Exercise And Depression Revisited

By Neuroskeptic | November 5, 2012 10:31 pm

A new study has found little evidence that aerobic exercise helps treat depression, contrary to popular belief.

Danish researchers Krogh and colleagues randomly 115 assigned depressed people to one of two exercise programs. One was a strenuous aerobic workout – cycling for 30 minutes, 3 times per week, for 3 months. The other was various stretching exercises.

The idea was that stretching was a kind of placebo control group on the grounds that, while it is an intervention, it’s not the kind of exercise that gets you fit. It doesn’t burn many calories, it doesn’t improve your cardiovascular system, etc. Aerobic exercise is the kind that’s most commonly been proposed as having an antidepressant effect.

So what happened? Not much. Both groups got less depressed but there was zero difference between the two conditions. The cyclists did get physically fitter than the stretchers, losing more weight and improving on other measures. But they didn’t feel any better.

If this is true, it might mean that the antidepressant effects of aerobic exercise are psychological rather than physical – it’s about the idea of ‘exercising’, not the process of becoming fitter.

While many trials have found modest beneficial effects of exercise vs a “control condition”, the control condition was often just doing nothing much – such as being put on a waiting-list. So the placebo effect or the motivational benefits of ‘doing something’, rather than the effects of exercise per se, could be behind it. In the current study though the stretching avoided that problem.

As I said in a post about a previous paper, I said that Exercise and Depression: It’s Complicated

The idea that exercise is a useful treatment for depression: it’s got something for everyone. For doctors, it’s attractive because it means they can recommend exercise – which is free, quick, and easy, at least for them – instead of spending the time and money on drugs or therapy.

Governments like it for the same reason, and because it’s another way of improving the nation’s fitness. For people who don’t like psychiatry, exercise offers a lovely alternative to psych drugs – why take those nasty antidepressants if exercise will do just as well? But this doesn’t mean it’s true.

This was a moderate sized study, and one study by itself doesn’t prove much – any more than one single political poll does. From personal experience I think there’s a good chance strenuous aerobic exercise can boost mood… but this is a reminder that the picture on exercise and depression is not quite as clear as the recent enthusiasm for it suggests…

ResearchBlogging.orgKrogh J, Videbech P, Thomsen C, Gluud C, & Nordentoft M (2012). DEMO-II Trial. Aerobic Exercise versus Stretching Exercise in Patients with Major Depression-A Randomised Clinical Trial. PloS one, 7 (10) PMID: 23118981

  • Kate Benson

    I think you make some key points about exercise as a treatment in general. Perhaps exercise appeals to insurance companies for many of the same reasons it appeals to doctors. Mine even offers to pay the pittance for some classes at the gym.

    May I add another possibility as to why so many studies promote exercise. Perhaps negative studies are less likely to be published than positive studies.

  • Yuri

    As you noted, I do also think that some of it has to do with the psychological effect of “doing something”.
    On the other hand, 30 minutes cycling 3 times a week is not much, maybe it's just not enough exercise to show any result.
    And on top of this, the control group was not only stretching, they also did low intensity exercises, which only makes the gap between groups even smaller.
    I find that theres much more to exercise than those studies tend to grasp, all the motivation involved, the challenge, getting better at something, feeling in control, all these must have great impact on depression, much more than a “come here and cycle 30 minutes studies” will be able to measure.

  • Anonymous

    but this is a reminder that the picture on exercise and depression is not quite as clear as the recent enthusiasm for it suggests…

    And the same can be said for the putative effects of anti-depressant medication.

  • http://www.blogger.com/profile/06834641501438709866 Jan Moren

    I sort of suspect a variant of the Hawthorne effect may play a role here. The participants in exercise studies are suffering from a mood disorder, and just the attention they receive from being participants may improve their mood and improve their evaluations, no matter what (if anything) they're asked to actually do.

  • http://www.blogger.com/profile/08010555869208208621 The Neurocritic

    I agree with Yuri's point about the modest nature of the aerobic intervention vs. the relatively active control. Also, the idea of going to a gym to pedal an exercise bike for 30 min 3 times a week isn't exactly thrilling. There are clearly good reasons for controlling the duration and intensity, but how many participants actually enjoyed that mode of exercise?

    And, did you notice this statement in the abstract?

    “Due to lower recruitment than anticipated, the trial was terminated prior to reaching the pre-defined sample size of 212 participants; therefore the results should be interpreted in that context.”

    And in the methods:

    “Sample Size Calculation: Based on our previous experience, we estimated the standard deviation of the HAM-D17 total score post-intervention to be six points [13]. Based on this standard deviation, a two-sided type 1 error probability of 5%, and a power of 90%, we should include 85 participants in each intervention group to detect a minimal relevant difference of 3 points on the HAM-D17 scale. Anticipating a 20% unavailability for follow-up assessment, based on previous research, the present study aimed to enroll 212 participants to offset the potential loss of power.”

    Wait a minute! I just noticed there was very poor compliance for both groups:

    “The mean attendance was 13.5 (range 0 to 34 and SD 9.4) sessions in the aerobic exercise group versus 12.5 sessions (range 0 to 34 and SD 9.3) in the stretching exercise group (mean difference = ?0.98 sessions; 95% CI ?4.4 to 2.5) of a planned total of 36 sessions. This corresponds to an average participation of one session per week.”

    Overall, I don't think this was a very good study.

  • omg

    Sex could be aerobic exercise no? Pedal me faster naughty boy.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Kate Benson: All good points. Exercise appeals to doctors/insurance/governments in particular, I think, because it clearly does have physical health benefits and as a society we don't get nearly enough of it. So you can see why they're keen on it, for depression and elsewhere.

    Neurocritic: It's not a brilliant study no. Compliance was low – but the cycling group did lose weight etc. so they clearly got some effects. Also, low attendance is the norm in exercise studies & probably realistic (as all those unused gym memberships attest)…

  • Ivana Fulli MD

    Jan,

    You were right to use the verb “suspect” because such a poor study cannot provide any knowledge to an educated mind.

    Many clients suffer from “bad pharma marketing ” and some psychiatrists liking the easy income from prescribing only pills.

    One should then be prohibited – on ethics grounds -to publish very poor study of that sortn since psychiatrists and other doctors are so prone to tell you “One study has shown…” selecting carefully -albeit unconsciously for the honest ones- the study they cite…

    Give exercise a chance unless proven wrong should be the ethics.

    PS: It is less tiring for a psychiatrist consultant to prescribe pills and check for the side effects than to argue about how to exercise-particularly when a client is in a low mood.

    When to exercise, which kind of exercise, the cost in time and money arguments, clients accusing you of ruining their social life or their academic prospects or whatever because they are exhausted at the beginning after their exercise and want to go home and sleep early three times a week etc…

    Exhausting sessions much more time consuming and tiring that talking about incest and suicidal thoughts and/ or prescribing pills for sure.

  • Jack

    “The initial 10 minutes were low-intensity warm-up on a stationary bike, then a 20 minutes program of stretching, followed by 15 minutes of various low intensity exercises such as throwing and catching balls.”

    That's the stretching program. Does it sound like a “not exercise” placebo to you? Because to me it sounds like a low intensity exercise program.

  • http://neurobonkers.com Neurobonkers

    It's an interesting study, reminds me of this similar case:

    http://neurobonkers.com/2012/06/06/breaking-news-simply-telling-depressed-people-to-jog-on-does-not-help-relieve-symptoms-of-depression/

    It's a really tough one to test, because the need for control in the experiment may invalidate important factors – such as making the exercise rewarding and actually fun!

  • http://twitter.com/jdottan JT

    What is the proposed mechanism by which exercise would help depression?

    I guess I'm not seeing it, other than generally helping quality of life for the “worried well” who may be reporting depressive symptoms.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Let's keep comments on topic about this paper please.

    JT: Well I've seen everything from endorphins to hippocampal neurogenesis proposed…

  • ramesam

    When exercise is said to help depression, is it not open air exercise – something like even a walk in the Park amidst greenery?

    I am sure it must be more depressing to be confined to a cycle in a gym in sultry, smelly atmos.!

  • Anonymous

    I'm sure that exercize improve my mood. And how about the validity of the depression measure?

  • http://petrossa.me/ petrossa.me

    Exercise has been endowed with magical powers by the cult of the environmental back to naturists.

    Exercise also has been claimed to be extremely good for health, despite that the 3rd cause of cardiac arrest/death is exercise as well as that exercise counts for 20-30% of emergency care intakes.

    But those are just mere facts. And for the real cultist facts don't matter.

    Exercise is the snake-oil of modern times, a cureall for anything that ails, including mood disorders.

    Sitting on my seaside bench, overlooking the calm blue Mediterranean, everyday exercists run by. None of them look very happy. Most of them look like they'd rather be elsewhere.

    I discovered over the years 4 distinct categories:

    1) The narcissists. In full spandex, sunglasses, highly visible clean sweatband, gadgets all over the place measuring i don't know what, music player firmly plugged in the ears.

    Shooting without words: HERE I AM, BEHOLD!!!

    2) Those poor sods which have been old by their doctors they need to exercise for their health. Middle aged, overweight, in old shorts and likewise tshirt, sweat pouring down their bodies, hobbling along desperately to a healthy heart attack.

    3) Women who think their butt is to big. Loosely clothed, bit and pieces wobbling up and down, running as inefficiently as humanly possible.

    4) Professionals. Firemen, police, athletes. Running smoothly seemingly without effort, looking like they kill you on sight if you block their way.

    Can't say i've a category for mentally challenged other then the first 3 categories as a whole being daft.

    Homo Sapiens ran when it was necessary to hunt for food, otherwise they didn't do nothing much. Which is natures way of conserving energy.

    http://petrossa.me/2012/07/26/exercise-and-obesity/

  • Ivana Fulli MD

    petrossa,

    Exercise inspired you a nice hilarious piece of writing and I agree with you about running not being the smartest choice for everybody.

    You missed the friendly pairs talking as they run together though- handy since as long as you can talk, you do not need to mesure your heart rate.

    The psychiatrists and GP should discuss different sport options with the client and respect the wishes of those who only want to take their pills and sit on a bench.

    jake,

    Good point!

    JT,

    Of course, you are aware that we do not have any scientific knowledge about how antidepressant pills might work in the few people were they really seem to work.

  • Yuri

    “What is the proposed mechanism by which exercise would help depression?”

    One wont find much of how exercise help mood disorders by simply studying exercise of “the brain in a treadmill”, theres so much more to it.

    “3rd cause of cardiac arrest/death is exercise”
    This doesnt mean anything.

    “But those are just mere facts. And for the real cultist facts don't matter.”
    I think you are a hater of exercise and your view is completely biased.

    “Exercise is the snake-oil of modern times”
    Oh please… of course there are downsides to exercise, injury is one.

    “I discovered over the years 4 distinct categories”
    Your categories does not represent the sample I have access to.

    And even if true, it's possible to change it, it is possible to make people enjoy exercising and its possible to make people exercise efficiently.

  • Anonymous

    How would this fit in with behavioural activation as a treatment for depression (either standalone, as a behavioural intervention or as part of a CBT programme)? I'm just wondering, given what Yuri said above about the motivation/challenge/achievement inherent in taking part in an exercise programme and it seems to me that maybe exercise is simply an aspect of BA, rather than something that specifically lifts mood? BA alone can be a very effective intervention (anecdotally, I can't lay my hands on any references at the moment), but it works best when it's tailored to the client – did any of these participants even want to exercise? Or would they have gained more enjoyment/achievement from another activity?

  • spike

    I am totally with you on your main point, just curious to know how one explains the visuospatial memory effect!

  • Yuri

    Yes, thats also true, you can have great improvement in depression by simply having people “walk 5km per day” anywhere they want, be it a mall, street, a park, wherever, but it wont be the walk itself that did something to the person brain that made her better, rather, the person will be exposed to different contingencies other than those that reinforced her depression.
    You won't get any of it if the depressed person walk on a treadmill at their house.
    (this is not even exercising, but you get the point)

    I find that much of the benefits on mood of exercise has to do with the meaning people give to it, how they engage and relate to it.
    There is more…

  • http://indigomoodrhythms.wordpress.com/ indigorhythms

    Perhaps exercise studies have similar problems much like antidepressant studies,where the subjects are too heterogeneous in regard to degree/type of depression?

    Personally speaking, exercise and diet seemed to help more when I have felt euthymic/mildly depressed,than when moderately- severely depressed.

  • http://www.blogger.com/profile/17401232760394588049 John

    I still don't understand why we don't recognise that depression is multi-faceted, that the solution has to be oriented towards the individual not some statistical analysis. There are thousands of studies on depression and no consensus emerges. Surely that suggests that there is something fundamentally wrong with presupposing that depression and its treatment can be understood as a single entity requiring a single solution.

  • http://www.blogger.com/profile/04594432604835317193 MS Al-Rawi

    One was a strenuous aerobic workout – cycling for 30 minutes, 3 times per week, for 3 months.

    May be the authors should have considered a design with up to 5 times a week, two times a day?

    And, it would be better to do open air exercise.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    indigorhythms: That's been my experience too.

  • Anonymous

    My name is David Horton and I am grateful to Dr Ivana Fulli for being a psychiatrist listening to me in a considerate manner she is also very honest with you. I do not object to receiving help from professionals it is just the typ of help that professionals give that causes me concern.

    There are many different treatments for Asperger’s syndrome and I welcome the desire to ameliorate its negative effects. However all treatments for a problem depend on the practitioners knowledge. If Doctors, Psychiatrists and other professionals do not administer these treatments in the correct manner they can case the patient additional problems, instead of helping them to become fulfilled productive members of society they can increase the individuals dysfunctional behaviours.

    The text Dr Fulli posted is taken from a collaborative work between her and I : an abstract that has being written from the point of view of someone who has suffered as a result of such treatments and hopes to play a small part in preventing others being similarly damaged.

    Exercise helped me a great deal.

  • Ivana Fulli MD

    David,

    Here the text I posted this morning but was just a transient comment. It must have been thought spammage by neuroskeptic 's ptotection system – or whatever:

    ///(…)Once I was diagnosed with Asperger’s Syndrome I was told about the problems I would have with the condition. Problems with socialising, problems with work and the other problems that we are all familiar with.

    It made me feel powerless, I felt like I had no ability to affect the world or other people around me in any way. The impression of Asperger’s Syndrome that I got was completely negative and that would affect me for the rest of my life.

    I was very negatively affected by the advice from the professionals. I never heard anything positive or encouraging from them.

    I decided that since there was nothing positive about Asperger’s Syndrome and Asperger’s Syndrome was part of me that I needed to dispense with myself in order to be successful in life.

    I decided that all of my feelings and emotions were unnecessary and should be ignored and supressed.(…)

    I studied GCSE’s and all of the proceeding subjects as well as outdoor walks (which I hated) and I left with only mediocre GCSE’S.

    I then went on to college and enjoyed myself but never achieved a great deal. After that I went to University College Worcester. University College Worcester gave me a chance to live away from home for the first time. I studied A Business and Information technology HND there and passed. When I went on to study a degree I could not cope and decided to drop out.

    After dropping out of University I spent several years on my own trying to find a job and failing. (…)
    I was not used to living on my own and went a little stir crazy, I once stayed in my flat for three days without leaving.

    I decided to correct this by taking a walk every day. (…)
    I also mearted to get involved in disability politics. It was good for me and helped me to become more assertive.

    In Birmingham I spent a long time working on my physical Fitness.

    I also worked on my anxiety levels over the period of about a year and a half.

    I could feel great changes being made.

    I decided that the time had come to go back to university.

    I felt that I had changed enough to be able to cope with the environment. The first grade I got was 86 Per cent considering that in the past I had only go mediocre grades at best this was a great achievement for me. I am now in my second year and hoping for similar success(…)///

  • http://petrossa.me/ petrossa.me

    @Yuri

    My sample you don't have access to because you're stuck in a world of numbers without real life.

    I sit for years on my bench along the seaside and observe real life.

    Do the same, and then we'll discuss because the dry numbers i've read, so we'll be on an even footing.

  • http://www.blogger.com/profile/17401232760394588049 John

    I read this earlier this evening:

    “Depression seems especially sensitive to the placebo effect. Numerous studies … genuine antidepressants account for 25% of the improvement, while the place effect accounts for the remaining 75%. Believing you are getting something to help you is more than half the battle …

    only works for mild depression but for severe depression the placebo effect is almost useless.

    Robert Trivers, Deceit and Self Deception, 73,4

    —-

    Keep in mind that Trivers is not a specialist in the field. The claims don't surprise me because sustained severe depression induces neurophysiological changes that can take months to change. For eg. A few weeks ago I read a paper showing how sustained CRH receptor activation at the Nacc eventually depletes dopamine output from there, so the mPFC, strongly implicated in the placebo effect, cannot come into play.

    So the drugs really can help but the majority of depression is not severe, it only becomes severe after sustained depression due to the neurophysiological alterations, which often include glucocorticoid resistance, a sure sign of a sustained stress response of which CRH is very high up in the chain. Glucocorticoid resistance also explains the increased inflammatory state seen in some cases of depression.

    The drugs have their place but the clinician is well advised to treat the patient with more consideration, a more compassionate attitude, as this helps instantiate the placebo effect.

  • Vatos

    I suspect that exercise can only help with depression to the extent that distraction can help. If exercise itself is a miserable activity that does not provide distraction, then little benefit will occur.

    But why should I have to speculate? It is a sad indictment of the NHS that we do not have the high-quality evidence to avoid speculation. No one wants to fund real science which actually controls for all variables.

    And so we have GPs recommending exercise even to people who may never benefit from it

  • http://petrossa.me/ petrossa.me

    “And so we have GPs recommending exercise even to people who may never benefit from it”

    And so we have GPs recommending exercise even to people who most likely die because of it

    Better, and conform the facts.

    Taking into account the OR and the prevalences of exposure, the highest PAF was estimated for traffic exposure (7·4%), followed by physical exertion (6·2%)

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62296-9/abstract

  • Ivana Fulli MD

    Mr petrossa,

    The soothing effect of looking at the blue sea and taking your pills is your treatment of choice.

    Nobody could insinuate, without making a fool of himself, that those choices of yours have taken from you a superb intelligence, a sound critical sense and a talent with words.

    Still, the subject of that post is depression treatment not autistic sensory perceptual issues you suffer from Mr petrossa- and those troubles can make exercise in the just hell- the more so in the open air!

    Other people complain about their SSRI antidepressant pills – plus neuroleptics often enough- making their life hell with side-effects like vertigo, becoming overweight and impotent and numb-even suicidal or/and dangerous for others people to the point of murder thoughts etc…

    Human beings- Aspies and Neurotypicals and any other types of brains so to speak – are a very diverse lot, Mr petrossa.

    I am the first to be sorry about it but there is not a one treatment fit all depressed people.

    So, let's give exercise a chance -of course only for those clients who come to like it after a little persuasion from their doctor- until proven otherwise!

    PS: I wish you well Mr petrossa-and also that society could offer any aspie, clinically likely to benefit from it, a bench in front of a very blue sea.

    Seriously, I think it might be cost effective but real social psychiatry prescription is not trendy at all for the time being.

    So, let's give exercise a chance before prescribing pills, please!

  • http://creativethresholds.com/ Mellissa

    It's funny because when I went into a clinical depression my psychiatrist told me to stop exercising (trying to exercise) because the pressure of trying to keep it up everyday was worse. During my descent into depression I was running, teaching aerobics, lifting weights and spinning. I had run a marathon not too long before. I'd been very active for years. And now I could barely get out of bed. Every step drained energy. He said exercise helped until depression reached a certain degree and then it could actually hurt. The pressure to “do the right thing” that everyone wants you to do so you “get better” simply adds to the depression. In my case, I needed the right meds. Period. I'm bipolar II. (And it took years to get the meds right. But when they finally were it was amazing.) HOWEVER, exercise is definitely helpful to stay in a healthy place or even to help give a lift if I'm a little down–it's just not helpful for me if I'm already *clinically* depressed.

  • http://www.blogger.com/profile/10654138293659468787 NeuroPsych

    I wonder what the implications are for the role of BDNF and anti depressant function. It's been a while since I've research this, but the thinking was that BDNF explains how antidepressants work and since exercise also produces BDNF, the research supporting exercise as an effective treatment for depression was seen as supporting this proposed role of antidepressant function. this.

  • http://www.blogger.com/profile/17401232760394588049 John

    Neuropsych,

    An old study on mice found that a direct infusion of BDNF into the hippocampus immediately reduced depressive markers. Electro shock therapy, unfortunately demonised by silly movies, alleviates depression in a similiar timeframe(under 24 hours) and I did find data that stated it immediately boosted BDNF. I suspect the recent results of ketamine for depression are related to the above but haven't worked that through yet. BDNF is deficient in many neurologic conditions. We have focused far too much on amines and only in recent years have we come to appreciate the importance of growth factors in modulating behavior and mental health.

    Some argue that the key biomarker for the efficacy of an antidepressant is the instantiation of neurogenesis, of which BDNF is an important player. What is significant here is that reduction in stress hormone prodn also seems important and it does seem that antidpressants do act on the PVN rather quickly, possibly via the hippocampal-fornix. Don't know.

    As regard to exercise, having done much athletic training there are clearly times when your body is saying: need to rest. Exercise can be a stressor which is one reason why I used to rant against turning exercise into a bloody competition. Additionally exercise can increase inflammation and in depression systemic inflammation is often raised. So I think exercise can help but not if the patient is already well down the road of neurologic changes that are resulting from the sustained stress with the additional loading of exercise in those patients only exacerbating the existent pathology.

  • http://www.blogger.com/profile/17401232760394588049 John

    Ivana,

    Some years ago a study on treatment resistant depression found that the patients were developing antibodies against thyroid hormones. Only a low percentage, 10% of patients demonstrated this. Low thyroid can mimic as depression(I think) and increased inflammatory mediators may potentiate auto-antibody production perhaps … . What most people do not appreciate is that we are constantly producing “self-sensitive antibodies” and under certain conditions this may potentiate autoimmune conditions.

    What it does suggest is that when we encounter treatment resistance we need to look beyond the brain.

    One study on that:

    Thyroid autoimmunity and treatment response to escitalopram in major depression.
    http://www.ncbi.nlm.nih.gov/pubmed/20088751

  • Anonymous

    How likely is it that the improvements we see reported from these sorts of interventions are largely just a result of patients wanting to be polite about those who have attempted to help them? If one spends time with a likeable therapist who seems to be genuinely committed to helping improve one's health, it might seem rather mean to not report some improvement at the end of the trial. To me, it seems that some can be too quick to assume that subjective reports of improved health are a result of real health gains stemming from increased hope/sense of self efficacy/etc.

    Following on from Kate Benson's comments about the more self-interested reasons some may want to promote the value of exercise as a treatment, there is also our desire to believe some sort of Just World Theory. If we can believe that exercise treats depression effectively, then we can be less concerned about coming to suffer from depression, and also feel less responsibility to aid those who do suffer from depression yet choose not to exercise. I think that this is one of the reasons why there seems to be such tolerance for those who exaggerate the efficacy of their treatments for a range of conditions.

  • Vatos

    “Let's give exercise a chance”?

    Why not give science and reason a chance? Why is there this need to try to pretend the evidence is better than it is?

    Can we not have doctors who have to courage to say “I do not know what will help you”? Is it so hard to be a human being when dealing with patients?

  • Jeanette

    “Exercise treats depression” is so engrained in clinicians' minds that earlier blog commenters are dismissing the current study's results. Yes, the study was very poorly done. However, it is increasingly becoming apparent to enlightened clinicians that exercise does not help treat depression. There are no antidepressant effects of aerobic exercise! To the earlier people who commented, exercise may help you, and it is reassuring to you (and engrained in you) to believe that clients will also benefit. But, I doubt you're immersed in a severe Major Depressive Disorder. I'm a professional who has suffered from moderate and severe depression. After several years of mild, moderate and intense exercise (outdoors, indoors), it's obvious that exercise has not helped. Thankfully, my psychiatrists acknowledge that earlier exercise studies were not conclusive and can see first-hand that exercise is not effective.

    Neuroskeptic, Yuri and others, the belief that depression helps depression is old dogma. It's unfortunate that this

  • Jeanette

    Neuroskeptic, Yuri and others, the belief that exercise helps depression is old dogma. It's unfortunate that this belief exists.

  • Vatos

    The NHS should be fighting “old dogma” with proper science done even if it is expensive.

    People can study those who continue to exercise and note that they are healthier without realising that perhaps the causality is reversed. So, people who feel better feel more willing to exercise. Unless you control for all factors, your research cannot distinguish between A causing B and B causing A.

    And funding considerations (like you will not get any for unhelpful conclusions) may encourage people to say exercise causes health, rather than health encourages exercise

  • Ivana Fulli MD

    Jeanette and Vatos,

    Exercice does not work for everyone in my own clinical experience. It sometimes do wonders especially physiotherapy to elderly clients and often helps.

    What the vast majority of clients get with antidepressant pills are side-effects during the treatment plus the risk of a prescription list becoming longer and longer with time and the risk of a very long withdrawal painful time!

    You just ignore or pretend to ignore the state of knowledge which is drug treatment for depression being only slightly superior to placebo in controlled studies and rich in adverse effects and withdrawal problems for many people.

    You might also work for the drug industry or think your own case applies to everyone (if the later be true I would strongly recommend cognitive therapy in addition to your pills since generalization bias is something often easy to overcome and very useful to overcome depression sometimes.

  • Ivana Fulli MD

    john,

    I agree that many hormonal problems give psychiatric symptoms to suffer from as do paraneoplasia and other deseases. Some sufferer of the above listed deseases are likely to be exhausted and worsened by exercise -of course specially the Addison desease with its chronic fatigue to start with…

  • Vatos

    I am not pretending to ignore anything. If you really believe you have mind-reading powers, I suggest you apply for the Randi prize.

    The NHS should not employ doctors who cannot manage a decent bedside manner

  • Ivana Fulli MD

    Vatos,

    Indeed, you do not pretend to ignore anything.

    Quite the opposite!

    NB: neuroskeptic has worldwide admirers and followers and I do not work for the NHS.I hope that makes you feel a little better.

  • Olga

    What an interesting approach in treating depression! Another benefit of exercise, indeed. Depression patients should take note that antidepressants may cause harmful side effects such as the birth defects linked with Zoloft. Thus, it is vital to seek medical advice on how to safely deal with it.

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About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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