‘motorcycle’ as an alternative?
  - arethuza 9mo ago
    This chap certainly recommends it for his worries: https://www.youtube.com/watch?v=S83zwxkNio8 https://www.youtube.com/watch?v=S83zwxkNio8 Edit: A motorcycle that is, unless someone has created 200mph dogs...
beezlebroxxxxxx 9mo ago
If you take a "brisk" 20 minute walk every day, you'll meet the recommended weekly amount of aerobic exercise for Americans. (I think people should do more.) The actual amount you need to exercise, or the intensity, is not very big. The good thing with exercise is also that once you make it a habit to walk, say, 20 minutes a day, then walking 25 minutes a day becomes pretty trivial, and so on.

resoluteteeth 9mo ago

Exercise, therapy, and antidepressants have all been shown to have similar effect sizes for depression. It seems like some people take that to mean that therapy and antidepressants are pointless but unless there's some reason to think that the effects are mutually exclusive, a more reasonable interpretation is probably that it's good to try to do all of these things if possible if you are depressed.

weli 9mo ago
The problem is that people who are depressed often don't have the energy to change their lifestyle to start exercise, which requires significant effort. That's why psychiatrists will suggest antidepressants or Electroconvulsive therapy (in extreme cases of depression) because clients are unable to help themselves.
- bobomonkey 9mo ago
  Happens for physical heath too. I jumpstarted progress with GLP-1 and Statins and now I probably don't need them because I enjoy exercising and eating well.
nasir 9mo ago
Mens sana in corpore sano Taking the antidepressant has become the dominant go to approach as it is more commercially profitable for the seller and easier to commit to for the taker.
- jmye 9mo ago
  > Taking the antidepressant has become the dominant go to approach Cite?
- graemep 9mo ago
  Its also cheaper. A lot cheaper. In the UK a GP can just lot prescribe an anti-depressant. There are waiting lists for NHS therapy and paying privately is expensive.

throw4847285 9mo ago

I've seen the exact same post on HN maybe a dozen times. The psychology of people posting this sort of advice is more interesting to me than the advice itself.

giglamesh 9mo ago
I hope this phenomenon is not limited to HN, but this is the only place I'm aware of where the comments are often more interesting and useful than the posts.
- throw4847285 9mo ago
  I'm addicted to HN comments in a way that's almost certainly bad for me. I skim the articles (if that) and then hop into the comments section to pontificate about whatever topic is marginally related to the article I didn't read. Maybe my attention span has entirely eroded, or maybe I lack an outlet for the never-ending torrent of racing thoughts that keeps me up at night. But either way, here we are.

sublinear 9mo ago

This might sound strange, but a trick that got me off my ass was doing housework. It started to spill over into the rest of my life... If I'm sweating already and warmed up, I might as well take a walk to cool down. If I'm already walking and a good song comes on, I might as well jog. If I'm feeling sore already, I might as well lift some weights to gain some strength. To boost this all, I might as well eat more protein. If moving around is kinda making me feel nauseous sometimes, it's probably a vitamin thing so I go for more veggies. Hey veggies are slowly replacing bread and other empty carbs! Then my nerd brain kicked in and developed an obsession with cooking. On the other end of this, I was doing more housework because I was inviting people over more often and otherwise working from home. The mess became harder to avoid. I think we all did a little of that because of the cultural shift in the first half of this decade. That also meant entertaining more which meant trying to put out better food. All the incentives aligned to break me out of a cycle of bad habits for long enough that I genuinely can't go back. My life is objectively way better and I know exactly how it got that way, so there's nothing intimidating about it anymore. The level of effort also went down as all the new habits were streamlined into a coherent lifestyle. At the risk of sounding condescending, I think most of this is really just a matter of growing up anyway (I entered my 30s during this time period). I just wanted to share how it happened to me.

BenFranklin100 9mo ago

Reistance training — moreso than cardiovascular exercise — can improve sleep quality and duration. Both have significant effects on daytime mood and cognition. A good exercise program incorporates both resistance and cardiovascular exercise.

weatherlite 9mo ago
Thanks this is new to me (I'm mostly a cardio guy), didnt' know there was any difference in sleep quality/duration between cardio and lifting. They both help sleep btw it just turns out according to recent research resistance training helps more. Both are need though for a healthy lifestyle and I think cardio is actually more accessible for most people; I'm gonna count brisk walking as cardio for most people and that's the most accessible type of excercise everyone but the extremely debilitated can do.
- BenFranklin100 9mo ago
  I don’t like anecdotal evidence, but for myself I was running regularly but still experiencing suboptimal sleep. I started resistance training again and my sleep immediately got better.
  - weatherlite 9mo ago
    I'm down with that , resistance training is clearly good. Cardio is also clearly good (both groups had better sleep than the group that didn't do any cardio). People should just do something, even walking birskly. We should all simply try to move and/or lift things.
wvh 9mo ago
It's important to keep cortisol low, and over-exercise can cause cortisol to spike – as does depression in general, hence the sleeping difficulties many depressed people experience. Likely that's why resistance training and HIIT are more helpful in this case as there is less built up of stress hormones. I've been diagnosed with moderate to severe depression, and I'm a trial runner and do CrossFit. It's a balancing act to find strength and feeling capable through sport without increasing insomnia and early waking, likely because of cortisol spikes. Sport does more for me than antidepressants, which have little effect than making me feel tired all the time. I've gone through a whole battery of them with little success and I've become quite critical of them. But I'm lucky to generally like sport and eat pretty healthily; I can imagine for others that can be an extra stressor they really don't need.

gowld 9mo ago

OP site is blogspam. Here's the paper: https://pubmed.ncbi.nlm.nih.gov/41500513/ https://pubmed.ncbi.nlm.nih.gov/41500513/ It's a review/summary of existing research, not anything new. The fundamental problem with studying alternatives to therapy is that "being in a study" may be as effective as therapy! It's a structural placebo effect. For a depressed person, "Exercise guided by a researcher" is different from "trying to make myself exercise". > Authors' conclusions: Exercise may be moderately more effective than a control intervention for reducing symptoms of depression. > Exercise appears to be no more or less effective than psychological or pharmacological treatments, though this conclusion is based on a few small trials. > Long-term follow-up was rare. Nothing new: > The addition of 35 RCTs (at least 2526 participants) to this update has had very little effect on the estimate of the benefit of exercise on symptoms of depression.

tpoacher 9mo ago

But only for "per protocol" analyses. "Intention to treat" analyses, now ... very different conclusions.

dsm4ck 9mo ago

Show me a disease with multiple unreliable treatment methods and I'll show you a disease that is not well understood

butlike 9mo ago

Nothing says "I can finally conquer my fears and anything that comes up" like a little strength in your back pocket.

gavinray 9mo ago

There's no money in telling people "You will feel better if you move around a little each day, and don't eat junk food." Plus, the grand of majority of people would rather NOT move around and continue to eat junk food regardless. Animals evolved to be lazy.

thefz 9mo ago
Waiting for the inevitable peak HN comment "we should distillate the chemicals released during exercise into a pill and give it to people so they don't need to move"
- gavinray 9mo ago
  I've taken several of those, they're called "exercise mimetics". https://en.wikipedia.org/wiki/Exercise_mimetic https://en.wikipedia.org/wiki/Exercise_mimetic Unfortunately we've not invented one that can fully replace exercise yet.

_DeadFred_ 9mo ago

This is the worst thing about having long COVID (well other than no one believing it is a thing). I had worked for years working back to being fit, had gotten up to benching 245 for 3 sets of 10. Workouts kept helped keep me balanced. Now I can barely squat 100lbs 5 times. It's so frustrating. And no one believes it's real. Like I had the fortitude to spend years building back strength and then one day I just chose to stop.