Running For Your Life: Depression and Exercise

Unlike the lovely Ms. Diller, I love to exercise. It gets me going in the morning, it gives me energy throughout the day, it fights the ravages of age. I love it enough to want to talk about it–a lot. I like to discuss the new poses I’ve learned in yoga, my recent switch from the treadmill to the elliptical, some of the pilates moves that may not sculpt me like they do the instructor, but which are challenging nonetheless.

However, I’ve learned that, in order to maintain even a modicum of popularity, I really do need to limit the time spent on this topic. Apparently not everyone shares my tremendous enthusiasm. In fact, I’m coming to the perplexing conclusion that many people–sit down for this–just do not like to exercise.

I know–I was shocked, as well.

But whether people like it or not, I’m a huge advocate of exercise, because of all it can do for people. But more to the point, here, is that I particularly encourage my depressed patients to exercise, as difficult as it is to motivate themselves, because the difference it can make in their depression is worth all the unpleasantness that so many people find in time spent working out.

There is a plethora of research on the benefits of exercise vis-a-vis depression, covering the young to the elderly, mild exercise to intense aerobic workouts. A google search should set you running. I just mention a few here for variety’s sake–and to show you I’m not full of wind. However, in fairness, a number of these studies are not terribly rigorous methodologically speaking, and one meta-analysis by Lawlor & Hopker in 2001 goes as far as to claim that the actual effectiveness of exercise vis-a-vis depression can’t be proven due to “a lack of good quality research on clinical populations with adequate follow-up.” [If you want to take a look at a somewhat dated (1993) survey of the literature which indicates some of the methodological difficulties in some of the studies, I include the Byrne & Byrne article, “The Effect of Exercise on Depression, Anxiety and Other Mood States: A Review” here for your delectation.]

Tai Chi Punch

I persevere, however, because the studies are improving, because simply not meeting scientific research standards still does not mean these studies don’t have something important to say–and because it’s so clear to those who try, despite their suffering, that exercise helps, isn’t it? As much as we hate to get moving, once we’ve finished, don’t must of us agree that we feel somewhat better–even if it’s just better that dreaded task is now over?

So here’s just a sample of what you can dismiss as un-rigorous–or you could actually think about it. Dimeo et al published a real gung-ho article in an unusal forum, the British Journal of Sports Medicine, in 2001. “Exercise” didn’t even sound too bad, really, for this one, as it was 30 minutes a day on a treadmill for 10 days, and the researchers found a statistically significant reduction in depression in that short of a time. Sounds a little Pollyanna-ish to me, to think we could cure depression in 10 days, but what if it was just a lift, just something to boost a person enough to believe that an end to this illness just might be in sight?

A study published in 2005 by Andrea Dunn et al in the  American Journal of Preventive Medicine found just twiddling your thumbs didn’t cut it–but if people met public health recommendation standards for exercise [and they’re not all that rigorous, trust me], then that effort was significantly correlated with reducing scores on the Hamilton Rating Scale for Depression.

And one of my favorites, given my love of exercise coupled with my abhorrence of TV, was a study entitled “Relation Between Clinical Depression Risk and Physical Activity and Time Spent Watching Television in Older Women: A 10-Year Prospective Follow-Up Study” by Michael Lucas et al just published in 2011. My favorite part about this one is that it studies non-depressed people. Clever.

Turns out, it seems, that higher levels of physical activity are clearly associated with lower depression risk [I don’t know how they figured out who would have become depressed anyway–I was a disaster at Statistics–but I’ll let it be]–and, in the piece-de-resistance to all who know my distaste for TV–you ready?–risk of depression increased with television-watching time. I love it.

Look, I see it this way. When you’re sick, and depression is an illness, there’s no doubt about that, it’s important to do whatever you can do make yourself better. I don’t recommend throwing all your pills down the toilet [or whatever they tell you to do with them now] and heading for marathon-training-courses. I just firmly believe that it’s crucial that you do everything in your power to make yourself better–and exercise is one tool in your arsenal, difficult as it is to motivate to do it.

So please, do something.

Park your car farther away from the store and walk.

Ride your bike to work if it’s close.

Take the stairs two at a time.

Get up from the computer once an hour and walk around the house or the halls.

Walk to the local mailbox instead of sticking the mail in the slot.

Give your young children a the piggy-back-ride of their lives. Put on the music and dance.

Instead of a lunch-date, make a walking date with one of your chatty friends who helps you pass the time with her engrossing gossip.

Garden.

Shovel your own snow. [I live in Chicago, and at times I regret this decision mightily, but I must do it when it snows, and it is a fantastic workout that you don’t really get on the machines.]

Do jumping jacks with the First Lady on the White House lawn.

First Lady with her jumping-jack crew on White House lawn

Find a work-out partner who resembles Schwarzenegger in his approach to fitness, rather than Garfield. Let him guilt you into working out.

Heck–join me at yoga and stand on your head.

Just do something, so you can contribute as much as possible to your return to health. Because frankly, the alternative stinks.

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Depression and ‘The Twinkie Defense,” cont.

So back to Dan White, the San Francisco city supervisor who had been let go–and had returned to plow bullets into Mayor George Moscone and his own supervisor, Harvey Milk. And how he got away with, well, murder.

To make a complex story somewhat less so, White definitely did not see eye-to-eye with Milk, his boss, who was a happy man when White resigned. But White reversed his resignation and tried to garner support from Moscone to go over the head of Milk. Ultimately Moscone refused, under Milk’s persuasion, and in November of 1978 Dan White headed to San Francisco City Hill with the express intention of killing Milk and Moscone, which he did most handily, by shooting both men in their bodies, and then twice each in their heads when they fell.

Anyway, the interesting part comes next. White, who had premeditated that assassination as much as anyone guilty of murder, pleaded not guilty by reason of reduced capacity. What reduced the aforesaid capacity? His recurrent depression.

But that wasn’t really enough. I mean, many people are depressed–and by far the vast majority of them don’t go out and kill their bosses [tempting as that may sound at times].

So a defense expert witness, psychiatrist Martin Blinder, bolstered this with what later become known as the Twinkie Defense. White’s episodes of depression, claimed Dr. Blinder, were made worse by the fact that “whenever he felt things were not going right, he would abandon his usual program of exercise and good nutrition and start gorging himself on junk foods: Twinkies, Coca Cola” [see the Trial Testimony of Dr. Martin Blinder (defense psychiatrist) at http://law2.umkc.edu/faculty/projects/ftrials/milk/blindertestimony.html].

White had been in a funk–a junk-food infested funk–the entire time his job was at stake, but when he definitively found out that he was not getting his job back, he sat up the entire night, “drinking copious quantities of soda pop and eating high-sugar cupcakes and candy bars” (See Trials of an Expert Witness by Dr. Harold L. Klawans).

 

Choco;ate factory Tuesday Sep 24 2013 (1)

Thus, White was not just depressed–rather he was depressed and “intoxicated” on junk food, yielding diminished capacity.

And that, thought the jury, was good enough reason to find extenuating circumstances for White’s crime, due to his diminished capacity.

Now, if replacing a healthy diet with one of junk food is so damaging to a man’s depression it could, in a convoluted leap of logic, lead him to murder–mightn’t it just possibly be bad for you, too?

Depression and ‘The Twinkie Defense’

I think we all, if we’re forced to fess up about it, have some sort of sense of what is better for us to eat, depressed or not depressed, and what is generally–how to put this delicately?–junk?

I mean, if the foods you see below make up, say, 87% of your diet, we all have a sense that that’s less than ideal, right?

But there’s actual research highlighting the importance of sticking with a whole-foody type diet, and staying away from processed foods, in terms of depression prevention.

Entitled “Dietary Pattern and Depressive Symptoms in Middle Age” (and I see no reason why I can’t count myself among the middle aged, so no comments, please), published by Dr. Tasmine N. Akbaraly et al in the British Journal of Psychiatry, the article concludes that a diet heavily tilted towards processed foods–in contrast to a diet rich in whole foods–is actually a risk factor for depression. The researchers conclude:

“Our results suggest a protective effect of an overall diet rich in fruits, vegetables and fish, whereas an overall diet rich in processed meat, chocolates, sweetened desserts, fried food, refined cereals and high-fat dairy products seems to be deleterious for depression.”

Now, that’s unpleasant, I admit, particularly to those of us who think a chocolate omellette, then a Nutella sandwich, and, finally, salmon in white chocolate sauce, comprise a satisfying breakfast, lunch and dinner menu-provided the salmon meal is topped up with Hershey Kisses.

[Frankly, I think the word ‘chocolates’ just snuck itself into the research by mistake, and when I read it I assume it’s just a typo–no reason to worry about it.]

 

file2501305995650But, as one of my friends, a real southerner with a perfect drawl, once informed my adolescent daughter, complaining about some nonsense: “There’s a lot of things you’re going to find out about in this life, my dear–and most of them ain’t pleasant.”

This leads me to the topic of the Twinkie Defense. See if you can recall when San Francisco city supervisor Dan White shot Mayor George Moscone and Harvey Milk, one of San Francisco Board of Supervisors, White’s boss, and the first openly gay man to be elected to public office. White shot the men with premeditation–and, yes, malice aforethought–and killed them both. In fact, after after both men fell, he shot them again in the head.  Yet White was found guilty only of voluntary manslaughter, and given the maximum sentence for that crime–only seven years and eight months in prison.

Why, you ask? Welcome to what has become known as the Twinkie Defense–and to how a California jury seemed to think, 20 years before Akbaraly et al’s publication, that there just might be something to this correlation between lousy eating and depression.

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Mental Health Awareness Week: Anxiety/Depression and Women’s Health

If you’re anything like me (and let’s hope for your sakes you’re not), being aware really takes a lot out of you. With ‘aware’ having synonyms like ‘cognizant,’ ‘mindful,’ ‘wide-awake,’ ‘vigilant,’ and ‘wary’ (I took ‘conscious’ alright–I’m pretty sure I’ve got that pegged), expecting me to be ‘aware’ for any length of time seems to be asking a lot.

So I was going through life, not vigilant, for sure, but ‘alert’ (another synonym)-at least most of the time–until I ran into the 2014 Health Observance and Recognition Calendar Days. Look–I already provided you the link–you really must go take a look. Because you may have thought that you were ‘watchful,’ but I bet for years you’ve failed to notice Root Canal Awareness Week (April 5-12), Medical Transcriptionist Week (May 18-24), Health Care Recruiter Recognition Day–anyone?–June 3; I bet few have properly been mindful of School Backpack Awareness Day (September 17) and I’m pretty skeptical that an appropriate number of people have been vigilant when it comes to  a personal favorite in our household, what’s known as Time Out Day, September 1, which–I am not making this up–“emphasizes the importance of surgical teams taking a “time out” to confirm vital patient information before beginning every invasive procedure.”  That’s right–I’m all for a day that encourages surgeons to find out if I’m actually the one who’s supposed to be in surgery or if it is my 87-year-old roommate, to determine if I’m keeping my uterus–or finally throwing in the towel on the thing, to make absolutely certain that it’s the right side that’s problematic–so they should probably do their business there.

Be that all as it may, there were two weeks asking for my attention that I felt I really should summon up mindfulness for, and, if you haven’t spent all your intentness elsewhere, perhaps you’d join me.  It’s a bit of a challenge, because they’re both the same week, May 12-18, but I think we should all give it a try.

National Anxiety and Depression Awareness Week

When it comes to anxiety and depression, there are a few things it’s definitely worth being mindful of.

  • Anxiety disorders are the most common mental illness in the U.S., and they affect nearly 40 million adults in the United States age 18 and older (18% of U.S. population) (Anxiety & Depression Association of America).
  • Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.
  • Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country’s $148 billion total mental health bill, according to “The Economic Burden of Anxiety Disorders,” a study commissioned by ADAA (The Journal of Clinical Psychiatry,60(7), July 1999).

According to the National Institute of Mental Health:

  • Major depressive disorder is the leading cause of disability in the U.S. for ages 15-44.
  • Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.
  • Of course it can develop at any age–but the median age of onset is 32.
  • The National Alliance for the Mentally Ill tells us that depression affects more than 6.5 million of the 35 million Americans aged 65 years or older.
  • The New York Times, which always teaches me something, made me cognizant of the fact that researchers report nearly 60 percent of the people in treatment do not receive adequate care.
  • Breaking down the stats reveals in any given one-year period, 13 million to 14 million people, about 6.6 percent of the nation, experience the illness.
  • I further learned that, although I was quite interested in stats on ECT, no one keeps them.  ECT.org attempts to clarify the situation with this obfuscating information: “Only a handful of US states require reporting, and many other countries either do not collect data at all, or do so partially.” Illuminating.

Note that you won’t find any such lack of knowledge when it comes to Awareness Day # 2  You ready? It really doesn’t take much vigilance at all–I’ll walk you through.