“Melancholia Minus Its Charms”
Depression â€” not to be confused with normal sadness â€” has been called many things since Hippocrates first described the disease back in the 5th century BC. In fact, it may have been Hippocrates himself who first coined the term melancholy, which literally translates as “black bile.” He believed the feelings of sadness, emptiness and hopelessness associated with depression were caused by a buildup of toxic sludge in the spleen. More recently, psychologist and existentialist Rollo May described the condition as “the inability to construct a future,” while Spanish philosopher George Santayana said it is “rage spread thin.” Essayist and activist Susan Sontag put it more simply: “Depression,” she said, “is melancholia minus its charms.” If you suffer from the disease, you know exactly what she meant.
Years and Lives Lost
Mild to moderate major depressive disorder (MDD) is the leading cause of disability in the world and second only to ischemic heart disease for years of life lost due to premature death, according to the World Health Organization (WHO). Despite the fact that between 80 and 90 percent of people will go into remission within two years of their first episode, there’s a 50 percent chance it will strike again at some time during their lives. Lacking some form of preventative treatment, after three or more episodes the odds of a recurrence jumps to 70 to 80 percent within three years. And so it goes. With each recurrence, the chances of the depression becoming chronic increases, as do the odds of disability and suicide. It is estimated that seven percent of Americans suffer with MDD each year yet, despite its prevalence, less than a quarter of those with the disease will seek treatment. Worse, only ten percent of those who do reach out for help will receive adequate care.
The Brain’s Baffling Complexity
Though there are many ways to describe depression, defining it is something else entirely. For the depressed person, feelings of helplessness, anxiety and fatigue are the result of complex neurochemical processes in the brain involving billions of nerve cells constantly communicating over complicated neural networks that, even today, beg more questions than answers from the researchers who study them. For the past two and a half decades, discussions about how to treat depression have largely focused on psychotropic medications such as antidepressants.
Magic Bullet or Placebo Effect?
Currently, the most widely prescribed antidepressants are selective serotonin reuptake inhibitors, or SSRIs. SSRIs, which come with brand names like Prozac, Celexa and Zoloft, among others, help regulate the neurotransmitter serotonin in the brain â€” though researchers have little idea as to why they work or, as some studies suggest, whether they work at all for mild to moderate depression. With antidepressants, patients are often forced to choose between potential relief or the possibility of serious side effects, which range from nausea and a decreased sex drive to a heightened risk of suicide for some patients.
In many cases, alternative treatments such as cognitive behavioral therapy, acupuncture, St. John’s wort (hypericum perforatum) and SAM-e can be just as effective as antidepressants for treating MDD but, as with SSRIs, those treatments may be inadequate or ineffective for many people. Also, some alternatives â€” as is the case with St. John’s wort â€” come with their own side effects, including adverse and potentially life-threatening interactions with a variety of medications including some immunosuppressants, beta-blockers and even oral contraceptives.
The Best Treatment May Be the Oldest One
So if most of the people afflicted with MDD agonize in silence and the majority of those who do seek treatment receive scant relief, where does that leave the millions upon millions of sufferers? What if there was an already-available treatment that worked as well or better than antidepressants and their alternatives, cost virtually nothing and carried none of the side-effects or social stigmas? Well, there is and it’s been around since long before Hippocrates came on the scene. That “miracle” treatment is exercise.
Movement for Mood
Americans spend more than 10 billion dollars a year on antidepressants, so perhaps it isn’t surprising that the study of exercise and its relationship to mood has largely been overshadowed by the push for psychotropics. In addition, exercise has had some unique methodological problems to overcome. For example, is there a social component to exercise that boosts mood separate from any physiological advantages? Over the past dozen years researchers have pushed people to walk, run, swim and bicycle in the name of science. And, after thousands of gallons of sweat, they’ve reached a consensus: for depression, exercise may indeed be the best medicine. As little as 30 minutes a day, three to five days a week may be enough for most people to stem the tide of gloom and feelings of worthlessness, with more being better. A 2005 study in the American Journal of Preventative Medicine found remission rates to be significantly lower for people who exercised compared to either those on antidepressants or taking part in behavioral cognitive therapy.
How It Works
Exercise may work in much the same way antidepressants do â€” by regulating neurotransmitters like the feel-good chemical serotonin. In addition, exercise appears to switch on certain genes that pump up the brain’s level of galanin. That, in turn, regulates the stress hormone norepinephrine, which helps to control the body’s stress response. A side-effect of exercise is an increased body temperature, which has calming properties all its own.
5 Bonus Benefits of Exercise
Besides helping us to remain calm in the face of new challenges, exercise has a few added advantages as well.
1. Exercise works immediately
Unlike other treatments, with exercise you don’t have to wait around to get results. Performing heart-pumping aerobic activities such as brisk walking, jogging or bicycling for just 30 minutes can give an immediate mood boost. Also, the more you do, the greater the benefit say researchers.
2. Exercise builds confidence
Not only will exercise make you feel better in the short-term, it can also be a big boost your self-confidence down the road. While setting exercise goals and meeting them is a proven way to make you feel better about yourself on the inside, you’ll also look healthier on the outside, prompting comments and compliments from others. Talk about a healthy feedback loop!
3. Exercise is a great distraction
When your feet are hammering the pavement or pounding the pedals, you’ll have a lot more on your mind than dwelling on today’s worries. Even better, choose an activity you enjoy such as tennis, swimming or briskly walking around the mall. Not only will your mind be elsewhere, you’ll look forward to the next opportunity to get back to it.
4. Exercise invites social interaction
If you haven’t heard, human beings are social creatures. One of the best ways to stave off depression is to interact with other people. Whether you hit the gym or simply walk around the block, there are likely going to be lots of chances to connect. Take the opportunity to smile while you work out as well â€” you might even brighten someone else’s day.
5. Exercise helps you cope in a healthy way
Many people with depression choose to self-medicate using alcohol or other drugs but, as most of us already know, these “solutions” rarely help and often exacerbate a downward spiral. You’ll be doing both yourself and your family a big favor when you reach for a water bottle instead of the vodka or pill bottle.
If you’ve ever been caught in the cycle of depression, you know that one of the most pervasive symptoms is a nagging lack of motivation. One of the best ways to break out of the vicious cycle is to break a sweat. It makes perfect sense. We humans didn’t evolve for the sedentary lifestyle most of us are accustomed to today. Our ancestors had more immediate concerns than dwelling on an unsatisfying job, for instance â€” concerns that required a high level of fitness, like outrunning a saber-toothed tiger or chasing down a wooly mammoth dinner. Although there’s probably no way to ever know for sure, depression wasn’t likely a condition our pre-agrarian predecessors could afford to live with for very long. When you take into account all of its other benefits â€” including preventing and healing a range of other illnesses and ailments, its low-cost and confidence-boosting abilities â€” exercise is not likely something modern humans can, or should, live without. Think of it as one of the key ingredients for living a charmed life.