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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Franz on August 8, 2008, at 6:11:57
In a recent discussion on National Public Radio about alternative approaches to mood disorder, I raised the “intention to treat” issue. Most studies of interventions like exercise are “completer” trials. They look at people who follow through on the regimen and see how many get better. But of course, people disinclined to exercise might drop out of the “active intervention” arm of a trial of say, jogging. If those are the same people who carry a predisposition for low mood, then any positive research outcomes become suspect. Perhaps it’s not the exercise but the pressure for vulnerable subjects to quit the study that makes running look better than placebo. The Archives analysis makes clear why we should hold alternative treatments to the same research standards that apply to psychotherapy and medication.
I recommend at least a trial of exercise for all my depressed patients. But a good number are already working out vigorously — exercise is no panacaea.
The new evidence notwithstanding, I’m back to my summer regimen of swimming and bicycling. I’ll return to the intention-to-treat issue presently, in my promised second posting on cognitive behavior therapy in the treatment in anxiety [http://blogs.psychologytoday.com/blog/in-practice/200807/debunking-cbt].
http://blogs.psychologytoday.com/blog/in-practice/200808/a-grand-week-couch-potatoes
---I get good results from exercise but this makes me think if they are good enough or if I am not in such a bad condition. It is true that when one feels too bad it is hard to move.
What do you think?.
Posted by Chris O on August 13, 2008, at 17:27:10
In reply to Peter Kramer debunks exercise, CBT, posted by Franz on August 8, 2008, at 6:11:57
I get a very mild anti-depressant, anti-anxiety effect from vigorous exercise. However, it is nothing like the benefits I get from medication. Plus, exercise for me is much easier when I'm on medication. I have more stamina. My anxiety disorder and depression beat me to the ground, so the mild benefit I get is not worth the torture I put myself exercising half the time anyway.
Chris
Posted by linkadge on August 13, 2008, at 20:38:06
In reply to Re: Peter Kramer debunks exercise, CBT, posted by Chris O on August 13, 2008, at 17:27:10
I don't know if 'debunks' is the right word. Ok, so poor study design and the obvious limitations of the application of exercise are issues, but that does not, in any way prove anything about exercise.
I have had severe depressive episodes off and on for many years. I get very little help from prescription antidepressants. They generally make my anxiety worse and induce intollerable apathy. If anything turns me off to exercise its a prescription of paxil and zyprexa.
Exercise is *not* something that works immediately. In mice studies, the types of biochemical changes in nerotransmitter function, brain growth factor levels, neurogenesis, cytogenesis and HPA axis functioning do not occur over night.
The notion that exercise chooses its responders is only supported by a few studies. Sure its true that some patients cannot complete the studies but that doesn't mean that it would not have had an effect if the treatment were continued.
If there is a biochemical target of antidepressant agents, then exercise modifies it.
Oftentimes, exercise produces a much more robust effect on brain growth factor levels than antidepressants do. For instance, in the following study, escitalopram alone had no effect on BDNF levels, whereas exercise alone had a significant effect. The antidepressant effect of BDNF administration is evident in many anmial studies.I think there is no proof here that exercise does not have an effect on mood and there are many studies which suggest that it can.
I think that people don't like to exercise and they don't like to continue exercising. They want to look for proof that they are entitled to sit on their behinds. They want to believe that their depression is due to some genetic flaw that only a pill can solve.
Consider this. Even in the completely genetically inherited Huntington's disease, exercise can have a profound modifying effect on disease pregression. It elevates BDNF, it exerts neuroprotective and neurotrophic effects in the disease model.
Sure exercise may not do it for everbody, it may not produce the artificial buzz of a prescription drug (thats going to poop out for you in a few years anyway), put what if it is disease modifying in depression too? I.e. exercise could be a long haul treatment that patients are turned off to by the alternative availability of the quick AD boost?
but its a heck of a lot safer than siting on the couch and popping a pill and when combined with judicious use of medication, it will probably lead to a more favorable outcome. IMHO.
Think of it this way. If a patient presents with the a diagnosis of diabeties and is currently exercising that does not lead the physician to conclude that exercise has no effect upon the diabeties and therefore the patient should stop exercising and take their medication. On the contrary, it is likely that the exercise may have been exerting an effect that was outstripped by the disease sevarity. This doesn't mean that any good doctor would still not advise exercise.
Linakdge
Posted by Chris O on August 14, 2008, at 15:59:12
In reply to Re: Peter Kramer debunks exercise, CBT, posted by linkadge on August 13, 2008, at 20:38:06
Link:
I think everyone is different in terms of how much exercise can benefit their mental health. For some, perhaps continuous exercise is the magic bullet. For others, maybe not.
I resisted taking medication for most of my 20s and 30s despite a horrible anxiety disorder. I was in the best shape of my life in my 20s. I regularly did 10K runs, did some biathalons, rode my bike on a couple 500 mile trips. Yet, during all of that, I was still having massive anxiety and panic. Sure, there was some benefit. The exercise maybe took a five percent edge off my anxiety. But it was never able to do much of anything else. I wish to god it was different for me. I've also tried every type natural supplement/treatment out there. I can ride my bike 10 miles a day for months on end and still only get a mild benefit today. The only thing (regretfully) that has had a significant impact on my anxiety (and depression) is antidepressant medication.
Chris
Posted by no_rose_garden on August 17, 2008, at 11:31:26
In reply to Peter Kramer debunks exercise, CBT, posted by Franz on August 8, 2008, at 6:11:57
I run at least a few times a week. Sometimes it's ok, but sometimes I have to stop after less than a mile because i'm so frustrated with myself or not feeling well...then i feel slow and fat and cry. Sometimes i just don't have the motivation.
So sometiemes exercising leaves me more depressed...knowing i'm not good enough
Posted by Lao Tzu on August 18, 2008, at 5:57:41
In reply to Peter Kramer debunks exercise, CBT, posted by Franz on August 8, 2008, at 6:11:57
I've found that exercise did help me with low mood, but only when I was also on the right psychiatric medication for my condition, which is bipolar depression. Bipolars can fluctuate between having a lot of energy and low energy, and exercise can raise mood, but if you are in a cycle of low energy, excessive exercise can make you feel more tired and so depressive symptoms could theoretically seem worse. As far as cognitive behavioral therapy, it did help me with the strange thoughts I was having at the time, i.e. putting things into more perspective, but still strange thoughts persisted, depression persisted, and social anxiety was not helped much by cognitive behavioral therapy for me, though I suspect that people who do not have a diagnosis of bipolar disorder or schizophrenia probably do better with cognitive behavioral therapy. It certainly is a driving force for helping one to be more realistic in day to day living, but I still think that certain groups of depressed people (namely, bipolar and schizophrenia) benefit greater with medication and nutritional supplements.
Posted by linkadge on October 10, 2008, at 18:46:27
In reply to Re: Peter Kramer debunks exercise, CBT, posted by Lao Tzu on August 18, 2008, at 5:57:41
Don't get me wrong. I take meds too but I just don't believe people when they say that "exercise does nothing for me". Peraps they believe this, or want do believe it. I just don't believe it.
Linkadge
Posted by Tomatheus on October 10, 2008, at 23:58:56
In reply to Re: Peter Kramer debunks exercise, CBT, posted by linkadge on October 10, 2008, at 18:46:27
> Don't get me wrong. I take meds too but I just don't believe people when they say that "exercise does nothing for me". Peraps they believe this, or want do believe it. I just don't believe it.
Well, believe it or not (in your case, not), exercise does nothing for me. It did, however, when I was taking Nardil. I actually felt good after exercising. I'd much rather have exercise do something for me mood-wise, but the fact of the matter is that I don't notice any antidepressant benefits from exercise.
Tomatheus
Posted by elanor roosevelt on December 3, 2008, at 20:35:42
In reply to Re: Peter Kramer debunks exercise, CBT » linkadge, posted by Tomatheus on October 10, 2008, at 23:58:56
i hate going to the gym but it helps with my anger, my dullness and my posture. I have never seen posture discussed here. Depression can really fold you up-- you don't get enough air.
Walking is the best. I live in NYC and when all else fails I walk. There is something to be said about putting one foot in front of the other. Gives me a sense of purpose.
Exercise is not the cure-all, just part of the plan.
This is the end of the thread.
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