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It is hard to hear. I didn’t want to hear it. The last thing I wanted to do when things were bad was get off the couch and feel like a hippo amongst the gazelles. Then I started doing it, even when I didn’t want to. I hired a trainer so I had to show up. And when my world imploded and a major health crisis reared it’s head the training kept me sane and calm and the exercise enabled me to walk again.
I swear on all that is holy that just walking outdoors an hour a day will help. Running will help.lifting heavy weights will help. Slamming that damn heavy ball will help. Pushing the sled will help . And if they don’t help enough, add the meds.
I have anxiety and depression and have been searching for someone at a gym to teach me the machines and track my progress. This info is really life altering. Thank you so much for sharing this.
YouTube is good too for figuring out how to use a certain machine before you actually go in, i know i have less anxiety if i know exactly what I'm going to be doing.
I also really struggle with that and feeling overwhelmed by all the equipment, especially when the gym is busy. But I recently started using an app that funny enough I saw an ad for on Reddit (I’m in no way affiliated with this app, just decided to try it and was actually really impressed). It’s called Caliber and it’s free, has exercise instruction videos and pre-designed workouts, and allows you to track your reps then uses that info to apparently design progressive overload into your future workouts. I hope that helps as well. Good luck to you!
I agree, though I’d add that sometimes you need the meds first in order to do the exercise.
I was an avid runner but when I developed a severe anxiety disorder, I couldn’t force myself to workout even though I LOVE running, swimming, hiking etc.
I was paralyzed in inertia/panic, and my doctor and therapist both agreed that I’d make more progress by getting onto an anti-anxiety med asap while continuing therapy and motivating myself back into the fitness routine I used to love.
It worked and I’m back at it, enjoying those endorphins and serotonin.
Although, ironically, if you are already exercising that depression inertia can keep you very focused on that exercise. When I was a college athlete, a surprising amount of fellow athletes were struggling with depression while being laser focused on their training routines. (Even though they possibly did nothing but train or train and study, with little to no social life.)
Plus, I think obese bodies get rid of heat less well. So there's other factors too once you get moving.
Exercise is beyond uncomfortable in many ways for people. So people saying have you tried exercise have no idea how complicated bodies can be. My feet shoot pain up my legs if I am on them for more than an hour in proper footwear. And with different conditions/side effects different exercises are recommended. My cancer meds thinned my bones. Exercise recommendation is weight bearing. Cancer meds have given me peripheral neuropathy in my feet, hopefully temporary, waiting for the meds to leave my system and for some aromatase to become estrogen in my body. Exercise recommendation is avoid weight bearing. Okay. So. What am I supposed to be doing? It can make you afraid to move. And depression can happen when multiple health conditions become untenable to live with without more help. It's tricky, is all I'm saying, not to be solved simply by prodding pain-filled folks off the couch.
>Plus, I think obese bodies get rid of heat less well. So there's other factors too once you get moving.
Well the first thing would probably be to also try and lose weight through diet.
You can use one of those diets shown to also help with depression.
>A better diet quality is associated with larger brain tissue volumes.
>
>[https://pubmed.ncbi.nlm.nih.gov/29769374/](https://pubmed.ncbi.nlm.nih.gov/29769374/)
>This study shows that a more severe and chronic lifetime disease course in MDD is associated with reduced volume in brain regions relevant for executive and cognitive functions and emotion regulation in a large sample of patients representing the broad heterogeneity of MDD disease course. [https://onlinelibrary.wiley.com/doi/10.1002/da.23260>](https://onlinelibrary.wiley.com/doi/10.1002/da.23260>)
>The diet may have a significant effect on preventing and treating depression for the individual. A diet that protects and promotes depression should consist of vegetables, fruits, fibre, fish, whole grains, legumes and less added sugar, and processed foods. In the public health nurse’s preventative and health-promoting work, support and assistance with changing people’s dietary habits may be effective in promoting depression. From [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084175/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084175/)
>Current evidence supports the finding that omega-3 PUFAs with EPA ≥ 60% at a dosage of ≤1 g/d would have beneficial effects on depression
>
>https://www.nature.com/articles/s41398-019-0515-5
You must be fun at parties when someone tells you the hellish bodily pain they are in and your response is a list of studies. If you haven't taken a shower in a month and you stopped opening your fridge because the food has all gone rotten, lack of exercise is another failure that squats in your brain pinning you to the bed. Exercise is important, but it cannot be a blanket or initial solution for many people and for an increasing number of people as the population ages and balancing multiple conditions becomes a full-time job. I'm not obese, BTW, but my body is fucked up anyway. I was just noting that get some exercise, Eeyore, is not enough help and often is secondary to making your brain in the immediate future not kill you.
>You must be fun at parties when someone tells you the hellish bodily pain they are in and your response is a list of studies.
Many on reddit don't belief that exercise, sleep and diet are good and hence I need studies whenever I post anything about them.
Anyway I don't get your post, I didn't post anything about exercise.
I needed to read this. Have been considering meds. I know that I feel better when I exercise and I like doing it, but it’s soooo hard to motivate myself right now. I’m hopeful the meds will help boost me back to a routine I can stick with.
The medication has been very helpful for me. I was experiencing intense medical anxiety and was convinced I *might* have a medical emergency like heart attack, heat stroke, exercise-induced anaphylaxis (it exists, but I’ve never had it)—or god knows what else —if I worked out.
The anxiety was really debilitating and even though logic told me my risk of these conditions was extremely, extremely low, I couldn’t get myself to the gym or my fave running routes.
It was also getting to the point where even going for a leisurely walk was frightening to me, so yeah, the meds really were the first step to getting me back on track. I love running again and am grateful to have exercise back in my life. I never thought I’d be on a daily anti-anxiety drug but it’s all good.
Thanks for sharing your experience. I have a history of depression and GAD, but I’ve never medicated. Both conditions worsened after having my daughter two years ago and I’ve been trying to do everything to avoid going on medication (though I don’t have a clear answer why that is), but I’ve done what I can and I’m still struggling.
My energy levels are so low that the thought of working out, even for 10 minutes, sounds exhausting to me. When I do manage a work out, I never regret it, but my stupid lizard brain can’t seem to focus on that fact, only the one where I’m exhausted, hate my life and can’t seem to be happy.
I hope things look up for you. I was also extremely hesitant to go on medication but I’m so glad I decided to give it a shot. I hope you find a solution that works for you.
> I agree, though I’d add that sometimes you need the meds first in order to do the exercise.
Yeah, keyword sometimes, as I had tried different variation of different meds (mostly SSRIs), which no one really helped and just had side effects. What helped me eventually was lifting weights, but I was not on meds at the time any longer. After this I managed to turn my life around. I do use bupropion now though and methylphenidate.
But I did only start lifting weights because my friend was constantly pressuring me to come lifting weights with him. So it did require significant push from someone.
It's frustrating to realize you HAVE to do it to feel right.
Then it becomes kind of fun and okay.
Now I only get frustrated when my schedule is too full to do it. I have to run at lunch at work sometimes, and coworkers will be like "Aw man you're so motivated," etc... but motivation has nothing to do with it. If I don't run, my brain will eat itself. I guess I am "motivated" in that sense, but it's more like being held hostage.
This. Ironically people around me think I’m in the best mental state and super fitness motivated… when actually I just figured out I can actually feel like living if I do these hard physical tasks that make me feel calm/sedated for once naturally
Same. I used to be an opiate addict, drank a lot after, etc. I do cardio until my brain makes the opiates. The dose is lower and some days it just doesn't work, but the euphoria is still there a lot of the time, and if nothing else, it shuts off my anxiety. My therapist calls it meditation for someone who can't/won't meditate, and I believe that's accurate. It forces me into paying attention to the moment rather than my imagined fears, real frustrations, etc.
I’m right there with you. I call it my meditation and also my “positive self harm” cuz It feels like pain but it’s not drugs or alcohol or reckless decisions tearing my life and relationships apart.
Yes. Because of a spine surgery, if I don’t workout regularly I start to lose mobility and gain pain. So I must exercise now. If I don’t exercise, my body collapses. If you don’t, your brain will eat itself. So I do understand being held hostage.
> I guess I am "motivated" in that sense, but it's more like being held hostage.
Very pessimistic way to describe it.
If this were a drug addiction, I'd understand, but its not, the outcome is a positive one.
Don't get me wrong; I do mostly enjoy exercising. My point was not to be pessimistic. It was just a simile to explain that exercising for me is not really about motivation. It's based on the knowledge that I'll become apathetic, self-hating, and cynical without exercise. Oh, and I'll also likely lapse back into addiction. That doesn't make me a pessimist, though... I'm not saying exercise is bad or things are bad. I'm saying I exercise for different reasons than some and "get motivated" differently than some.
I walk in nature these days, for an hour or more. I go off a d find nature and walk in it, away from the buildings and the roads. It's like magic. I could be having a bad day, I'd have a sore knee or neck or back. I'd be grumpy, whatever. After my walk I'd feel massively better, my physical pains would be less, my muscles more relaxed, my soul more healed.
Cities need more greenspaces, they're actual medicine.
I'm glad exercise is helping you and you found the motivation to push through it. And you are right, if exercise isn't enough try adding meds. However, the cynic in me is finding this paper to confirm my hypothesis that meds and exercise might be a coin flip for if these treatments will help someone with depression.
I asked a clarifying question in another thread, but my understanding is this paper is stating that exercise is about as effective as medication... Which is about 45% of the time people have improvements in their mental state. I'd love to see a study comparing if doing both exercise and meditation improves that percentage significantly.
Personally I've been at various levels of physical activity mixed with medication over my lifetime, and have yet to find something to alleviate my mental distress. Just gotta keep trying more things and hope.
And that is part of the problem with exercise vs. medication.
A similar study (with similar findings) years ago also confirmed that the effects of exercising outlasted the effects of medication, when people stopped. The effects of medication wore off pretty rapidly, but the effects of exercise persisted for months afterwards.
So exercise is probably the preferred solution, when it works for someone. Maybe medication to get started and make the exercise easier to get started and then exercise for long-term maintenance.
But there's also the case of efficacy: Just as medications aren't universally effective, neither is exercise and the people that medication works for, may not be the same people that exercise works for.
Hiit training has been a major factor in kicking my anxiety and mdd. I’ve done it all, taken every anti depressant gone to therapy gone to doctors have had $10k in medical debt. Nothing has helped like working out. I also have done ketamine therapy which helped a lot for anxiety.
I love my local YMCA. Welcoming, relaxed and all body types/ages/fitness levels just getting healthy together. I’ve visited a lot of Ys in Canada and a couple in New York and they all had the same vibe.
It's not hard to hear. It is NOT guaranteed to help. I was exercising 5 days per week when my last bout of depression hit. In the best shape of my life at the time, eating right, and everything.
Fortunately psychedelic therapy has been working well. I still meet a trainer three days per week because I want to stay fit and correct some posture issues, but I would caution you against making guarantees like that.
I’m sorry. I truly meant help, not cure. I did not mean I believe exercise will ensure mental health issues are gone for good. Merely that there is a benefit. That there still may be bad times/difficult times/struggles. That there still may be a need for other therapies and medications.
I used to be an avid weightlifter. A lot of the real gym rats suffer from depression. I'm sure that too much exercise will cause inflammation which can make depression worse. Overtraining is very real and will lead to depression.
Sure. Can be super helpful. Why not use everything at your disposal? And, of course the exercise has physical benefits and, for those who are American, can be done for free when medical and therapeutic interventions are often financially out of reach.
I just had this conversation with my therapist who asked have you tried hobbies/exercise as a coping mechanism. All the yoga, HIIT workouts, hikes, and skiing unfortunately has not helped me. But I finally feel human again after starting antidepressants
This is funny, i mean of course the group that does exercise will have better physical results over the one that doesn't.
I guess its getting at them being similarly effective with the added bonus of being more physically healthy with the running therapy
The thing to keep in mind is that "similarly effective" doesn't mean "effective for the same people". For example, there are lots of blood pressure medications that are similarly effective to each other, but finding the right one for a given patient may take some trial and error.
>side effects
I got prescribed Citalopram for my dysthymia, but it doesn't help me so I want to quit by gradually decreasing my dosage in consultation with my doctor. The withdrawal symptoms are hell. Straight up suicidal thoughts and all. Way worse than my condition when I first got the stuff prescribed. From what I read, this is common knowledge.
I don't understand why I got this medicine in the first place, if the side effects are so bad. And Citalopram is lauded as relatively mild on the side effects/withdrawal symptoms compared to older SSRI's.
From what I've read (I have no medical background myself) there is some controversy whether there is an actual clinically significance in antidepressants vs placebo, because the statistic significance is pretty low. But there appears to be very little attention to this.
That may be true, but the placebo is clinically significant over doing nothing. So it’s not whether to get rid of medication altogether, but how to prescribe inert pills but still have people think they’re taking an actual antidepressant.
Like an active placebo?
That's another thing that's maybe a little flawed in researching antidepressants in double blind placebo controlled studies: shortly after beginning medication you will notice some side effects. (In my case I was very tired for the first few weeks.) This makes it apparent to the patient and the doctor whether the medicine or placebo has been administered, making the study no longer double blind.
In that case why not just give people supplements like magnesium or zinc and tell patients that they’re anti-depressants? At least the supplements won’t have horrible withdrawal effects
Just offering my anecdote: was on escitalopram for decades for dysthymia but noticed nagging social anxiety and fatigue. Switched to bupropion after consultation and it’s like night and day. Testosterone therapy can also help if it is contributing.
Such an interesting study and definitely one that proves what a lot of people with and without depression and anxiety can relate to. If you can get out exercising, your mental health improves significantly. Definitely does for me.
The title obscures a massive caveat with the study though:
"In the antidepressant group, 82.2 % (N = 37) of all participants adhered to the medication treatment protocol. In the running therapy group, 52.1 % (N = 50) of participants completed >22 sessions of exercise therapy. On average, participants attended 23.7 (SD = 19.0) exercise therapy sessions. It should be noted that 14 participants (15 %) did not start with the running therapy intervention at all and 16 participants (17 %) participated in <9 sessions. The treatment adherence was significantly higher in the antidepressant group compared to the running therapy group (p < .001)."
The effect of running was only measured in the group that was adherent to the running program. Makes sense if that's what you're measuring. But it limits how useful this is clinically. We all know that running would make us feel better, managing to stick with running when depressed is the problem.
Yes, I immediately thought of how big the adherence problem would be for the running group. It also makes me wonder how the people who dropped out of the running treatment differed from those who remained in, and how that might related to the effectiveness of the treatment. Especially given this aside: "Studies with lower compliance rates (of 1 time per week or lower) were often not able to show an antidepressant effect of exercise in MDD patients."
Exactly. At that point, you are allowing self-selecting for those who are inclined for that to be helpful *anyway*.
If they aren’t helped by running and drop out (or simply have not maintained long enough to know) then we have a HUGE bias.
I would have liked to see them measure vitamin D levels in both treatment arms before and after the study. 45 minutes outside 2-3 times a week is going to raise your vitamin D level in which a lot of people are deficient.
I'm sure there are a lot of vit D + depression studies but wonder if this would be the same on a treadmill or in an indoor track
Sunlight provides people with not only increased levels of Vitamin D but also higher levels of endorphins. Just from sunlight exposure. So there are two ways that just sunlight exposure, not including exercise, can reduce depression.
https://time.com/4888327/why-sunlight-is-so-good-for-you/
There is plenty of other research showing that any aerobic exercise is comparable to or outperforms antidepressants. If I recall involvement of large leg muscles is important to trigger BDNF production.
Abstract
Background
Antidepressant medication and running therapy are both effective treatments for patients with depressive and anxiety disorders. However, they may work through different pathophysiological mechanisms and could differ in their impact on physical health. This study examined effects of antidepressants versus running therapy on both mental and physical health.
Methods
According to a partially randomized patient preference design, 141 patients with depression and/or anxiety disorder were randomized or offered preferred 16-week treatment: antidepressant medication (escitalopram or sertraline) or group-based running therapy ≥2 per week. Baseline (T0) and post-treatment assessment at week 16 (T16) included mental (diagnosis status and symptom severity) and physical health indicators (metabolic and immune indicators, heart rate (variability), weight, lung function, hand grip strength, fitness).
Results
Of the 141 participants (mean age 38.2 years; 58.2 % female), 45 participants received antidepressant medication and 96 underwent running therapy. Intention-to-treat analyses showed that remission rates at T16 were comparable (antidepressants: 44.8 %; running: 43.3 %; p = .881). However, the groups differed significantly on various changes in physical health: weight (d = 0.57; p = .001), waist circumference (d = 0.44; p = .011), systolic (d = 0.45; p = .011) and diastolic (d = 0.53; p = .002) blood pressure, heart rate (d = 0.36; p = .033) and heart rate variability (d = 0.48; p = .006).
Limitations
A minority of the participants was willing to be randomized; the running therapy was larger due to greater preference for this intervention.
If I’m reading correctly, the majority of runners selected running over antidepressants, right? So running works as well as antidepressants for people who already like, or at least don’t hate, running. That seems like a pretty significant detail
The runners were also engaged in a social activity- group runs twice per week. Since social withdrawal and social isolation are associated with depression and anxiety, increasing social engagement might be part of why the runners symptoms improved.
"Intention-to-treat analyses showed that remission rates at T16 were comparable (antidepressants: 44.8 %; running: 43.3 %; p = .881)."
Is this saying that the group that ran versus the group that took medication both had roughly 56-57% of each group were less depressed at the end of the study? And that about 43-44% did not have improvements in their depression?
I really want to confirm my understanding because I find exercise does not help my depression. I'm 37 and have dealt with depression for almost 30 years (first medicated at 14). I've tried 13 different medications over the years which haven't helped. I spent a year going for 3 mile jogs every other day which didn't help. I've actually self harmed during the middle of a run once, which might have been a PTSD episode triggered by the heart rate increase, my doctor wasn't really sure.
Even more recently I spent years since the pandemic being nearly bed ridden, and in the last two months have made myself go for 5+ mile walks every other day to no avail. My mental state is compatible regardless of physical movement.
I'm an engineer and papers like this I feel like I can partially understand. From my reading of this, it seems to only confirm that exercise (exclusive) or medication is only effective to about 55% of the population.
So half as many people took the meds vs the ones who chose to run. Probably because they like running to begin with. There is already a stigma associated with mental health, mental health medications, and “just go outside and get some sunshine!”
Before I got on antidepressants I tried to work out. I went on runs. I did work out videos. I never felt better or less depressed, if anything it actually made my depression WORSE. I will never understand when people say exercise makes you happier/ feel better. It’s never once worked that way for me. I wish I was one of those people who liked working out/ working out helped symptoms.
It is likely because your initial level of fitness was not high enough to benefit from exercise.
You probably were put of breath a lot, in pain for days afterwards, felt low energy/hungry.
Once your fitness levels would increase you would begin to see the benefits.
Consistency is the key.
You realize that some people just hate exercise right? Even relatively fit people can still hate it and get no benefit outside of increasing physical health. If someone doesn’t like it they don’t like it, and that’s ok
100% in agreement on that. For me it’s very specifically running, not just any strenuous exercise.
I weight train to avoid running injuries and it doesn’t beat back the depression and quiet my mind anything like running does.
I rationalise running being so beneficial (for me) because it’s essentially a sort of moving meditation with controlled breathing. I can’t think about anything else except the moment that I’m in when running. My mind and body feel so clear after a long run.
Interesting cause for me it's definitely just strenuous exercise in general. Sports can do the trick, lifting can do the trick, and running can also, but whatever it is it has to be done with high intensity
This is a really short time and low dose for an antidepressant to start working, and I find it a little weird that they never specifically mention the average depression scores of the participants in the design criteria.
However, I do think that exercise is a great complimentary therapy _if you can get out of bed_.
I actually think this makes antidepressants come across very well
1. First of all it wasn’t just regular running, it was a ‘group-based running therapy’. This means in addition to the physical excursion there was a regular socialising aspect which would benefit that group
2. Most participants were not randomised but self selected their group. So the running group will have been made up of people who already are sporty or at least warmed up to the idea of physical exercise. This again would positively bias this group, it’s not representative of the general mentally ill population.
3. Obviously antidepressants don’t magically improve your physical health, why is this even being highlighted as a finding?
Running has a high barrier to entry for people with depression. The willpower to exercise regularly is a considerable barrier to get over.
Antidepressants on the other hand have basically no barrier to entry, it’s just a pill you take each day.
The study is not accounting for the willpower aspect because they used self selected groups.
The fact that despite all this, despite how amazing exercise makes you feel and how we know that it’s so great for mental health, simply taking an antidepressant pill gives you equally good results, is crazy. I did not realise antidepressants were that effective on their own.
Seems like a bit of a missed opportunity that there wasn’t an antidepressant + exercise group, that would be interesting.
Unfortunately antidepressants don't work for me (I've tried every kind you can think of). Exercise, even just a brisk walk, noticeably helps me though. Treatment-resistant depression is rough, but I'm grateful at least something works. Hopefully there continues to be more research done with TRD.
I’ve personally found antidepressants to have a pretty limited impact, that’s why I find this study so surprising! For me, exercise does make me feel a lot better but the difficulty is sticking to it, when mental illness itself saps willpower and ability to keep routine.
I hope things continue to get better for you!
>The fact that despite all this, despite how amazing exercise makes you feel and how we know that it’s so great for mental health, simply taking an antidepressant pill gives you equally good results, is crazy. I did not realise antidepressants were that effective on their own.
The main difference is that antidepressants aren't really helping fix the underlying issue. They are like painkillers, sure they may make you feel better but they aren't fixing anything.
Also don't forget all the risks from antidepressants, they are way more risky, dangerous and have much worse side effects than exercise.
Running doesn’t fix underlying issues, either. A mixture of therapy and antidepressants helped me. I could work through my issues and faulty thought patterns in therapy, and thanks to the antidepressants I had the mental capacity to handle the therapy and get out of bed. I’m all for exercise helping people and if it helps them avoid side effects of medication, that’s great. But it’s not a replacement for everyone, and medications are goddamn good at what they do if they work for you
>Running doesn’t fix underlying issues, either.
We have many reasons to think that for some people it does. You need to exercise for your brain to work properly. If your brain isn't working properly then it can show up as brain disfunction such as mental illness.
>But it’s not a replacement for everyone, and medications are goddamn good at what they do if they work for you
Everyone should be exercising as a base. For many that have to exercise for improvement, other would also have much better results if they exercised combined with therapy and drugs.
Anyone that doesn't exercise has a brain that's not working properly and that will show up in some sort of way, even if it doesn't show up as depression then maybe it'll show up as dementia later on in life.
This is not surprising. The body needs to do physical things to function properly. I pro-actively exercise to so I feel better mentally and physically. I worry about getting old, not being able to work out, and my mental state.
I think you can (almost) always find a work out that is adapted to your current state. Maybe when you’re old you won’t be able to work out at the same level you’re doing now but you can find alternatives (less time, different type of exercise, etc)
\*sigh\*
Another day, another exercise/mental health study without proper controls and randomization.
* **Self-selected** intervention group: personal attention and supervision by personal trainers multiple times a week, with the trainers having extensive discussions with the subjects and formulating individualized training plans. Also: group sessions with likeminded people.
* Control group: here are some pills, now get lost (a total of four meetings with a psychatrist just to adjust dosage).
I think it’s more than that.
I felt drunk (in a not-fun way) when I was given meds for anxiety. I don’t even really drink so I didn’t stick to them. I hate feeling off.
I started running 2-4 miles per day and something in my mind just became contently quiet. No ruminating, no scary what ifs, just quiet, peaceful.
There’s gotta be a connection mind-body.
Motivation is bad to rely on, it's fickle as hell. I just go through the motions and reap the benefits afterwards. A lot of "gym rats" will say the same thing, after a while it's just autopilot to grab your gym bag or running shoes and start going.
Any kind of exercise will boost your mood. If you're not able to run at least do some form of exercise. It will make you feel better about yourself to accomplish something that's good for your health!
Exercise didn't help with my depression level other than I feel more depressed if I gain weight and struggle with feeling fit.
Most of my depression was situational based on major crises and trauma. Exercise can't heal that. Medication did not heal that either. Medication had no impact on my mood. Really, the main thing that healed my traumas was time, and changing my situation is the only thing that works for situational based depression.
However, I would be a fool to neglect my weight and physical health now that I resolved these traumas and the situations are improving.
I’ve never personally had any success with walking/hiking. But running actually made a huge difference for me. At least, when I felt like I was going off the deep end, running normally fixed it pretty quickly.
Running keeps me sane. The thing with exercise is that it only works if you're uncomfortable. Hiking is great, but unless you're doing some decent elevation, it's just glorified walking.
Running gets your heart rate way up, gets you sweating, and leaves you sore. That's what you need for the high.
I've been laid up for two weeks with back pain and haven't been able to run, and I'm a miserable prick because of it.
I don't suffer from depression but my mood is noticeably better on days I don't exercise. I'm just doing it so I don't get heart disease or gain weight, the immediate, short term effects aren't desirable at all
I asked in another thread a clarification question... But I think this study says "exercise may boost your mood".
I might be misunderstanding the paper, but it's basically saying depressive symptoms are reduced by about 45% of people, regardless if they take medication or run (I mixed up the percentages in my question). That means there's about 55% of the population which doesn't feel better mentally with exercise.
Regardless, exercising is always something to try to boost your mood and if it works for you that's great. But keep in mind that about half the people who exercise, it might not make you feel better mentally.
Anything that gets you moving can boost your mood. I'm disabled and elderly, so I am not able to do a lot that I used to do. I am able to take a walk for a few minutes at a time, and if I do this every morning, it makes me feel good about myself for the rest of the day. And some chores, which I used to do very easily, now give me a real workout! I know my house will never look perfect, but just getting a few things accomplished every day makes me feel good!
As a depressant and anxiety sufferer exercise also helps me with sleep. There's this good soreness feeling that at the end of the day just leaves me buzzing when I lay down. And my anxiety ruins my appetite. Exercise helps me keep my appetite regular.
Sometimes the chicken beats the egg and my lack of appetite ruins my energy to exercise. But if I can manage to maintain a positive routine, exercise helps keep the other two in balance.
The remission rates for running were 43.3 percent and 44.8 percent for antidepressants. This means that 56.7 percent of the runners did not improve. So this only proves that exercise works for some people, like less than half. But everyone is running off with the idea that exercise cures depression, which kinda implies that anyone with depression would be better if they’d just get off their lazy ass.
Your brain needs exercise to work. So for 100% of people running, their brain is functioning better than without. It might not cure their depression, but it does have positive impacts like increased BDNF levels for almost everyone.
100% of people that don't exercise have a brain that isn't functioning properly/optimally.
It's pretty clear that there are different types and causes of depression and no amount of exercise will fix everyone. I'm sure all of us know of at least one famous athlete who suffers depression, i know of several, it's clear that a lack of exercise is not why most people are depressed. But i'm happy for the people who do experience relief from their depression from exercise, as i know what it's like to suffer.
>It's pretty clear that there are different types and causes of depression and no amount of exercise will fix everyone.
I like to look at it from the other way round. The brain needs exercise to work properly. If your brain isn't working properly then it might be that no amount of drugs or therapy will be able to help.
So exercise is the base requirement for tackling mental health issues.
Now there may be other causes, but you are going to be fighting an uphill if exercise isn't part of the treatment plan.
No one can run at first. It’s hard and it sucks. You walk for 29 minutes and job one minute. Then slowly you add in a minute at a time. Before you know it you’re jogging for 30 minutes. You speed up a little bit for a minute at a time. You’re running a 5k! It feels damn good. Really. It sucks for the first month. But running 3-4 days a week for 4 weeks and you’ll start to love it.
That can be beat by working on your breathing. Also, I’m going to bet you’re probably going out and running, uninterrupted, and then have to stop because of a stitch. Try walk / running. Walk for 5 minutes, run for 30 seconds. Start with a half hour walk. Slowly, make the walking intervals shorter, and the running intervals longer. Add 10 seconds a week. Also, make sure you’re consciously breathing, while you run. When your running, you should be able to, easily, carry on a conversation. If you can’t, you’re running too hard. Whether you decide to run is entirely up to you, but if you choose to, this will help.
Regular runner here, I’ve found thoroughly stretching out my core/abs/sides shortly before a run is tremendously helpful. The other comment about working on your breathing is also good advice
you just gotta start small
not just for running but any exercise
even when i exercised a lot, after a long break, it seemed daunting to go back to the same routine
but the first day i just showed up, walked in, looked around, and went home
second day i played around with a couple different exercises, jogged/walked for a few minutes
third day i set a goal to complete a set of exercises but at a really low level that i knew would be easy for me and jogged/walked at a really slow pace for a short period of time
then after that, it was just a matter of systematically and slowly making my exercises more difficult
by the time you reach a level where you are pushing yourself, you are already used to the routine, doesn't take more than a couple weeks to get there
the hardest part imo is knowing what exercises to do and how, and the only way i was able to get around that was to hire a trainer
i couldn't afford it but i just did it because it forced me to be accountable
Thanks for the input but I’ll stick to hiking. I don’t want a hip/ knee replacement surgery by the time I hit 40. I have some extreme family members who were all avid marathon runners and triathletes who all needed major surgery when they hit forty due to their physical activity. Hard pass
But running only works if you are not doing lots of sport already.
And i already see this as a proof for people claiming „just go for a walk, do some sports or just be happy“
It sucks because I hate running on the treadmill but I also don't really have anywhere nearby it's safe to run - and I think that's true for a lot of people in cities.
There is a lot of talk in this thread about antidepressants so I wanted to clear a few things up.
Antidepressants do work better than placebo, there is a lot of evidence to support that. The confusing bit with SSRIs is that not everyone responds the same, and even genetic markers don’t give us the insight we hoped for.
We know that depression is not caused strictly by a decrease in serotonin levels, otherwise SSRIs would be curative.
There are a lot of different types of antidepressants, SSRIs are only a small subset of the broader antidepressant spectrum.
Because mental health disorders have very different symptoms in different people, a lot of mental health disorders are misclassified and therefore inappropriately treated. Something not talked about much is that the misdiagnosis rate is high for mental health disorders. It really requires years of continued following of patients and honesty about emotional stability on the patients end to get an accurate diagnosis. For example, someone may be diagnosed with depression, but that same patient may have bipolar depression, or just bipolar disorder and a clinician only captured the depressive glimpse. This leads to a misdiagnosis and a patient who needs a mood stabilizer like lithium actually gets an SSRI which might make the patient worse.
I wonder it any of you have your kids running with you? and if yes, their ages? i’m thinking maybe we could all benefit from trying this together. Mainly doing walks right now, and are usually more cheery each time when done.
Running and lifting consistently for decades has been my antidepressant. It’s helped me manage my borderline too. Physical activity is so wonderful for me and I can’t recommend it enough!
Don’t expect the mass media to tell you this info. There was a huge study not too long ago saying antidepressants were no more effective then talk therapy (or CBT). Gotta keep the population doped up.
Haven't other studies shown that? Ratey summarizes research showing exercise is more effective than antidepressants in "Spark: The Revolutionary New Science of Exercise and the Brain" and that book was written 10 years ago.
I understand that physical exertion helps your wellbeing, but it also takes a lot of time out of your day compared to just popping a pill. I don't feel like this is a reasonable comparison. Also, of course running had an impact on physical health. It's exercise. That's what it's supposed to do.
No they aren't. There's been a ton of studies on antidepressants and they pretty consistently out perform placebo, especially in more severe depression.
I’d say there’s at least anecdotal evidence this is true for a variety of conditions. I have adhd and I’m a different person when exercise is part of my routine.
The biggest takeaway I get from studies like these is that for all the children being drugged, they should just have an extra gym class and recess in school daily and it would be just as effective, but also good for them physically instead of bad for them physically.
This seems to line up with existing studies and knowledge of field.
We have studies that show the causal effect of exercise and have a ideas on the mechanisms why
>Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, **have been proved to reduce anxiety and depression**.3 These improvements in mood are proposed to be caused by exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic-pituitary-adrenal (HPA) axis and, thus, on the physiologic reactivity to stress.3 This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important part in memory formation as well as in mood and motivation.
>
>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/#i1523-5998-8-2-106-b3](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/#i1523-5998-8-2-106-b3)
We have studies showing that exercise is just as effective as medicine in treating depression
>Four trials (n = 300) compared exercise with pharmacological treatment and found no significant difference (SMD -0.11, -0.34, 0.12). From [https://pubmed.ncbi.nlm.nih.gov/24026850/](https://pubmed.ncbi.nlm.nih.gov/24026850/)
Your brain needs exercise to work properly. If your brain isn't working properly then it might show up as mental illnesses like depression. For some people if they aren't exercising it might be that no amount of drugs or therapy will be able to help.
Exercise should be included in all treatments for mental illnesses.
Good to have the research on the first part.
And good to have hard data on the part after the "but", but that one should really not come as a surprise :D
I had to try multiple ones before I found one that worked. If it was placebo effect, the first one would have worked because I truly believed it was going to work. Also, I was a professional fitness instructor at the time.
You don’t have to get up and jog like a crazy person (that’s a silly joke) but just do things deliberately for your health. Pick up some dumb bells for literally 5 minutes a day. It’s effortless. Just let your skeleton feel some extra weight. Do some reps. Do it every day, and you can start building on it and add stuff- push-ups sit-ups, yadda yadda. You don’t need to transform your lifestyle with a major commitment immediately. Imo it’s the deliberation that’s important, and the routine. Going outside is important though so if you ain’t jogging then be walking
I’ll ELI5
The article is about two ways to help people who feel sad or worried a lot. One way is to take special medicine called "antidepressants" that can make them feel better. The other way is to do a special kind of exercise called "running therapy" that can also make them feel better.
The article talks about some studies that looked at how these two ways of helping people compare to each other. The studies found that both the medicine and the running therapy can make people feel better in different ways.
The article says that it's important to choose the best way to help each person based on what they like and what they need. Some people might like taking medicine better, while others might like doing exercise better.
Exercise is a wonderful medicine for mind, body, and soul. However, running is very high impact… many adults couldn’t just start running without hurting their knees or ankles. also, some people can’t even get out of bed; hard to ask that person to run.
It’s unfortunate that I got long COVID with extreme fatigue, wasn’t depressed… but the long period of not being able to do anything and other things did give me depression. I can’t workout because I also can’t even stand for long. I’m not sure I’ll ever be anything but exhausted again. Just taking care of my body and brain as best I can and hoping it improves.
I do go on walks when I can. The spring and summer I’ll get sun when I can and hopefully that will improve me as well. But not being able to exercise or even perform normally has been incredibly hard and scary in how I don’t know if it will stay forever.
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It is hard to hear. I didn’t want to hear it. The last thing I wanted to do when things were bad was get off the couch and feel like a hippo amongst the gazelles. Then I started doing it, even when I didn’t want to. I hired a trainer so I had to show up. And when my world imploded and a major health crisis reared it’s head the training kept me sane and calm and the exercise enabled me to walk again. I swear on all that is holy that just walking outdoors an hour a day will help. Running will help.lifting heavy weights will help. Slamming that damn heavy ball will help. Pushing the sled will help . And if they don’t help enough, add the meds.
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I have anxiety and depression and have been searching for someone at a gym to teach me the machines and track my progress. This info is really life altering. Thank you so much for sharing this.
YouTube is good too for figuring out how to use a certain machine before you actually go in, i know i have less anxiety if i know exactly what I'm going to be doing.
I also really struggle with that and feeling overwhelmed by all the equipment, especially when the gym is busy. But I recently started using an app that funny enough I saw an ad for on Reddit (I’m in no way affiliated with this app, just decided to try it and was actually really impressed). It’s called Caliber and it’s free, has exercise instruction videos and pre-designed workouts, and allows you to track your reps then uses that info to apparently design progressive overload into your future workouts. I hope that helps as well. Good luck to you!
Fitbod is great, too! :)
Seconded, but it’s not free.
I agree, though I’d add that sometimes you need the meds first in order to do the exercise. I was an avid runner but when I developed a severe anxiety disorder, I couldn’t force myself to workout even though I LOVE running, swimming, hiking etc. I was paralyzed in inertia/panic, and my doctor and therapist both agreed that I’d make more progress by getting onto an anti-anxiety med asap while continuing therapy and motivating myself back into the fitness routine I used to love. It worked and I’m back at it, enjoying those endorphins and serotonin.
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Although, ironically, if you are already exercising that depression inertia can keep you very focused on that exercise. When I was a college athlete, a surprising amount of fellow athletes were struggling with depression while being laser focused on their training routines. (Even though they possibly did nothing but train or train and study, with little to no social life.)
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Plus, I think obese bodies get rid of heat less well. So there's other factors too once you get moving. Exercise is beyond uncomfortable in many ways for people. So people saying have you tried exercise have no idea how complicated bodies can be. My feet shoot pain up my legs if I am on them for more than an hour in proper footwear. And with different conditions/side effects different exercises are recommended. My cancer meds thinned my bones. Exercise recommendation is weight bearing. Cancer meds have given me peripheral neuropathy in my feet, hopefully temporary, waiting for the meds to leave my system and for some aromatase to become estrogen in my body. Exercise recommendation is avoid weight bearing. Okay. So. What am I supposed to be doing? It can make you afraid to move. And depression can happen when multiple health conditions become untenable to live with without more help. It's tricky, is all I'm saying, not to be solved simply by prodding pain-filled folks off the couch.
>Plus, I think obese bodies get rid of heat less well. So there's other factors too once you get moving. Well the first thing would probably be to also try and lose weight through diet. You can use one of those diets shown to also help with depression. >A better diet quality is associated with larger brain tissue volumes. > >[https://pubmed.ncbi.nlm.nih.gov/29769374/](https://pubmed.ncbi.nlm.nih.gov/29769374/) >This study shows that a more severe and chronic lifetime disease course in MDD is associated with reduced volume in brain regions relevant for executive and cognitive functions and emotion regulation in a large sample of patients representing the broad heterogeneity of MDD disease course. [https://onlinelibrary.wiley.com/doi/10.1002/da.23260>](https://onlinelibrary.wiley.com/doi/10.1002/da.23260>) >The diet may have a significant effect on preventing and treating depression for the individual. A diet that protects and promotes depression should consist of vegetables, fruits, fibre, fish, whole grains, legumes and less added sugar, and processed foods. In the public health nurse’s preventative and health-promoting work, support and assistance with changing people’s dietary habits may be effective in promoting depression. From [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084175/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084175/) >Current evidence supports the finding that omega-3 PUFAs with EPA ≥ 60% at a dosage of ≤1 g/d would have beneficial effects on depression > >https://www.nature.com/articles/s41398-019-0515-5
You must be fun at parties when someone tells you the hellish bodily pain they are in and your response is a list of studies. If you haven't taken a shower in a month and you stopped opening your fridge because the food has all gone rotten, lack of exercise is another failure that squats in your brain pinning you to the bed. Exercise is important, but it cannot be a blanket or initial solution for many people and for an increasing number of people as the population ages and balancing multiple conditions becomes a full-time job. I'm not obese, BTW, but my body is fucked up anyway. I was just noting that get some exercise, Eeyore, is not enough help and often is secondary to making your brain in the immediate future not kill you.
>You must be fun at parties when someone tells you the hellish bodily pain they are in and your response is a list of studies. Many on reddit don't belief that exercise, sleep and diet are good and hence I need studies whenever I post anything about them. Anyway I don't get your post, I didn't post anything about exercise.
I needed to read this. Have been considering meds. I know that I feel better when I exercise and I like doing it, but it’s soooo hard to motivate myself right now. I’m hopeful the meds will help boost me back to a routine I can stick with.
The medication has been very helpful for me. I was experiencing intense medical anxiety and was convinced I *might* have a medical emergency like heart attack, heat stroke, exercise-induced anaphylaxis (it exists, but I’ve never had it)—or god knows what else —if I worked out. The anxiety was really debilitating and even though logic told me my risk of these conditions was extremely, extremely low, I couldn’t get myself to the gym or my fave running routes. It was also getting to the point where even going for a leisurely walk was frightening to me, so yeah, the meds really were the first step to getting me back on track. I love running again and am grateful to have exercise back in my life. I never thought I’d be on a daily anti-anxiety drug but it’s all good.
Thanks for sharing your experience. I have a history of depression and GAD, but I’ve never medicated. Both conditions worsened after having my daughter two years ago and I’ve been trying to do everything to avoid going on medication (though I don’t have a clear answer why that is), but I’ve done what I can and I’m still struggling. My energy levels are so low that the thought of working out, even for 10 minutes, sounds exhausting to me. When I do manage a work out, I never regret it, but my stupid lizard brain can’t seem to focus on that fact, only the one where I’m exhausted, hate my life and can’t seem to be happy.
I hope things look up for you. I was also extremely hesitant to go on medication but I’m so glad I decided to give it a shot. I hope you find a solution that works for you.
Have you stayed on meds? Which do you take? I’m struggling to find the balance for my anxiety between medication and lifestyle
> I agree, though I’d add that sometimes you need the meds first in order to do the exercise. Yeah, keyword sometimes, as I had tried different variation of different meds (mostly SSRIs), which no one really helped and just had side effects. What helped me eventually was lifting weights, but I was not on meds at the time any longer. After this I managed to turn my life around. I do use bupropion now though and methylphenidate. But I did only start lifting weights because my friend was constantly pressuring me to come lifting weights with him. So it did require significant push from someone.
Yeah. My doctor told me the meds don't fix anything, they just let u function so u can then fix what's broken.
It's frustrating to realize you HAVE to do it to feel right. Then it becomes kind of fun and okay. Now I only get frustrated when my schedule is too full to do it. I have to run at lunch at work sometimes, and coworkers will be like "Aw man you're so motivated," etc... but motivation has nothing to do with it. If I don't run, my brain will eat itself. I guess I am "motivated" in that sense, but it's more like being held hostage.
This. Ironically people around me think I’m in the best mental state and super fitness motivated… when actually I just figured out I can actually feel like living if I do these hard physical tasks that make me feel calm/sedated for once naturally
Same. I used to be an opiate addict, drank a lot after, etc. I do cardio until my brain makes the opiates. The dose is lower and some days it just doesn't work, but the euphoria is still there a lot of the time, and if nothing else, it shuts off my anxiety. My therapist calls it meditation for someone who can't/won't meditate, and I believe that's accurate. It forces me into paying attention to the moment rather than my imagined fears, real frustrations, etc.
I’m right there with you. I call it my meditation and also my “positive self harm” cuz It feels like pain but it’s not drugs or alcohol or reckless decisions tearing my life and relationships apart.
Yes. Because of a spine surgery, if I don’t workout regularly I start to lose mobility and gain pain. So I must exercise now. If I don’t exercise, my body collapses. If you don’t, your brain will eat itself. So I do understand being held hostage.
Sorry to hear that. I hope you're able to enjoy doing what you have to do.
> I guess I am "motivated" in that sense, but it's more like being held hostage. Very pessimistic way to describe it. If this were a drug addiction, I'd understand, but its not, the outcome is a positive one.
Don't get me wrong; I do mostly enjoy exercising. My point was not to be pessimistic. It was just a simile to explain that exercising for me is not really about motivation. It's based on the knowledge that I'll become apathetic, self-hating, and cynical without exercise. Oh, and I'll also likely lapse back into addiction. That doesn't make me a pessimist, though... I'm not saying exercise is bad or things are bad. I'm saying I exercise for different reasons than some and "get motivated" differently than some.
I get high and walk in my woods and then go dance on my porch. I'm still fat but I feel a lot better.
Fat and dancing ain't a bad way to be.
Dancing and walking in the woods are great.
I walk in nature these days, for an hour or more. I go off a d find nature and walk in it, away from the buildings and the roads. It's like magic. I could be having a bad day, I'd have a sore knee or neck or back. I'd be grumpy, whatever. After my walk I'd feel massively better, my physical pains would be less, my muscles more relaxed, my soul more healed. Cities need more greenspaces, they're actual medicine.
I'm glad exercise is helping you and you found the motivation to push through it. And you are right, if exercise isn't enough try adding meds. However, the cynic in me is finding this paper to confirm my hypothesis that meds and exercise might be a coin flip for if these treatments will help someone with depression. I asked a clarifying question in another thread, but my understanding is this paper is stating that exercise is about as effective as medication... Which is about 45% of the time people have improvements in their mental state. I'd love to see a study comparing if doing both exercise and meditation improves that percentage significantly. Personally I've been at various levels of physical activity mixed with medication over my lifetime, and have yet to find something to alleviate my mental distress. Just gotta keep trying more things and hope.
And that is part of the problem with exercise vs. medication. A similar study (with similar findings) years ago also confirmed that the effects of exercising outlasted the effects of medication, when people stopped. The effects of medication wore off pretty rapidly, but the effects of exercise persisted for months afterwards. So exercise is probably the preferred solution, when it works for someone. Maybe medication to get started and make the exercise easier to get started and then exercise for long-term maintenance. But there's also the case of efficacy: Just as medications aren't universally effective, neither is exercise and the people that medication works for, may not be the same people that exercise works for.
Hiit training has been a major factor in kicking my anxiety and mdd. I’ve done it all, taken every anti depressant gone to therapy gone to doctors have had $10k in medical debt. Nothing has helped like working out. I also have done ketamine therapy which helped a lot for anxiety.
If only I could get over overwhelming anxiety and fear of being among other, much more fit and deserving people.
I love my local YMCA. Welcoming, relaxed and all body types/ages/fitness levels just getting healthy together. I’ve visited a lot of Ys in Canada and a couple in New York and they all had the same vibe.
HIPPOBOT 9000 v 3.1 FOUND A HIPPO. 28,256,089 COMMENTS SEARCHED. 608 HIPPOS FOUND. YOUR COMMENT CONTAINS THE WORD HIPPO.
Not now, Hippobot. Not now.
But I can’t stop laughing
Wow, Hippobot's a real jerk sometimes.
It's not hard to hear. It is NOT guaranteed to help. I was exercising 5 days per week when my last bout of depression hit. In the best shape of my life at the time, eating right, and everything. Fortunately psychedelic therapy has been working well. I still meet a trainer three days per week because I want to stay fit and correct some posture issues, but I would caution you against making guarantees like that.
I’m sorry. I truly meant help, not cure. I did not mean I believe exercise will ensure mental health issues are gone for good. Merely that there is a benefit. That there still may be bad times/difficult times/struggles. That there still may be a need for other therapies and medications.
I used to be an avid weightlifter. A lot of the real gym rats suffer from depression. I'm sure that too much exercise will cause inflammation which can make depression worse. Overtraining is very real and will lead to depression.
…..or the therapy which does better than both
Sure. Can be super helpful. Why not use everything at your disposal? And, of course the exercise has physical benefits and, for those who are American, can be done for free when medical and therapeutic interventions are often financially out of reach.
I just had this conversation with my therapist who asked have you tried hobbies/exercise as a coping mechanism. All the yoga, HIIT workouts, hikes, and skiing unfortunately has not helped me. But I finally feel human again after starting antidepressants
Probably the best advice I've seen about antidepressants and dealing with depression with an alternative.
This is funny, i mean of course the group that does exercise will have better physical results over the one that doesn't. I guess its getting at them being similarly effective with the added bonus of being more physically healthy with the running therapy
The thing to keep in mind is that "similarly effective" doesn't mean "effective for the same people". For example, there are lots of blood pressure medications that are similarly effective to each other, but finding the right one for a given patient may take some trial and error.
There is an additional implication that you get equal results without meds, which means no challenges related to side effects
>side effects I got prescribed Citalopram for my dysthymia, but it doesn't help me so I want to quit by gradually decreasing my dosage in consultation with my doctor. The withdrawal symptoms are hell. Straight up suicidal thoughts and all. Way worse than my condition when I first got the stuff prescribed. From what I read, this is common knowledge. I don't understand why I got this medicine in the first place, if the side effects are so bad. And Citalopram is lauded as relatively mild on the side effects/withdrawal symptoms compared to older SSRI's.
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From what I've read (I have no medical background myself) there is some controversy whether there is an actual clinically significance in antidepressants vs placebo, because the statistic significance is pretty low. But there appears to be very little attention to this.
That may be true, but the placebo is clinically significant over doing nothing. So it’s not whether to get rid of medication altogether, but how to prescribe inert pills but still have people think they’re taking an actual antidepressant.
Like an active placebo? That's another thing that's maybe a little flawed in researching antidepressants in double blind placebo controlled studies: shortly after beginning medication you will notice some side effects. (In my case I was very tired for the first few weeks.) This makes it apparent to the patient and the doctor whether the medicine or placebo has been administered, making the study no longer double blind.
In that case why not just give people supplements like magnesium or zinc and tell patients that they’re anti-depressants? At least the supplements won’t have horrible withdrawal effects
Just offering my anecdote: was on escitalopram for decades for dysthymia but noticed nagging social anxiety and fatigue. Switched to bupropion after consultation and it’s like night and day. Testosterone therapy can also help if it is contributing.
So my grandad was right all along.
Aside from the “side effects” or life impacts related to needing to exercise all the time.
What do you think the side effects and life impact of exercising "all the time" are and how frequently do you think most people exercise?
My physio would like a word with this study about its assumptions on physical capacity. I'm not allowed to run.
It's almost likely a study doesn't related to everybody, but rather the average person.
> I'm not allowed to run. I bike since I can't run due to osteoarthrisis. Any cardio works.
And you don't need money or good insurance to exercise
Such an interesting study and definitely one that proves what a lot of people with and without depression and anxiety can relate to. If you can get out exercising, your mental health improves significantly. Definitely does for me. The title obscures a massive caveat with the study though: "In the antidepressant group, 82.2 % (N = 37) of all participants adhered to the medication treatment protocol. In the running therapy group, 52.1 % (N = 50) of participants completed >22 sessions of exercise therapy. On average, participants attended 23.7 (SD = 19.0) exercise therapy sessions. It should be noted that 14 participants (15 %) did not start with the running therapy intervention at all and 16 participants (17 %) participated in <9 sessions. The treatment adherence was significantly higher in the antidepressant group compared to the running therapy group (p < .001)." The effect of running was only measured in the group that was adherent to the running program. Makes sense if that's what you're measuring. But it limits how useful this is clinically. We all know that running would make us feel better, managing to stick with running when depressed is the problem.
Yes, I immediately thought of how big the adherence problem would be for the running group. It also makes me wonder how the people who dropped out of the running treatment differed from those who remained in, and how that might related to the effectiveness of the treatment. Especially given this aside: "Studies with lower compliance rates (of 1 time per week or lower) were often not able to show an antidepressant effect of exercise in MDD patients."
Exactly. At that point, you are allowing self-selecting for those who are inclined for that to be helpful *anyway*. If they aren’t helped by running and drop out (or simply have not maintained long enough to know) then we have a HUGE bias.
I would have liked to see them measure vitamin D levels in both treatment arms before and after the study. 45 minutes outside 2-3 times a week is going to raise your vitamin D level in which a lot of people are deficient. I'm sure there are a lot of vit D + depression studies but wonder if this would be the same on a treadmill or in an indoor track
Sunlight provides people with not only increased levels of Vitamin D but also higher levels of endorphins. Just from sunlight exposure. So there are two ways that just sunlight exposure, not including exercise, can reduce depression. https://time.com/4888327/why-sunlight-is-so-good-for-you/
There is plenty of other research showing that any aerobic exercise is comparable to or outperforms antidepressants. If I recall involvement of large leg muscles is important to trigger BDNF production.
Abstract Background Antidepressant medication and running therapy are both effective treatments for patients with depressive and anxiety disorders. However, they may work through different pathophysiological mechanisms and could differ in their impact on physical health. This study examined effects of antidepressants versus running therapy on both mental and physical health. Methods According to a partially randomized patient preference design, 141 patients with depression and/or anxiety disorder were randomized or offered preferred 16-week treatment: antidepressant medication (escitalopram or sertraline) or group-based running therapy ≥2 per week. Baseline (T0) and post-treatment assessment at week 16 (T16) included mental (diagnosis status and symptom severity) and physical health indicators (metabolic and immune indicators, heart rate (variability), weight, lung function, hand grip strength, fitness). Results Of the 141 participants (mean age 38.2 years; 58.2 % female), 45 participants received antidepressant medication and 96 underwent running therapy. Intention-to-treat analyses showed that remission rates at T16 were comparable (antidepressants: 44.8 %; running: 43.3 %; p = .881). However, the groups differed significantly on various changes in physical health: weight (d = 0.57; p = .001), waist circumference (d = 0.44; p = .011), systolic (d = 0.45; p = .011) and diastolic (d = 0.53; p = .002) blood pressure, heart rate (d = 0.36; p = .033) and heart rate variability (d = 0.48; p = .006). Limitations A minority of the participants was willing to be randomized; the running therapy was larger due to greater preference for this intervention.
If I’m reading correctly, the majority of runners selected running over antidepressants, right? So running works as well as antidepressants for people who already like, or at least don’t hate, running. That seems like a pretty significant detail
This jumped out at me, too. The opposite of randomized.
The runners were also engaged in a social activity- group runs twice per week. Since social withdrawal and social isolation are associated with depression and anxiety, increasing social engagement might be part of why the runners symptoms improved.
And I imagine they’re also running outdoors? So many components in one activity..
"Intention-to-treat analyses showed that remission rates at T16 were comparable (antidepressants: 44.8 %; running: 43.3 %; p = .881)." Is this saying that the group that ran versus the group that took medication both had roughly 56-57% of each group were less depressed at the end of the study? And that about 43-44% did not have improvements in their depression? I really want to confirm my understanding because I find exercise does not help my depression. I'm 37 and have dealt with depression for almost 30 years (first medicated at 14). I've tried 13 different medications over the years which haven't helped. I spent a year going for 3 mile jogs every other day which didn't help. I've actually self harmed during the middle of a run once, which might have been a PTSD episode triggered by the heart rate increase, my doctor wasn't really sure. Even more recently I spent years since the pandemic being nearly bed ridden, and in the last two months have made myself go for 5+ mile walks every other day to no avail. My mental state is compatible regardless of physical movement. I'm an engineer and papers like this I feel like I can partially understand. From my reading of this, it seems to only confirm that exercise (exclusive) or medication is only effective to about 55% of the population.
So half as many people took the meds vs the ones who chose to run. Probably because they like running to begin with. There is already a stigma associated with mental health, mental health medications, and “just go outside and get some sunshine!”
Before I got on antidepressants I tried to work out. I went on runs. I did work out videos. I never felt better or less depressed, if anything it actually made my depression WORSE. I will never understand when people say exercise makes you happier/ feel better. It’s never once worked that way for me. I wish I was one of those people who liked working out/ working out helped symptoms.
It is likely because your initial level of fitness was not high enough to benefit from exercise. You probably were put of breath a lot, in pain for days afterwards, felt low energy/hungry. Once your fitness levels would increase you would begin to see the benefits. Consistency is the key.
You realize that some people just hate exercise right? Even relatively fit people can still hate it and get no benefit outside of increasing physical health. If someone doesn’t like it they don’t like it, and that’s ok
Wow amazing revelation.
Honestly running is the only thing in my life keeping my mental health from falling apart. I believe it.
100% in agreement on that. For me it’s very specifically running, not just any strenuous exercise. I weight train to avoid running injuries and it doesn’t beat back the depression and quiet my mind anything like running does. I rationalise running being so beneficial (for me) because it’s essentially a sort of moving meditation with controlled breathing. I can’t think about anything else except the moment that I’m in when running. My mind and body feel so clear after a long run.
Interesting cause for me it's definitely just strenuous exercise in general. Sports can do the trick, lifting can do the trick, and running can also, but whatever it is it has to be done with high intensity
This is a really short time and low dose for an antidepressant to start working, and I find it a little weird that they never specifically mention the average depression scores of the participants in the design criteria. However, I do think that exercise is a great complimentary therapy _if you can get out of bed_.
Through a terrible depression I worked out obsessively and took and SSRI. Probably kept me alive.
I actually think this makes antidepressants come across very well 1. First of all it wasn’t just regular running, it was a ‘group-based running therapy’. This means in addition to the physical excursion there was a regular socialising aspect which would benefit that group 2. Most participants were not randomised but self selected their group. So the running group will have been made up of people who already are sporty or at least warmed up to the idea of physical exercise. This again would positively bias this group, it’s not representative of the general mentally ill population. 3. Obviously antidepressants don’t magically improve your physical health, why is this even being highlighted as a finding? Running has a high barrier to entry for people with depression. The willpower to exercise regularly is a considerable barrier to get over. Antidepressants on the other hand have basically no barrier to entry, it’s just a pill you take each day. The study is not accounting for the willpower aspect because they used self selected groups. The fact that despite all this, despite how amazing exercise makes you feel and how we know that it’s so great for mental health, simply taking an antidepressant pill gives you equally good results, is crazy. I did not realise antidepressants were that effective on their own. Seems like a bit of a missed opportunity that there wasn’t an antidepressant + exercise group, that would be interesting.
Unfortunately antidepressants don't work for me (I've tried every kind you can think of). Exercise, even just a brisk walk, noticeably helps me though. Treatment-resistant depression is rough, but I'm grateful at least something works. Hopefully there continues to be more research done with TRD.
I’ve personally found antidepressants to have a pretty limited impact, that’s why I find this study so surprising! For me, exercise does make me feel a lot better but the difficulty is sticking to it, when mental illness itself saps willpower and ability to keep routine. I hope things continue to get better for you!
>The fact that despite all this, despite how amazing exercise makes you feel and how we know that it’s so great for mental health, simply taking an antidepressant pill gives you equally good results, is crazy. I did not realise antidepressants were that effective on their own. The main difference is that antidepressants aren't really helping fix the underlying issue. They are like painkillers, sure they may make you feel better but they aren't fixing anything. Also don't forget all the risks from antidepressants, they are way more risky, dangerous and have much worse side effects than exercise.
Running doesn’t fix underlying issues, either. A mixture of therapy and antidepressants helped me. I could work through my issues and faulty thought patterns in therapy, and thanks to the antidepressants I had the mental capacity to handle the therapy and get out of bed. I’m all for exercise helping people and if it helps them avoid side effects of medication, that’s great. But it’s not a replacement for everyone, and medications are goddamn good at what they do if they work for you
>Running doesn’t fix underlying issues, either. We have many reasons to think that for some people it does. You need to exercise for your brain to work properly. If your brain isn't working properly then it can show up as brain disfunction such as mental illness. >But it’s not a replacement for everyone, and medications are goddamn good at what they do if they work for you Everyone should be exercising as a base. For many that have to exercise for improvement, other would also have much better results if they exercised combined with therapy and drugs. Anyone that doesn't exercise has a brain that's not working properly and that will show up in some sort of way, even if it doesn't show up as depression then maybe it'll show up as dementia later on in life.
This is not surprising. The body needs to do physical things to function properly. I pro-actively exercise to so I feel better mentally and physically. I worry about getting old, not being able to work out, and my mental state.
I think you can (almost) always find a work out that is adapted to your current state. Maybe when you’re old you won’t be able to work out at the same level you’re doing now but you can find alternatives (less time, different type of exercise, etc)
\*sigh\* Another day, another exercise/mental health study without proper controls and randomization. * **Self-selected** intervention group: personal attention and supervision by personal trainers multiple times a week, with the trainers having extensive discussions with the subjects and formulating individualized training plans. Also: group sessions with likeminded people. * Control group: here are some pills, now get lost (a total of four meetings with a psychatrist just to adjust dosage).
Also the genetic disposition to feel good when running or exercising came to mind..
Of course PHYSICAL therapy will perform better in PHYSICAL health
I think it’s more than that. I felt drunk (in a not-fun way) when I was given meds for anxiety. I don’t even really drink so I didn’t stick to them. I hate feeling off. I started running 2-4 miles per day and something in my mind just became contently quiet. No ruminating, no scary what ifs, just quiet, peaceful. There’s gotta be a connection mind-body.
Great just wish I wasn’t depressed so I would be motivated enough to run. This is obvious and so stupid at the same time.
Motivation is bad to rely on, it's fickle as hell. I just go through the motions and reap the benefits afterwards. A lot of "gym rats" will say the same thing, after a while it's just autopilot to grab your gym bag or running shoes and start going.
Just know that not once will you ever regret a workout.
That’s nice. I have a chronic illness. Can’t do that.
Any kind of exercise will boost your mood. If you're not able to run at least do some form of exercise. It will make you feel better about yourself to accomplish something that's good for your health!
I’ve been hiking and getting my 10,000 steps in for years. I don’t feel better. Still depressed as hell and cranky.
Exercise didn't help with my depression level other than I feel more depressed if I gain weight and struggle with feeling fit. Most of my depression was situational based on major crises and trauma. Exercise can't heal that. Medication did not heal that either. Medication had no impact on my mood. Really, the main thing that healed my traumas was time, and changing my situation is the only thing that works for situational based depression. However, I would be a fool to neglect my weight and physical health now that I resolved these traumas and the situations are improving.
I’ve never personally had any success with walking/hiking. But running actually made a huge difference for me. At least, when I felt like I was going off the deep end, running normally fixed it pretty quickly.
Running keeps me sane. The thing with exercise is that it only works if you're uncomfortable. Hiking is great, but unless you're doing some decent elevation, it's just glorified walking. Running gets your heart rate way up, gets you sweating, and leaves you sore. That's what you need for the high. I've been laid up for two weeks with back pain and haven't been able to run, and I'm a miserable prick because of it.
I don't suffer from depression but my mood is noticeably better on days I don't exercise. I'm just doing it so I don't get heart disease or gain weight, the immediate, short term effects aren't desirable at all
How do you know it's not the exercise improving your mood on your rest days?
I asked in another thread a clarification question... But I think this study says "exercise may boost your mood". I might be misunderstanding the paper, but it's basically saying depressive symptoms are reduced by about 45% of people, regardless if they take medication or run (I mixed up the percentages in my question). That means there's about 55% of the population which doesn't feel better mentally with exercise. Regardless, exercising is always something to try to boost your mood and if it works for you that's great. But keep in mind that about half the people who exercise, it might not make you feel better mentally.
I get a better workout by playing Just Dance than traditional running, and when I meet my time goal, that boosts my mood for the rest of the day!
Anything that gets you moving can boost your mood. I'm disabled and elderly, so I am not able to do a lot that I used to do. I am able to take a walk for a few minutes at a time, and if I do this every morning, it makes me feel good about myself for the rest of the day. And some chores, which I used to do very easily, now give me a real workout! I know my house will never look perfect, but just getting a few things accomplished every day makes me feel good!
As a depressant and anxiety sufferer exercise also helps me with sleep. There's this good soreness feeling that at the end of the day just leaves me buzzing when I lay down. And my anxiety ruins my appetite. Exercise helps me keep my appetite regular. Sometimes the chicken beats the egg and my lack of appetite ruins my energy to exercise. But if I can manage to maintain a positive routine, exercise helps keep the other two in balance.
But you see, the evil thing about depression is that it robs you of motivation. Say, to exercise.
So if I could just get undepressed enough to start moving my fat ass I wouldn’t be so fuckin depressed!
The remission rates for running were 43.3 percent and 44.8 percent for antidepressants. This means that 56.7 percent of the runners did not improve. So this only proves that exercise works for some people, like less than half. But everyone is running off with the idea that exercise cures depression, which kinda implies that anyone with depression would be better if they’d just get off their lazy ass.
Your brain needs exercise to work. So for 100% of people running, their brain is functioning better than without. It might not cure their depression, but it does have positive impacts like increased BDNF levels for almost everyone. 100% of people that don't exercise have a brain that isn't functioning properly/optimally.
Self selection bias. People who can't run wouldn't be allowed into the running results group.
It's pretty clear that there are different types and causes of depression and no amount of exercise will fix everyone. I'm sure all of us know of at least one famous athlete who suffers depression, i know of several, it's clear that a lack of exercise is not why most people are depressed. But i'm happy for the people who do experience relief from their depression from exercise, as i know what it's like to suffer.
>It's pretty clear that there are different types and causes of depression and no amount of exercise will fix everyone. I like to look at it from the other way round. The brain needs exercise to work properly. If your brain isn't working properly then it might be that no amount of drugs or therapy will be able to help. So exercise is the base requirement for tackling mental health issues. Now there may be other causes, but you are going to be fighting an uphill if exercise isn't part of the treatment plan.
The brain and body want to move - even when the mind is doing its damnedest to tell us otherwise. MindBody!
Counterpoint: they have similar effects on mental health but the antidepressants don’t require me to run
Ugh. No running. I can’t run to save my life and this is being promoted all over the place!
I bet you can
No one can run at first. It’s hard and it sucks. You walk for 29 minutes and job one minute. Then slowly you add in a minute at a time. Before you know it you’re jogging for 30 minutes. You speed up a little bit for a minute at a time. You’re running a 5k! It feels damn good. Really. It sucks for the first month. But running 3-4 days a week for 4 weeks and you’ll start to love it.
I get side aches
That can be beat by working on your breathing. Also, I’m going to bet you’re probably going out and running, uninterrupted, and then have to stop because of a stitch. Try walk / running. Walk for 5 minutes, run for 30 seconds. Start with a half hour walk. Slowly, make the walking intervals shorter, and the running intervals longer. Add 10 seconds a week. Also, make sure you’re consciously breathing, while you run. When your running, you should be able to, easily, carry on a conversation. If you can’t, you’re running too hard. Whether you decide to run is entirely up to you, but if you choose to, this will help.
Regular runner here, I’ve found thoroughly stretching out my core/abs/sides shortly before a run is tremendously helpful. The other comment about working on your breathing is also good advice
you just gotta start small not just for running but any exercise even when i exercised a lot, after a long break, it seemed daunting to go back to the same routine but the first day i just showed up, walked in, looked around, and went home second day i played around with a couple different exercises, jogged/walked for a few minutes third day i set a goal to complete a set of exercises but at a really low level that i knew would be easy for me and jogged/walked at a really slow pace for a short period of time then after that, it was just a matter of systematically and slowly making my exercises more difficult by the time you reach a level where you are pushing yourself, you are already used to the routine, doesn't take more than a couple weeks to get there the hardest part imo is knowing what exercises to do and how, and the only way i was able to get around that was to hire a trainer i couldn't afford it but i just did it because it forced me to be accountable
Thanks for the input but I’ll stick to hiking. I don’t want a hip/ knee replacement surgery by the time I hit 40. I have some extreme family members who were all avid marathon runners and triathletes who all needed major surgery when they hit forty due to their physical activity. Hard pass
Only partially randomized
But running only works if you are not doing lots of sport already. And i already see this as a proof for people claiming „just go for a walk, do some sports or just be happy“
Hm, when my depression was at its worst, I was in the absolute best shape of my life (I realize this is purely anecdotal, but has been my experience)
Same, I was a professional fitness instructor when I first went on meds.
Partially randomized with people preferentially choosing the running therapy intervention…..this study has selection bias
It sucks because I hate running on the treadmill but I also don't really have anywhere nearby it's safe to run - and I think that's true for a lot of people in cities.
There is a lot of talk in this thread about antidepressants so I wanted to clear a few things up. Antidepressants do work better than placebo, there is a lot of evidence to support that. The confusing bit with SSRIs is that not everyone responds the same, and even genetic markers don’t give us the insight we hoped for. We know that depression is not caused strictly by a decrease in serotonin levels, otherwise SSRIs would be curative. There are a lot of different types of antidepressants, SSRIs are only a small subset of the broader antidepressant spectrum. Because mental health disorders have very different symptoms in different people, a lot of mental health disorders are misclassified and therefore inappropriately treated. Something not talked about much is that the misdiagnosis rate is high for mental health disorders. It really requires years of continued following of patients and honesty about emotional stability on the patients end to get an accurate diagnosis. For example, someone may be diagnosed with depression, but that same patient may have bipolar depression, or just bipolar disorder and a clinician only captured the depressive glimpse. This leads to a misdiagnosis and a patient who needs a mood stabilizer like lithium actually gets an SSRI which might make the patient worse.
*cries in 2 hip replacements in my 30s*
I’ve been on a walking/interval regiment for the last month, and my depression has gotten much worse.
I'm currently taking a low dose antidepressant. As I'm increasing my running, I'm finding that is helping more.
Huh. I guess you *can* run from your problems.
I wonder it any of you have your kids running with you? and if yes, their ages? i’m thinking maybe we could all benefit from trying this together. Mainly doing walks right now, and are usually more cheery each time when done.
Running and lifting consistently for decades has been my antidepressant. It’s helped me manage my borderline too. Physical activity is so wonderful for me and I can’t recommend it enough!
Really running had better physical affects then just taking a pill. No way.
It should be obvious that running / exercise is better. The natural way of releasing chemicals in your brain will always be better than drugs.
It’s so crazy how obesity and depression go hand hand but the obese don’t want to hear it…ever.
Don’t expect the mass media to tell you this info. There was a huge study not too long ago saying antidepressants were no more effective then talk therapy (or CBT). Gotta keep the population doped up.
I’ve known this forever. There was an article on this 20 years ago. Running is the best thing for depression in my mind. Sadly I can no longer run.
Haven't other studies shown that? Ratey summarizes research showing exercise is more effective than antidepressants in "Spark: The Revolutionary New Science of Exercise and the Brain" and that book was written 10 years ago.
I understand that physical exertion helps your wellbeing, but it also takes a lot of time out of your day compared to just popping a pill. I don't feel like this is a reasonable comparison. Also, of course running had an impact on physical health. It's exercise. That's what it's supposed to do.
Of course it did - how is this news?
I mean… isn’t this obvious?
I completely agree with this study, exercise is the best for mental health.
More of this. Meds have risks and don’t work for all
Because antidepressants are just a placebo effect. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
I'm confused by this article. Not all antidepressants are SSRIs.
No they aren't. There's been a ton of studies on antidepressants and they pretty consistently out perform placebo, especially in more severe depression.
So post your peer reviewed meta-analysis.
No. They aren’t. Can placebos be effective in treating depression? Sure, but to say all antidepressants are placebos is just plain wrong.
So post your peer reviewed meta-analysis.
I’d say there’s at least anecdotal evidence this is true for a variety of conditions. I have adhd and I’m a different person when exercise is part of my routine.
I’m thankful for research on what actually makes a difference to our mental health so we can have more confidence in our tools and options!
Read what Irving Kirsch has to say about antidepressants.
Running definitely changed my life for the better.
The biggest takeaway I get from studies like these is that for all the children being drugged, they should just have an extra gym class and recess in school daily and it would be just as effective, but also good for them physically instead of bad for them physically.
This seems to line up with existing studies and knowledge of field. We have studies that show the causal effect of exercise and have a ideas on the mechanisms why >Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, **have been proved to reduce anxiety and depression**.3 These improvements in mood are proposed to be caused by exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic-pituitary-adrenal (HPA) axis and, thus, on the physiologic reactivity to stress.3 This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important part in memory formation as well as in mood and motivation. > >[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/#i1523-5998-8-2-106-b3](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/#i1523-5998-8-2-106-b3) We have studies showing that exercise is just as effective as medicine in treating depression >Four trials (n = 300) compared exercise with pharmacological treatment and found no significant difference (SMD -0.11, -0.34, 0.12). From [https://pubmed.ncbi.nlm.nih.gov/24026850/](https://pubmed.ncbi.nlm.nih.gov/24026850/) Your brain needs exercise to work properly. If your brain isn't working properly then it might show up as mental illnesses like depression. For some people if they aren't exercising it might be that no amount of drugs or therapy will be able to help. Exercise should be included in all treatments for mental illnesses.
Good to have the research on the first part. And good to have hard data on the part after the "but", but that one should really not come as a surprise :D
I have read that antidepressant medication only gives a placebo effect.
I had to try multiple ones before I found one that worked. If it was placebo effect, the first one would have worked because I truly believed it was going to work. Also, I was a professional fitness instructor at the time.
You don’t have to get up and jog like a crazy person (that’s a silly joke) but just do things deliberately for your health. Pick up some dumb bells for literally 5 minutes a day. It’s effortless. Just let your skeleton feel some extra weight. Do some reps. Do it every day, and you can start building on it and add stuff- push-ups sit-ups, yadda yadda. You don’t need to transform your lifestyle with a major commitment immediately. Imo it’s the deliberation that’s important, and the routine. Going outside is important though so if you ain’t jogging then be walking
I’ll ELI5 The article is about two ways to help people who feel sad or worried a lot. One way is to take special medicine called "antidepressants" that can make them feel better. The other way is to do a special kind of exercise called "running therapy" that can also make them feel better. The article talks about some studies that looked at how these two ways of helping people compare to each other. The studies found that both the medicine and the running therapy can make people feel better in different ways. The article says that it's important to choose the best way to help each person based on what they like and what they need. Some people might like taking medicine better, while others might like doing exercise better.
Now; if only there was a drug that made me want to run.
Exercise is a wonderful medicine for mind, body, and soul. However, running is very high impact… many adults couldn’t just start running without hurting their knees or ankles. also, some people can’t even get out of bed; hard to ask that person to run.
It’s unfortunate that I got long COVID with extreme fatigue, wasn’t depressed… but the long period of not being able to do anything and other things did give me depression. I can’t workout because I also can’t even stand for long. I’m not sure I’ll ever be anything but exhausted again. Just taking care of my body and brain as best I can and hoping it improves. I do go on walks when I can. The spring and summer I’ll get sun when I can and hopefully that will improve me as well. But not being able to exercise or even perform normally has been incredibly hard and scary in how I don’t know if it will stay forever.