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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

#91

Post by psunavy03 »

PaulHoule wrote: post #18
2muchcoffeeman wrote: post #13

Earlier quoted context omitted.

And you think the effects of drugs is universal? Exercise is a side effect free treatment that works for some people so it’s worth a shot because it sometimes works.

I'd argue that depression kills and optimal therapy is: anti-depressants, exercise AND talking therapy and the time to start is NOW. I wouldn't knock the effectiveness of any of them with the caveats that: (1) you can get anti-depressants from you primary care doc, the best practice is to start on something, ramp up your dose and try something different if it is not working or you don't like the sides. I really thoug…

> People in the military do insane amounts of cardio because it helps dealing with insane amounts of stress.

This is giving the military way too much credit for organized stress management. If military people give the impression of doing "insane amounts of cardio" it's because that's what the physical fitness tests are biased towards.

And we also won't talk about the fact that getting a psych diagnosis, especially in fields like aviation, can end your career, while managing stress via alcohol gets a wink and a nod as long as you don't have an alcohol-related incident.

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

#92

Post by ambicapter »

AnthonBerg wrote: post #31
Insanity wrote: post #26

Earlier quoted context omitted.

Nail on the head. I know that exercise will make me feel better, but during a period of depression/grief I could not even get out the house.

To my surprise, it has been my experience that this turns out to be pulmonary . It was always the chicken-and-egg of... breathing. Seems like this has been my story: Severe prolonged stress floored me. Turns out that the autonomous control of bronchoconstriction and dilation had gone out of wack, into dysregulation. My lungs were basically clamped shut. (Muscular tension and sundry dysregulation from severe prolonged…

That's interesting. I've noticed when I go for a long-enough run and my body warms up to an optimal state, breathing feels easy and effective. I wish I could breathe like that all the time.

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

#93

Post by nineteen999 »

stuffn wrote: post #34
PaulHoule wrote: post #18

Earlier quoted context omitted.

I'd argue that depression kills and optimal therapy is: anti-depressants, exercise AND talking therapy and the time to start is NOW. I wouldn't knock the effectiveness of any of them with the caveats that: (1) you can get anti-depressants from you primary care doc, the best practice is to start on something, ramp up your dose and try something different if it is not working or you don't like the sides. I really thoug…

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…

100% I have found the same, SSRI's definitely make things worse and I stay away from them, and regular exercise has offered the biggest consistent/persistent improvement in mood.

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

#94

Post by D-Machine »

imzadi wrote: post #38

This is only talking about therapy and not medication. The original study is a bit light on details https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... > For the 57 trials (2189 participants) comparing exercise with no treatment or a control intervention, the pooled SMD for depressive symptoms at the end of treatment was −0.67 (95% confidence interval (CI) −0.82 to −0.52; low‐certainty evidence), showing…

It means nothing, standardized effect sizes have no clinical meaning here, they are purely statistical. To measure if these kinds of changes matter, you need to determine the Minimal (Clinically) Important Difference [1-2]. I.e. can clinicians (or patients) even notice the observed statistical difference.

In practice, this is a change of about 3-5 points on most 20+ item rating scales, or a relative reduction of 20-30% of the total (sum) score of the scale [1-2]. Unfortunately, anti-depressants are under or just barely reach this threshold [3-4], and so should be widely to be considered ineffective or only borderline effective, on average. Of course this is complicated by the fact that some people get worse on these treatments, and some people experience dramatic improvements, but, still, the point is, depression is extremely hard to treat.

Unfortunately, this also means that if exercise is only nearly as effective as therapy for depression, it may mean that the benefits of exercise are not actually really clinically observable, if measured properly and not just based on arbitrary statistical significance.

EDIT: There is less data on MCIDs for therapy, but at least one review suggests therapy effects can be in the 10+ point range [5]. But the way the exercise study is presented, with standardized effect sizes, we have no idea if the results matter at all [6].

[1] Button, et al. (2015). Minimal clinically important difference on the Beck Depression Inventory - II according to the patient’s perspective. Psychological Medicine, 45(15), 3269–3279. https://doi.org/10.1017/S0033291715001270 [https://www.cambridge.org/core/journals/psychological-medici...]

[2] Masson, S. C., & Tejani, A. M. (2013). Minimum clinically important differences identified for commonly used depression rating scales. Journal of clinical epidemiology, 66(7), 805-807. [https://www.jclinepi.com/article/S0895-4356(13)00056-5/fullt...]

[3] Hengartner, M. P., & Plöderl, M. (2022). Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evidence-Based Medicine, 27(2), 69-73. https://doi.org/10.1136/bmjebm-2020-111600 [https://ebm.bmj.com/content/27/2/69.abstract]

[4] Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should antidepressants be used for major depressive disorder?. BMJ evidence-based medicine, 25(4), 130-130. https://doi.org/10.1136/bmjebm-2019-111238 [https://ebm.bmj.com/content/25/4/130.abstract]

[5] Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of affective disorders, 159, 118–126. https://doi.org/10.1016/j.jad.2014.02.026 [https://pubmed.ncbi.nlm.nih.gov/24679399/]

[6] Pogrow, S. (2019). How Effect Size (Practical Significance) Misleads Clinical Practice: The Case for Switching to Practical Benefit to Assess Applied Research Findings. The American Statistician, 73(sup1), 223–234. https://doi.org/10.1080/00031305.2018.1549101

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

#95

Post by cheald »

smeej wrote: post #87
yomismoaqui wrote: post #68

Earlier quoted context omitted.

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…

> There is no question if I want to do it, it is set at that time and I have to do it, period. Gosh it must be nice to have at least an ordinary amount of executive function skills. Is it really this easy for neurotypical people to build routines? That's really all it takes? I don't see how this removes willpower at all. It just determines what time you have to use it.

It still requires willpower, but to use a metaphor, it's much easier to travel down a well-trod path than it is to cut a new path through the jungle. Repetition and consistency establishes the path, so the willpower required to travel down it the next day is reduced over time. Establishing a pre-set time and committing to that time ahead of time removes the "will I or won't I" decision at "go time", when you're most likely to falter.

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

#96

Post by D-Machine »

Unfortunately, if exercise is only nearly as effective as therapy for depression, it may mean that the benefits of exercise are not actually really clinically observable, if measured properly and not just based on arbitrary statistical significance.

Standardized effect sizes like the ones reported here have no clinical meaning, they are purely statistical. To measure if these kinds of changes matter, you need to determine the Minimal (Clinically) Important Difference [1-2]. I.e. can clinicians (or patients) even notice the observed statistical difference.

In practice, this is a change of about 3-5 points on most 20+ item rating scales, or a relative reduction of 20-30% of the total (sum) score of the scale [1-2]. Unfortunately, anti-depressants are under or just barely reach this threshold [3-4], and so should be widely to be considered ineffective or only borderline effective, on average. Of course this is complicated by the fact that some people get worse on these treatments, and some people experience dramatic improvements, but, still, the point is, depression is extremely hard to treat.

EDIT: There is less data on MCIDs for therapy, but at least one review suggests therapy effects can be in the 10+ point range [5]. But the way the exercise study is presented, with a standardized effect size, we can have no idea if the results matter at all [6].

[1] Button, et al. (2015). Minimal clinically important difference on the Beck Depression Inventory - II according to the patient’s perspective. Psychological Medicine, 45(15), 3269–3279. https://doi.org/10.1017/S0033291715001270 [https://www.cambridge.org/core/journals/psychological-medici...]

[2] Masson, S. C., & Tejani, A. M. (2013). Minimum clinically important differences identified for commonly used depression rating scales. Journal of clinical epidemiology, 66(7), 805-807. [https://www.jclinepi.com/article/S0895-4356(13)00056-5/fullt...]

[3] Hengartner, M. P., & Plöderl, M. (2022). Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evidence-Based Medicine, 27(2), 69-73. https://doi.org/10.1136/bmjebm-2020-111600 [https://ebm.bmj.com/content/27/2/69.abstract]

[4] Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should antidepressants be used for major depressive disorder?. BMJ evidence-based medicine, 25(4), 130-130. https://doi.org/10.1136/bmjebm-2019-111238 [https://ebm.bmj.com/content/25/4/130.abstract]

[5] Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of affective disorders, 159, 118–126. https://doi.org/10.1016/j.jad.2014.02.026 [https://pubmed.ncbi.nlm.nih.gov/24679399/]

[6] Pogrow, S. (2019). How Effect Size (Practical Significance) Misleads Clinical Practice: The Case for Switching to Practical Benefit to Assess Applied Research Findings. The American Statistician, 73(sup1), 223–234. https://doi.org/10.1080/00031305.2018.1549101

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

#97

Post by RickJWagner »

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…

I subscribe to Arnold Schwarzenegger’s newsletter, which has a surprising amount of great, well researched content.

Right after New Year’s Day, he said pretty much what you said. Discipline beats Herculean effort that’s sporadic.

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

#98

Post by taeric »

yoyoma1234 wrote: post #66
taeric wrote: post #63

I would assume that "doing something" is the key here? Successfully doing exercise probably has add on benefits that you can more successfully do other things afterward. But successfully reading a book can help me get out of depression. Successfully cleaning the kitchen. Really, just successfully doing anything is a huge cure against depression.

No, it’s more specific - doing something physical. Cleaning dishes yes, reading a book no

My point in including both is that both can be surprisingly effective and turning my mood around. Despite them being very different. Included the dishes because that is physical and a chore that most people actively dislike.

Edit: Just to be clear, per my other post sibling to this, I should say that they can both seem to be very effective at turning my mood around. I do not, necessarily, think either is causal on their own.

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

#99

Post by azkalam »

avidiax wrote: post #74
LorenPechtel wrote: post #48

Earlier quoted context omitted.

Yup, which is why diets fail. People who are fat generally do not have enough available willpower to lose weight.

My suspicion as someone with lifelong weight struggles and having tried GLP-1 medication: overweight people require more willpower to lose or maintain weight relative to those of normal weight. So the advise or admonishment of the normally weighted that losing weight "just requires willpower" is true but facile. If we were to medically induce a constant feeling of hunger and insatiability into a person of normal weig…

Over-eating is not strictly a choice. Corporations spend billions on manipulating the public because it works. Regulation is needed, not willpower.

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

#100

Post by baincs »

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.

That may be true if you're severely depressed, but I think it can save you if you're starting to get depressed. That's what happened to me at one point, and an online comment saved me.

I was like 60% depressed but on my way there. I just took my first computer science class in college but I was overly ambitious when I participated in an undergrad CS research. The stress and imposter syndrome was shoving me to the downward spiral.

I posted some gloomy thoughts on an online forum. It was long ago, but I remember the post contained how I could kind of relate to the villain while watching the movie The Dark Knight Rises.

Some online person advised me "lift weights". I had never tried seriously lifting weights, but I was living in a student apartment 10 minutes away from the student gym, so I decided to give it a try. I can't forget the sensation when I did a set of bench press. After a period of amassing so much stress, each rep felt like I was reaching my hand into my brain, directly scooping out the waste and tossing it away.

I became much more active after that, and successfully finished the research and the degree.

It's like how homelessness is more reversible for people who became homeless less than a year ago, and why organizations focus on those groups.

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