- The debate on exercise and depression
- What do I mean when I say exercise is a ‘tool for managing my depression’?
- Antidepressants as maintenance for depression
- What does being cured look like?
- Two main roles for exercise in ‘helping depression’
- A low mood could trigger a depressive period if I don’t take action
- Maybe it is curing me after all?
Earlier this week, when the ‘exercise no help for depression’ stories were published on the BBC and the Guardian, I quickly pulled together some of my initial thoughts and frustrations with the way the research was reported. Since then, I’ve had a chance to think about it in a bit more depth.
I watched the debate and discussion throughout the day. Those involved came from a range of perspectives and angles. Many people who got involved had experienced depression themselves. Some were in the middle of a bad episode, others had experienced it in the past or felt that they were ‘managing’ their depression to prevent relapse.
Some had found exercise improved their mood or helped them manage, others not. For some it depended on the severity of the depression experienced. For some, exercise was not considered ‘helpful’ unless it formed part of a ‘treatment’ leading to a cure. For others if it enabled them to manage better on a day-to-day basis this was enough.
What was interesting was that while some were supporting or arguing against the research itself (that one particular form of facilitated ‘encouragement’ to exercise doesn’t help in treatment) many were responding to the simplified message in the headline – that exercise doesn’t help depression. And many responded with the simple answer, ‘Well, it helps me get by.’ While the Department of Health can conclude that TREAD, in the way it is currently delivered, does not work, the mass of anecdotal evidence that this study has generated should give them pause for thought.
The debate got me thinking (while on a run, incidentally) in a bit more depth about what role exercise does play in my life.While I am not currently in a depressive episode (and haven’t been in a really bad, extended one for a year and a half), I still consider depression as something in my life that I have to manage carefully to avoid it taking over. I’ve always considered exercise one of my ‘tools’ in managing my depression – but what is actually going on when I say that?
While I have been on antidepressants in various doses for 11 years, I don’t really feel as though they are ‘treating’ my depression. I feel that, at this point, my taking them is more about maintenance – to prevent relapse. I’ve tried to come off them a number of times. While I have succeeded in reducing the dose, the impact of cutting down too fast or too much is immediately obvious to me. I don’t know how much of this is chemical, or how much is psychological or whether it’s a combination of both.
Given that I have recently had a long period without a depressive episode, I’m currently cutting them down again, albeit very slowly. But cutting them down takes some getting used to, and while I am doing so, I feel as though I am at risk, without careful management, of it coming back.
I guess where I am getting at with this is that I’m not sure what being ‘cured’ looks like. In any direct and measurable sense it doesn’t feel like I am using exercise to cure my depression. I think I am using it to manage it, to keep it at bay and to prevent a mild low or a sad period turning into a more destructive relapse. While I might have long episodes without feeling depressed, I think those episodes come through self-management and using tools like exercise, mindfulness and writing to keep me on the right path.
And, in the same way that I notice when I cut down my antidepressants, I notice when I don’t exercise. Usually I can manage about two full days without some form of vigorous exercise before I start to notice symptoms I associate with depression returning. And if I am feeling low, a run or a swim often has the ability to stop that, either for good, or at least for a while.
I think I’m identifying two main roles that exercise plays in my life.
The first is maintaining emotional wellbeing and mental health in its’ positive sense. What perhaps is key here for a lot of people is that, for someone who has been depressed, emotional wellbeing and positive mental health are always going to be set against and compared to their opposite, the destructive and mentally unhealthy experience of depression.
The second is that ‘stopping in its tracks element’. I identify with a lot of the way that Mindfulness Based Cognitive Therapy describes the process of preventing relapse. It is based on the idea that moods influence thoughts – everyday sad moods can reawaken and trigger negative thoughts if people have experienced them before. People who have been depressed in the past have learned associations between low mood and negative and depressed thoughts.
Most people might be able to ignore the occasional sad mood. In people who have been depressed in the past, a slightly low mood risks bringing about much larger changes in thought patterns. When I am not in a depressed period, I see exercise as a way of responding to those ‘everyday’ low moods and ensuring they don’t trigger a downwards spiral. I think it probably does this in different ways – it creates a chemical ‘runners’ high’ which in turn calms me down and stops my thoughts from running (!) wild. It takes me out of the situation I’m in and gets me doing something different, usually outside. It gives me a sense of satisfaction and achievement. It makes me feel more positive about my body and it takes the focus away from pointless rumination.
So maybe, if what ‘cured’ looks like is a long period without a depressive episode (and potentially the erosion of those learned associations), then perhaps exercise is also, indirectly but essentially, curing me – although not in the way the research frames it. I’m not sure it’s possible to pull apart all the interlocking strands of influence and balance to be able to gain any more definite conclusions.
The nature of depression is enormously complex and varied, as well as being very widespread and difficult to treat. The headlines given to the reporting of this research are misleading, but there’s a place for the research as one among many that try and help us understand our relationship with depression better. And, if nothing else, the headlines got us all talking and thinking. Still, I have to say, when all’s said and done, I like Simon Hattenstone’s response– ‘nobody knows your own body and mind like you do…so sod the research, I’m off for a run!’