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Exercise can be nearly as effective as therapy for depression

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Re: Exercise can be nearly as effective as therapy for depression

#221

Post by Aeglaecia »

lazarus01 wrote: post #209

I can see how therapy can be helpful for some people. But I find it to be a big scam from my own personal experience. What incentive do they have to give you immediate and durable results? Why do most only take cash? I did some ML work with an addiction psychiatrist at the peak of the opioid crisis. He said,”To pay my bills, I have to treat rich people.” I find taking long walks and speaking candidly about how I’m fe…

and people wonder why i call psychiatrists legal drug dealers - what incentive does a psychiatrist have to fix someone , when they could make 10x more money keeping that person dependant forever

Re: Exercise can be nearly as effective as therapy for depression

#222

Post by djeastm »

BoneShard wrote: post #180
bluerooibos wrote: post #109

Earlier quoted context omitted.

All you need to do is go to sleep before 12 every single night and wake up at 7am without fail, hit the gym and crank out a few sets of squats, hit the pool and the sauna, read a chapter of that book, and then cook yourself an amazing breakfast, all before 9am. If you're a real go-getter, though, you'd wake up at 6am and do some vibe coding for an hour on that side hustle. Super simple.

and not have any kids.

Organized people have kids, too.

Re: Exercise can be nearly as effective as therapy for depression

#223

Post by PaulHoule »

D-Machine wrote: post #194
stuffn wrote: post #34

Earlier quoted context omitted.

Or avoid medication for anything but treatment resistant depression. SSRIs are not well understood. Their side effects are not great. Getting off them is miserable. I had them. I felt dead inside. Mission accomplished. Depression was gone, so was my desire to eat, have sex, or do anything else. I wasn’t depressed, I was a zombie. 8 adjustments and medications later I got off them and realized they’re yet another pill…

Dunno why you are being downvoted, probably cope. It is well known by now that antidepressants are only marginally effective on average [1-2]. You're right they should probably only be prescribed for quite severe or treatment-resistant depression. Although the treatment-by-severity effect has been somewhat disputed [3-4], it has rough support [5], and makes sense since it is dubious that we should be giving ineffecti…

My take is pessimsitic estimates of AD effectiveness assume you get one Rx and don't follow up and adjust dose and medication choice. I was lucky when I took ADs to have a good primary care doc who had a psychiatric nurse practitioner working at his office and being a good self-advocate.

Re: Exercise can be nearly as effective as therapy for depression

#224

Post by verteu »

D-Machine wrote: post #124
verteu wrote: post #72

Earlier quoted context omitted.

It's a standardized mean difference, which I believe can roughly be interpreted as: "treated groups had 0.67 stddev lower depression score than control groups." That's a pretty substantial improvement - consider someone who's more depressed than 75% of the population becoming completely average. (Because the 75th percentile is about 0.67stddev above the median.)

You cannot say if this is a substantial change or not, because you need to know by how much the groups actually differ on average, i.e. you need the unstandardized effect size, expressed as a mean difference in the scale sum scores, or as an actual percentage of symptoms reduced, or etc. In general, there are monstrous issues with standardized mean differences, even setting aside the interpretability issues [1-3]. Se…

Good point. Would it be roughly accurate to say: "consider someone who's more depressed than 75% of the *study treated* population becoming completely average *among the study treated population*"?

Re: Exercise can be nearly as effective as therapy for depression

#225

Post by femto »

yomismoaqui wrote: post #68
cheald wrote: post #2

This is a finding that keeps coming up, and I've certainly found it true in my life, but there's a significant chicken-and-egg problem in that depression frequently precludes the motivation to exercise, and if you don't already have a deeply-disciplined routine to overcome the lack of motivation, people won't do it. Exhortation to develop those good habits in the good times, I suppose.

Motivation is fleeting but routine persists. When there is something that you want to do regularly (exercise, doing the final boring part of some sideproject, cleaning the house...) you remove willpower from the equation and set a day and a time. For example, everyday from 18 to 19 I work on my sideprojects, or saturdays from 16 to 18 is house cleaning time. There is no question if I want to do it, it is set at that…

The key I found was to avoid self flagellation.

Try your hardest to do each session, but if you miss a session don't try to make it up. Just get on and do a normal session the next time it falls due. You're in it for the long term, so long term it doesn't matter if you were intermittent when building the habit, or the occasional session gets missed for a reason.

Re: Exercise can be nearly as effective as therapy for depression

#226

Post by PaulHoule »

stuffn wrote: post #157
skywhopper wrote: post #131

Earlier quoted context omitted.

[flagged]

[flagged]

Pfizer ad or not I'll say my AD experience was positive. I got it prescribed by a psychiatric NP in a time when my job situation was about to go to hell but I was planning to tough it out till I got the project done.

I did get the sexual side effects but because men often come too quick it can be a blessing as much as a curse, personally I found it took longer to orgasm and when it did happen it was a much more complex and richer experience with a definite periodization I haven't had before or since.

When I was taking ADs I did have problems I blamed on the ADs that really had to do with the "non-drowsy" antihistamine I was taking crossing my blood brain barrier anyway.

When I did stop ADs I tapered over a month and the physical effects were not bad at all. It was the beginning of a time of personal growth that I can look back on now and think it worked out great but was challenging for the people around me for a while.

Re: Exercise can be nearly as effective as therapy for depression

#227

Post by D-Machine »

verteu wrote: post #224
D-Machine wrote: post #124

Earlier quoted context omitted.

You cannot say if this is a substantial change or not, because you need to know by how much the groups actually differ on average, i.e. you need the unstandardized effect size, expressed as a mean difference in the scale sum scores, or as an actual percentage of symptoms reduced, or etc. In general, there are monstrous issues with standardized mean differences, even setting aside the interpretability issues [1-3]. Se…

Good point. Would it be roughly accurate to say: "consider someone who's more depressed than 75% of the *study treated* population becoming completely average *among the study treated population*"?

Nope, you can't say how many people return to average from standardized effect sizes. I wish we had a standardized effect size that was more useful and actually meant something. Cohen actually proposed something called a U3 statistic that told us the percent overlap of two distributions, but that still doesn't tell us anything meaningful about practical significance.

You can't make decisions / determine clinical value from standardized effect sizes sadly, so when I see studies like this, my assumption is unfortunately that the researchers care only about publishing, and not about making their findings useful :(

Re: Exercise can be nearly as effective as therapy for depression

#228

Post by sarchertech »

jjulius wrote: post #213
sarchertech wrote: post #207

Earlier quoted context omitted.

There’s a few things required to make that work for you. You fall asleep instantly every night or function on less than 7 hours of sleep long term. You have a 15 minute commute. You don’t seem to need any slack time to deal with any issues that pop up. 4 year old has a meltdown because the 6 year old ate the last fruit snack. One of the kids decides to wake up at 3am. Friends come over for dinner and throw off the ro…

So I made my original post knowing full well that my situation is my own and YMMV, but to speak to those concerns wrt my schedule/life... >You fall asleep instantly every night... Actually, yes! Two points there. First, when I'm out of my routine, not working out, drinking lots of coffee and eating like garbage, I sleep like ass. When I'm in my routine, eating well, and only having a cup of coffee with breakfast, I'm…

I’m not doubting that your schedule works for you, I’m just saying that it’s at the extreme of what is feasible with young kids.

> neither kid has ever got themselves out of bed in the morning

My wife is a pediatrician. This is so incredibly not normal to have 2 kids that absolutely never get up early that you won the lottery. And not the regular jackpot. You won the powerball multi-state $500 million lottery.

> For our own sanity wrt my wife and I's schedules, we hang with friends on the weekend. Weekends are a lot more freeform for us.

I wish I knew what a weekend was. My wife works in the ER, as do many of our friends.

> Naturally, whoever isn't playing with the kids just falls into keeping the laundry moving and cleaning the kitchen.

There’s so much more daily maintenance work for our house than an hour a night for one person.

Just making my kids lunch for the next day takes me 15 minutes. It takes me 20-30 minutes to fold one load of laundry.

And the irregular things I mentioned were just a tiny part of it. The other day my 4 year old got a whole stack of puzzles down and the 2 year old immediately dumped out all the pieces. Took me 2 hours to sort that out. Last week the tankless hot water started randomly cutting out and I spent 2 hours dealing with that.

Yesterday we took 2 of our 3 kids for a well check to their pediatrician. For some reason it took 1.5 hours instead of the 30 minutes we had planned. A few months ago one of my many spoke alarms started randomly going off once a night for a few days until I could track down the problem. 3 months ago my 2 year old tripped on the very bottom stair and had a freak fracture. That took hours of time up front and then reverted to crawling for 9 days. And for 6 weeks he had to wear a boot that I had to remove and reapply multiple times a day.

Our 2 month old blew out her diaper a few days ago and I had to take all the padding off, wash it, then figure out how to put it back on. Big storm recently knocked most of our Christmas wreathes off and I had to deal with that.

My kid was recently “snack leader” for his preschool class, which means for a week I had to make healthy snacks for the whole class.

All of that is just the random stuff that has popped up over the last few months that I can think of.

The original post who mentioned this kind of thing isn’t feasible with kids was correct. 2-2.5 hours of exercise/meditation and a full workday isn’t something that most people with kids can pull off.

Re: Exercise can be nearly as effective as therapy for depression

#229

Post by azan_ »

Aeglaecia wrote: post #221
lazarus01 wrote: post #209

I can see how therapy can be helpful for some people. But I find it to be a big scam from my own personal experience. What incentive do they have to give you immediate and durable results? Why do most only take cash? I did some ML work with an addiction psychiatrist at the peak of the opioid crisis. He said,”To pay my bills, I have to treat rich people.” I find taking long walks and speaking candidly about how I’m fe…

and people wonder why i call psychiatrists legal drug dealers - what incentive does a psychiatrist have to fix someone , when they could make 10x more money keeping that person dependant forever

If we had effective treatment, then psychiatrists that are effective would quickly displace ones that keep you hooked on non-effective ones.

Re: Exercise can be nearly as effective as therapy for depression

#230

Post by D-Machine »

PaulHoule wrote: post #223
D-Machine wrote: post #194

Earlier quoted context omitted.

Dunno why you are being downvoted, probably cope. It is well known by now that antidepressants are only marginally effective on average [1-2]. You're right they should probably only be prescribed for quite severe or treatment-resistant depression. Although the treatment-by-severity effect has been somewhat disputed [3-4], it has rough support [5], and makes sense since it is dubious that we should be giving ineffecti…

My take is pessimsitic estimates of AD effectiveness assume you get one Rx and don't follow up and adjust dose and medication choice. I was lucky when I took ADs to have a good primary care doc who had a psychiatric nurse practitioner working at his office and being a good self-advocate.

The "sequential treatment" or "tailored treatment" approach is at least plausible and what is done in practice, yes, if the prescribing doctor is good, and if this is feasible for the patient.

However, since this takes time, and most depression is temporary, it is hard to know if you really are tailoring the medication to the person in many cases, or it has just been long enough you are seeing regression to the mean (or a placebo response, which is still strong even in treatment-resistant depression https://jamanetwork.com/journals/jamanetworkopen/fullarticle...).

There aren't really any double-blinded or even just properly placebo-controlled / no-treatment controlled studies to test this, but the closest thing to looking at the sequential approach also doesn't find very impressive results (https://bmjopen.bmj.com/content/13/7/e063095.abstract).

I do believe the drugs help some people, and almost certainly take some experimentation / tailoring. The average effects are just very weak.

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