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Exercise To Beat Depression Doctors in the 1950s discovered that an experimental tuberculosis drug lifted people’s moods. A few years later doctors also found that a new antihistamine produced mood elevating effects. This was the beginning of tricyclic antidepressants. Doctors learned that medication could improve mood. This confirmed the theory that there was a biological component to depression and it was not entirely psychological. Doctors still don’t know what causes depression. However they do know that exercise elevates mood and that it counteracts depression at every level. In the United Kingdom doctors use exercise therapy as a first line treatment for depression. In South Africa and The United States it’s vastly underutilised. According to The World Health Organisation depression is the leading cause of disability in The US ahead of cancer, HIV and coronary heart disease. Depression is difficult to define as the illness encompasses a broad array of symptoms, most of which are experienced by everyone at some point in their lives. Everyone feels down on occasion. Sadness is a normal part of being human. However being sad is not the same as being depressed. Depression is an erosion of connections- in your life and your brain cells. The client feels hopeless and feels nothing can help. People who are depressed have different symptoms and therefore different types of depression. There are people who don’t eat and people who binge eat. There people who feel so lethargic and fatigued that they cannot get out of bed. Some cannot make the simplest decisions. Most clients with severe depression cannot work or look after their families. It is both biological and physcological. Exercise has a positive impact on all depressive symptons on both a mental and biological level. Regardless of the symptoms and whether the depression is mild or a full mental disorder. There is no blood test to diagnose depression. This makes it very difficult to treat as different symptoms surface at different times. Drug treatment is largely a trial and error process that is usually very frustrating says Dr Shabeer Jeeva a leading physciatrist. Dr Joseph Schildkraunt a physciatrist at Massachusetts Mental Health Centre discovered in 1965 that a breakdown product of norepinephrine, called methoxyhydroxphenylglycol ( MHPG) was reduced in depressed patients. The doctors got excited by the idea that there was something tangible to measure. His work led to the hypothesis which holds that depression is caused by a deficit of MHPG. Most of the treatments and research since them have tried to reverse that decifit. In the 1970s, Candice Pert a neuroscientist at john Hopkins University discovered that there were opiate receptors in the brain. This meant that the body had a built in way of killing pain with molecules that work like morphine. It was concluded that endorphins dulled the pain in the body and produced euphoria in the mind. Scientists measured endorphins in the blood of a group of runners. The high level of endorphins in these runners proved that exercise fills your brain with this morphine like substance and matched the ‘feel good’ feeling they got. © Joel Sassoon. All Rights Reserved. Page 1 The brain and the body all influence one another. The brain cannot be separated from the body. When people exercise it has been proven that brain chemistry changes. I have found all my clients feel a sense of achievement after completing a workout. If you are down and you start exercising you will feel better. The sense that you are OK and you feel more capable and confident shifts the entire attitude. Jeeva says stability of a routine shifts the attitude alone. Meeting your trainer 3 times a week at a set times is guaranteed to lift depression. Jeeva says that depressed patients who are exercising regularly require less or no medication than sedentary ones. He also says that exercise allows physciatric medication to work more effectively. One of the best examples is a landmark research project from The Human Population laboratory at Berkley University called the Almaeda Country Study. Researches tracked 8023 people for 26 years. The survey tracked a number of factors relating to lifestyle habits starting in 1965. They checked back with the participants in 1974 and 1983. The study concluded of all the people with no signs of depression at the beginning, those who had become physically inactive over the next nine years were 150 present more likely to have depression than their active counterparts. On the other hand those who were inactive to begin with but increased their physical activity were not depressed by 1983. Changing your exercise habits changes your risk of depression. There are three neurotransmitters in the brain that are affected by depression- serotonin, norepinephrine and dopamine. Prozac, the mother of a class of the new Selective Serotonin Reuptake Inhibitors (SSRIs) was invented and everyone got excited. This drug corrected the chemical imbalance of one of the neurotransmitters called serotonin. It does this by preventing the brain of recycling serotonin at the synapse. This leaves more available for use and thus restoring normal transmission in the brain. Doctors see now that certain patients may not respond to SSRIs like Prozac so through trial and error they prescribe other drugs that target norepinephrine, dopamine or all three. Some patients get good results and others don’t. These drugs have many side effects. Jeeva says on balance the benefits out way the side effects in most patients. It is also very hard for certain people to come off some of these drugs. A good example is venlafaxine (Effexor) which is very effective for most people and widely prescribed as it targets a combination of the neurotransmitters namely serotonin and norepinephrine. Jeeva says it is vital for patients wanting to reduce their medication to embark on a vigorous exercise programme. Dr J Ratey from The US wrote a book called Spark- The revolutionary new science of exercise and the brain. In his book he spoke about a patient named Dave. Dave had been to numerous doctors and had been on many medications but stopped all of them as they gave him severe headaches, nausea and gastro problems. The medications also did nothing in lifting the depression. Dave went to Dr Ratey out of desperation. He could not work or play with his children. His family had moved out. His friends had stopped calling him as he constantly cancelled social arrangements. His wife had threatened to divorce him. He had gained 20kg over 36 months and he was finding it very hard to get out of bed. Ratey insisted on a SSRI medication that he had not tried- Lexapro. He had a severe reaction and after one dose he started vomiting. They stopped the medication and Dave did not want to try any other drugs. Dave had been physically active in the past and Ratey had told him to during their first consultation to exercise every day. He also gave Dave many articles that illustrate the enormous effect exercise has on the brain. Dave attempted exercise on his own. He tried © Joel Sassoon. All Rights Reserved. Page 2 walking but could not persevere due to lack of commitment and motivation. Motivation and commitment are always lacking in depressed patients says Jeeva. Dave’s doctor referred him to a personal fitness trainer. Dave had an assessment and realistic goals were set. He was also given a sensible meal plan. Dave agreed to meet the trainer at set times in the week. It was hard for him at first. He felt uncomfortable exercising and was very self-conscious. He persevered and after 2 weeks he went back to his phyciatrist a changed man. He had lost 4kgs, he was smiling, and he felt more confident. He had even made new connections at the gym. Over the course of the next month he was offered a Job in a field he always wanted to be in by one of the other members of the gym. He was also making strides in reconciling with his wife. He was amazed that he felt so different compared to how he felt before. He felt the feeling was sustainable and he was not depressed any longer. Exercise not only elevates endorphins, exercise regulates all the neurotransmitters targeted by antidepressants. Firstly exercise immediately elevates the neurotransmitter norepinephrine in certain areas of the brain. It wakes up the brain and improves self-esteem. Exercise also boosts dopamine which jump starts the attention system. Dopamine is responsible for motivation and attention. Many studies show that regular exercise increases dopamine storage in the brain and also triggers the production of enzymes that create dopamine receptors and create a feeling of satisfaction when completing a goal. Serotonin is also increased which improves mood, impulse control and self-esteem. It is hard for people to believe that exercise plays such a powerful role in treating depression. The nature of someone who is heavily depressed is to want something external to immediately cure them. This is way the majority of people who go to doctors to treat their problem only want to take medication. I am not underestimating the use of medication in most cases it is highly effective. It however needs to be used with exercise. Jeeva says there are some people who do not respond to medication at all and the only way to regulate the neurotransmitters causing the depression is exercise. The exercise prescription The amount of exercise depends on the person as each client needs to be assessed individually by a qualified personal exercise trainer. Generally sessions should be 45 – 60 minutes and no less than 3 sessions per week. There should be a cardio component – usually one should rotate between interval cardio training and constant cardio training. Resistance training is also very important as it not only burns fat but builds and tones muscle. There should also be a stretching component at the end of the session. Sessions should have variety in order to keep the client motivated. Regular assessments tracking weight, body fat and girth measurements are essential in order to track progress and ascertain whether goals have been met. Routine is very important. One should aim to have sessions on certain days at the same times. Exercise is not an instant cure, but depressed people need to get their brains working again. If you move your body your brain won’t have a choice. It is a process and the best philosophy is to take it one step at a time. If the thought of exercising on your own freaks you out Start slowly and build it © Joel Sassoon. All Rights Reserved. Page 3 up or find a personal exercise trainer that has experience with mental illness and is upbeat and fun. Be honest with him/ her about how you are feeling and what medication you are on. I will leave you with this quote from Dr Ratey. ‘At its core depression is defined by the absence of moving toward anything, and exercise is a way to divert those negative signals and trick the brain into coming out of hibernation’. © Joel Sassoon. All Rights Reserved. Page 4