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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on April 7, 2006, at 10:43:56
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by Sobriquet Style on April 7, 2006, at 9:24:53
> > > Another thing to consider is exercise.
> > Been there. No dice. Not for me. Not for many others either.> From what I understand, exercise acts as a biological intervention for improving mood, depression and overall general health and well being - for depression which is thought to be of a biological cause, studies have shown it can be equally and sometimes more effective than both psychotherapy and medication.
Let me state things in another way. Exercise does nothing to improve my depressed affective state. To my detriment, the homunculus operating my brain stubbornly refuses to acknowledge the studies you and I have read.
To tell someone with bipolar disorder (BD) or a severe recurrent major depressive disorder (MDD) that exercise will relieve them of their depression is to sabotage their treatment and possibly bring them closer to reaching a point of hopelessness.
I don't begrudge anyone who can relieve themselves of depression by using exercise. I just wish they wouldn't tell me that it must certainly do the same for me. It doesn't. They are not me. I am not them. Studies of exercise do not demonstrate a 100% success rate. I don't think the exercise treatment failures should be ignored or be given the message that they themselves are failures at performing exercise.
As with healthy people, exercise can affect some people with BD or MDD by giving them a transient boost in activation, mental energy, or animation. This is not, however, an antidepressant response.
Depends on the person, I guess.
- Scott
Posted by Caedmon on April 7, 2006, at 11:08:10
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 7:42:21
> I think you will find that when psychomotor retardation is used as a gauge of the severity of depressive illness, drugs work much better than psychotherapy.
Yes.
And this is where exercise takes a backseat to pharmacology. When you're REALLY REALLY depressed, you literally do not even have the energy to exercise.
I've had moments during my darkest depressions in which I would be exhausted just walking about 20 yards/meters or so, and have to sit and catch my breath.
Mind you, I normally include powerlifting as one of my hobbies. (During my phases of not being depressed. Ah, the joys of atypical depression and BP-II!) I am not very out of shape. When I am feeling like absolute, total horsesh*t, the prospect of using exercise to come around is a joke.
- C
Posted by Sobriquet Style on April 7, 2006, at 11:51:00
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 10:43:56
>To tell someone with bipolar disorder (BD) or a severe recurrent major depressive disorder (MDD) that exercise will relieve them of their depression is to sabotage their treatment and possibly bring them closer to reaching a point of hopelessness.
http://www.psycheducation.org/depression/03_treatment_app.html#Anchor-What-50896
http://www.mcmanweb.com/article-39.htm
http://www.mhsanctuary.com/bipolar/selfcare.htm
They're just random links. I don't think I've ever come across any information that doesn't suggest exercise as an anjucnt treatment when relating to mental illness. Of course this doesn't suggest that everyone must do exercise. Neither are people forced to have therapy or medication if they wish not too.
Its my belief that medication and therapy is the main treatment for bipolar disorder. However, I believe that a healthy diet, good sleep hygine and exercise plays an important role too in treatment. Relying on exercise alone, well thats not a risk I'd get myself involved with as a sole treatment, I don't know of any information that would suggest, or a psychiatrist recommend that psysical exercise be used 'alone.'
>I don't begrudge anyone who can relieve themselves of depression by using exercise. I just wish they wouldn't tell me that it must certainly do the same for me. It doesn't. They are not me. I am not them.
I'd agree. Thats similar to suggesting to someone, I like eating a particular food, so they must to!
>Studies of exercise do not demonstrate a 100% success rate.
Do any?
>As with healthy people, exercise can affect some people with BD or MDD by giving them a transient boost in activation, mental energy, or animation. This is not, however, an antidepressant response.
Nope, its not marketed as one.
>Depends on the person, I guess.
Without a doubt! :-)
I will add, for me personally, when faced with the depths of manic depression, exercise has never happened, laying in bed close to 24 hours has. In no way am I going to be exercising when feeling that way, period. On the flip side, when I've felt well, not hypomanic etc my physical energy is good, and usually i'm getting adaqute exercise. I'm working at present to mantain myself with a healthy exercise programme of weight lifting and cardiac training. Just hope I can stick to it, if the illness gets the better of me with depression, based on my previous experience it will be halted.
~
Posted by greywolf on April 7, 2006, at 12:34:05
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by Sobriquet Style on April 7, 2006, at 11:51:00
The concept of using exercise to improve minor or moderate depression makes sense to me. But it's a joke to suggest that exercise can be anything more than a generally healthy thing to do for those with severe/treatment resistant depression or bipolar.
Posted by Sobriquet Style on April 7, 2006, at 12:49:36
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by greywolf on April 7, 2006, at 12:34:05
>But it's a joke to suggest that exercise can be anything more than a generally healthy thing to do for those with severe/treatment resistant depression or bipolar.
I guess thats my point, its a generally healthy thing to do, if and when you can do it.
:-)
~
Posted by greywolf on April 7, 2006, at 13:05:49
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by Sobriquet Style on April 7, 2006, at 12:49:36
> >But it's a joke to suggest that exercise can be anything more than a generally healthy thing to do for those with severe/treatment resistant depression or bipolar.
>
> I guess thats my point, its a generally healthy thing to do, if and when you can do it.
>
> :-)--Absolutely, Sobriquet. My comment wasn't directed toward you. It refers to the multitude of "get out and enjoy the fresh air" and "mind over matter" folks who think simple lifestyle changes will cure serious mental illnesses.
Posted by linkadge on April 7, 2006, at 15:03:45
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 7:42:21
>Been there. No dice. Not for me. Not for many >others either
I know we've been down this road too, but I don't believe there is a case of depression out there that cannot benifit in some way shape or form, from a moderate amount of regular aerobic exercise. Exercise doesn't have the initial umph that an antidepressant does.
Linkadge
Posted by linkadge on April 7, 2006, at 15:11:47
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 10:43:56
Not to say that I don't believe you, but in order for me to believe that a long term aerobic exercise program has (and would always have) zero impact on every domain of your illness is hard for me to believe.
My mother too clamis that exercise never helped her. But the whole family can see a difference when she hasn't been swimming for a few weeks.
Don't take that as an insult, thats just me.
Linkadge
Posted by linkadge on April 7, 2006, at 15:16:29
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by Caedmon on April 7, 2006, at 11:08:10
I realize that exercise can not be directly applied to illnesses of all states, but I would recomend that after an antidepressant has worked sufficiantly enough to give an individual energy, then exercise should be encouraged.
Linkadge
Posted by linkadge on April 7, 2006, at 15:22:33
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by Sobriquet Style on April 7, 2006, at 11:51:00
>To tell someone with bipolar disorder (BD) or a severe recurrent major depressive disorder (MDD) that exercise will relieve them of their depression is to sabotage their treatment and possibly bring them closer to reaching a point of hopelessness.
I don't know what you would consider recurrent major depressive disorder. Perhaps I don't fit your critera. I suppose repeated suicide attempts might be sufficiant, maybe not. To tell an individual that exercise will be their cure might be misguided, but to take exercise out of the equation, and to throw that tool out of the chest, would be a mistake in my opinion.
Linkadge
Posted by linkadge on April 7, 2006, at 15:32:16
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by greywolf on April 7, 2006, at 12:34:05
I think thats where people misunderstand. Exercise has been used in major depressive disorder. Exercise has been shown (not always) to be effective in major depressive disorder. Then again, no antidepressant drug has been show to be always effective in major depressive disorder.
So you've got drugs (partially effective) and exercise (partially effective), I don't see how it is fair to say that exercise should be taken out of the equation.
There are plenty of reasons that it might be effective.
Enhanced BDNF expression, enhanced NGF expression, enhanced NT-3 expression, enhanced GDNF expression, enhaced GAP-43 epression, ehnaced IGF-1 release, ehanced 5-ht1a recetor expression, activation of the endocannabanoid system, ehnaced anandamide activity, hpa axis downregulation, increased release of phenyethylamine PEA, neurotransmitter system downregulation, 5-ht1b autorecetor downregulation, enhanced dentage gyrus neurogenesis, the list goes on.
I think it is a mistake to take it out of the equation.
Linkadge
Posted by greywolf on April 7, 2006, at 15:58:44
In reply to Re: Drugs versus Psychotherapy - Backlash? » greywolf, posted by linkadge on April 7, 2006, at 15:32:16
> I think thats where people misunderstand. Exercise has been used in major depressive disorder. Exercise has been shown (not always) to be effective in major depressive disorder. Then again, no antidepressant drug has been show to be always effective in major depressive disorder.
>
> So you've got drugs (partially effective) and exercise (partially effective), I don't see how it is fair to say that exercise should be taken out of the equation.
>
> There are plenty of reasons that it might be effective.
>
> Enhanced BDNF expression, enhanced NGF expression, enhanced NT-3 expression, enhanced GDNF expression, enhaced GAP-43 epression, ehnaced IGF-1 release, ehanced 5-ht1a recetor expression, activation of the endocannabanoid system, ehnaced anandamide activity, hpa axis downregulation, increased release of phenyethylamine PEA, neurotransmitter system downregulation, 5-ht1b autorecetor downregulation, enhanced dentage gyrus neurogenesis, the list goes on.
>
> I think it is a mistake to take it out of the equation.
>
> Linkadge--I certainly would never say to take exercise out of the equation. Health benefits from any safe source--especially one that gets you out and active--must be generally helpful and, therefore, advisable.
But even my GP, who's a world-class runner (Olympic trials level), recognizes that exercise can do a lot, but has distinct limits when it comes to severe depression and bipolar. Sure, he will encourage me to drop a few pounds and generally get into better condition [I regularly hover at 25-30 lbs above my recommended weight, but I look damn good doing it ;) ], but it's more of a bit of good advice for everyone regardless of physical or mental malady.
But I think your advice is sound, Link. Exercise if and when you can and you will usually feel a benefit, and sometimes it will be significant enough to warrant doing more of it.
Posted by SLS on April 7, 2006, at 16:09:08
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by linkadge on April 7, 2006, at 15:11:47
> Not to say that I don't believe you, but in order for me to believe that a long term aerobic exercise program has (and would always have) zero impact on every domain of your illness is hard for me to believe.
I have a problem with those claims made that exercise is as effective as pharmacotherapy for treating bipolar and endogenous depressive disorders. If it were, I doubt we would see so many people visiting this website looking for advice and support. I also doubt that we would have so many people visiting psychiatrists and taking antidepressants. It's not like exercise is the best kept secret in psychiatry.
- Scott
Posted by linkadge on April 7, 2006, at 16:56:49
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by greywolf on April 7, 2006, at 15:58:44
I don't think that limits to its effectivenes have ever been clearly estabished.
I don't think when it can and cannot help has been clearly established either. I would like to see one clinical trial that shows that exercise has no effect on major depression. We do have clinical trials showing that major depression can beneifit from exercise though. I personally know of a guy who failed ECT, and is having success with exercise and CBT so go figure.
Doctors will always favor pills. My father's doctor prescribed high blood pressure pills and cholesterol pills without ever mentioning that diet and exercise changes can significantly reduce the need for these medications.
I agree with the doctors statements insofar as to not make the patient feel guilty for his or her own condition, but I don't agree with the doctors claims that severe depression cannot benifit from exercise.
Again, western medicine like magic bullits, wheras a wholistic approach may yeild superior results.
Linkadge
Posted by ed_uk on April 7, 2006, at 17:24:29
In reply to Re: Drugs versus Psychotherapy - Backlash? » linkadge, posted by SLS on April 7, 2006, at 16:09:08
Hi Scott
>I have a problem with those claims made that exercise is as effective as pharmacotherapy for treating bipolar and endogenous depressive disorders. If it were, I doubt we would see so many people visiting this website looking for advice and support. I also doubt that we would have so many people visiting psychiatrists and taking antidepressants.
It seems that exercise is an effective AD for some people, but by no means all. No one is claiming that it's a cure-all for depression!
Regards
Ed
Posted by linkadge on April 7, 2006, at 17:27:15
In reply to Re: Drugs versus Psychotherapy - Backlash? » linkadge, posted by SLS on April 7, 2006, at 16:09:08
>I have a problem with those claims made that >exercise is as effective as pharmacotherapy for >treating bipolar and endogenous depressive >disorders. If it were, I doubt we would see so >many people visiting this website looking for >advice and support. I also doubt that we would >have so many people visiting psychiatrists and >taking antidepressants. It's not like exercise >is the best kept secret in psychiatry.
Why is obesity on the rise? Clearly the use of exercise is declining. I don't believe that everybody on this site has given what proponents would consider a fair trial for exercise.
*As effective* is also hard to quantify. For instance, in the zoloft vs. exercise clinical trial in MDD, zoloft produced vastly superior results in the first few weeks. However, the margin decreased slowly over a month or two. Shortly after this, the exercise group was winning on almost every parameter. This continued for the duration of the trial. So while medications may seem to be ahead at first, we need to look at the longer term picture. Antidepressant poop out for a lot of people with major depressive disorder. When the drug solution is as hazy as it is, then a closer look at alternitives may seem to be benificial.For some, exercise will not be as effective as medications, but for others it will be. But in terms of sevaritly, I don't think that exercise just stops at a certain level. The same thing goes for SJW. I think a lot of drug companies wanted us to believe that it was only effective in mild to moderate depression. Over in Europe there are a lot of trials showing it is helpfull in severe depression.
Bipolar disorder is a different story. Exercise is not an antimanic agent. Bipolar depression can (not always) respond to exercise, just like it can (not always) respond to drugs.
Linkadge
Posted by SLS on April 7, 2006, at 17:30:11
In reply to Re: Drugs versus Psychotherapy - Backlash? » greywolf, posted by linkadge on April 7, 2006, at 16:56:49
> I don't think when it can and cannot help has been clearly established either. I would like to see one clinical trial that shows that exercise has no effect on major depression. We do have clinical trials showing that major depression can beneifit from exercise though. I personally know of a guy who failed ECT, and is having success with exercise and CBT so go figure.
Was he depressed or was he depressed?
I still think we have a problem in the identification of what we are trying to treat. ECT and antidepressants will probably fail every time when treating someone whose depression is entirely psychogenic.
I experienced a brief depression during the time my depression was in remission.
Better said:
I expererienced a brief psychogenic depression during the time my endogenous bipolar depression was in remission. Yes. A girl dumped me. I got depressed. It felt entirely different than the depression that was in remission. Not only that, but it resolved completely once I processed the event psychologically.
A depression is not a depression is not a depression.
What exactly are we talking about when we use the word "depression"?
- Scott
Posted by linkadge on April 7, 2006, at 18:04:18
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 17:30:11
Think of it another way. Huntingtons disease is a genetic disorder. That means that without treatment the disease will progress and take over. (Ie, it is endogenious). But, mice who posess HD genes actually benifit from exercise. Yes, that is an endogenious geneticly based disease being modified by the application of exercise.
Ie, mice who possess the Huntingtons gene benifit both symptomatically, and physiologically from exercise. It can delay the progression of many symyptoms. Exercising HD mice loose ballance much later, and also retain weight and brain volume much longer than mice who are sedintary.
I guess my argument is that the disease may be biolocial and endogeniously driven, but one cannot therefore deduce that exercise will have no impact on the course of illness.
It is funny because like in depression and other neurodegeneritive disorders, HD mice posess abnoramlly low levels of BDNF, and exercise can attenuate this decline. Depression and suicidal ideation are big problems in Huntintons. Perhaps due to the way that the disease interacts with the BDNF gene.
www.hdlighhouse.com discusses many agents that can modify the course of Huntintons. They discuss how diferent agents modify BDNF, and how they affect the progression of HD positive mice. They have found that DHA (fish oil) treats Huntintons, Lithium treats huntintons, Exercise treats Huntintons, and how many other agents affect the course of degeneration.
So for somebody to say that exercise cannot treat a depression that is endogeniously driven, may not be accuate at all. Some of the research I believe in (with depression) is how it relates to genes that affect BDNF. One potential gene found in bipolar families 22q. 11 (or something like that) is associated with dramatically decreased BDNF. Bipolar depression is associated with dramatically decreased BDNF.
Exercise alone (in many studies) acutally increases BDNF more than an antidepressant alone.
So if we see recurrent depresson as perhaps degeneritive, then perhaps exercise can modify the long term course of illness.
Linkadge
Posted by linkadge on April 7, 2006, at 18:18:48
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by linkadge on April 7, 2006, at 18:04:18
But, what is the common denominator between fluoxetine, and tianeptine? Enhanced BDNF expression / attenuation of stress induced BDNF supression.
Linkadge
Posted by Phillipa on April 7, 2006, at 18:59:34
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 17:30:11
Good question what is in your opinion depression.? Love Phillipa
Posted by SLS on April 7, 2006, at 19:42:14
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by linkadge on April 7, 2006, at 18:04:18
I appreciate the wealth of studies to be found on Medline reporting the efficacy of exercise in the treatment of depression in humans. I can't account for it. I must call into question the validity of their designs. These studies must be flawed because exercise doesn't work for me. ;-) They don't seem to be well-controlled, and the selection criteria are almost never divulged.
Thesis: Exercise is as effective as pharmacotherapy in the treatment of moderate to severe MDD.
If you ask me, I think all of the studies on Medline reporting parity between treatments in humans represent wishful thinking. Either that, or perhaps they are representative of a backlash against drug therapy. Either way, I don't believe they reflect real-world treatment outcomes.
I wish I had the armament to be able to refute the thesis, but I really don't have the energy to perform the research necessary to produce a cogent argument. Maybe someone else does. Either way, I know what does and doesn't work for me, and I know that exercise doesn't. n=1 Not much of a start, I know.
I guess this is a cop-out. Sorry.
Backlash. I can feel it. Ouch.
- Scott
Posted by SLS on April 7, 2006, at 20:09:56
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by Phillipa on April 7, 2006, at 18:59:34
> Good question what is in your opinion depression.? Love Phillipa
Hi Phillipa.
You caught me on a bad day. I don't think I could do a better job of describing MDD than the DSM. This comes pretty close, though.
http://www.mentalhealth.com/dis1/p21-md01.html
For me: loss of interest; apathy; anergia, psychomotor retardation; anhedonia; reduced libido; impairments of memory, concentration, and cognition; leaden paralysis; muscle weakness; breathlessness; dizziness; feeling cold; loss of smell and taste; reduced appetite; dry mouth; clumsiness; indecisiveness; social inhibition and anxiety; (That's it for now)
- Scott
Posted by Caedmon on April 7, 2006, at 20:30:24
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 19:42:14
You're right Scott, there isn't a way to do a placebo version of exercise. (Well, maybe those ab roller devices could work? Heh.) And I do think that different types of depression respond differently.
From the perspective of a patient, exercise is sometimes a daunting prospect when depressed, and when I'm *really* depressed it's almost impossible. But when I'm recovered, I exercise. It's not just the mental health aspect, I mean there are a million reasons to exercise. It's just good for you. There's very little downside to it.
I mean, the worst thing that could happen is you end up healthier. I wish I could say this about most psych meds.
- C
Posted by linkadge on April 7, 2006, at 21:02:38
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 19:42:14
When doing a little web searching, I found that many of the sites that downplayed the AD effect of exercise had effexor-xr adds on their sidebars.
Linkadge
Posted by linkadge on April 7, 2006, at 21:10:51
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 7, 2006, at 21:02:38
This is the study I was referring to.
http://www.additudemag.com/ourkids.asp?DEPT_NO=303&SUB_NO=19
Linkadge
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