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For Depression, Prescribing Exercise Before Medication

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Grown-up, nuanced article about the nitty-gritty of prescribing exercise for mental health issues. Yes it's cheap, more effective than pills (which are only as effective as placebo), and has few negative side-effects plus potentially a lot of positive ones. Slam dunk, right? Not so fast.

I didn't see any downsides mentioned in the article, other than health insurance pushes doctors to prescribe pills instead of exercise.

Though we don’t know exactly how any antidepressant works, we think exercise combats depression by enhancing endorphins: natural chemicals that act like morphine and other painkillers. There’s also a theory that aerobic activity boosts norepinephrine, a neurotransmitter that plays a role in mood. And like antidepressants, exercisehelps the brain grow new neurons.

But this powerful, non-drug treatment hasn’t yet become a mainstream remedy. In a 2009 study, only 40 percent of patients reported being counseled to try exercise at their last physician visit.

The issue is the same as prescribing exercise for any other health problem: COMPLIANCE IS LOW. And I imagine that for a lot of depressed people, "failing" to exercise can make them feel worse and less likely to go to the doctor.

Fair enough. I like this story in the article about baby steps:

He thought getting some exercise might help, but it was hard to motivate himself to go to the campus gym.

“So what I did is break it down into mini-steps,” he said. “I would think about just getting to the gym, rather than going for 30 minutes. Once I was at the gym, I would say, ‘I’m just going to get on the treadmill for five minutes.’”

“The world lost its color,” he told me. “Nothing interested me." Eventually, he found himself reading novels for long stretches at a time while pedaling away on a stationary bike. Soon, his gym visits became daily. If he skipped one day, his mood would plummet the next.

“It was kind of like a boost,” he said, recalling how exercise helped him break out of his inertia. “It was a shift in mindset that kind of got me over the hump.”

I have found that recommending to depressed people that they exercise for 5 minutes makes it seem a lot less arduous.  And, once the endorphins kick in, they tend to stick with it for longer than the 5 minutes.  It also depends on the severity of the depression - if the person isn't severely depressed, they are more likely to be able to force themselves to go for a walk or do something.

Sometimes, getting a partner is very helpful. Or someone to check in. I agree about the severity of the depression being a factor, that's why having partners helps, especially for people who haven't exercised as a pattern before. 

Patricia and Dawn, thanks for the tips.

1. Start with just 5 minutes.

2. Get a partner or someone to check in.

And yeah, severity of the depression matters so if you can't do these things, seek professional help.

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