Exercise and depression
Exercise is an important component of depression treatment (Current Psychiatry, June 2004). Exercise:
- helps metabolize cortisol, which is directly toxic to CNS neurons. Lowering cortisol levels improves neuronal connections.
- raises endorphin levels, which increases global feelings of well-being and activates reward centers in the brain.
- raises core body temperature, which promotes deeper and more restful sleep, during which serotonin is replenished.
Common reasons patients resist exercise include:
Lack of energy associated with a depressive episode. When I explain the benefits of exercise, however, patients are more likely to consider it.
Self-consciousness. Physically inactive patients are often reluctant to exercise in public, so help them choose an acceptable regimen and location.
Time management. I tell patients that exercise will increase their energy, making them more efficient. I also mention that exercise is a lifelong necessity for maintaining health.
I work primarily with young adults in a university health center. The key to getting students to exercise is to start very slowly—5 to 10 minutes of brisk walking three to five times weekly—then add 5 minutes per week until they are exercising about 30 minutes at a time.
I also preach persistence and patience, since the patient must exercise for 6 to 8 weeks to see a benefit. In the interim, I may help them choose a regular time to exercise, then encourage them to reward themselves by purchasing new walking shoes or exercise clothes if they are still exercising after 2 weeks. If a patient cannot follow a self-imposed schedule, participation in a fitness class may be more effective.
Linda L. Keeler MD
Counseling and Psychological Services
University of Kansas, Lawrence
The article, “Exercise for depression: Here’s how to get patients moving” shows the value of exercise in relieving depressive symptoms.
The authors summarize the evidence clinicians need for recommending that an exercise program may be just as effective as psychotherapy or pharmacotherapy for treating depression.
I plan to use the article to educate trainees in medicine, psychiatry, psychology, and social work. Thanks for publishing such a balanced, health-oriented discussion.
Stanley E. Harrris, MD, DFAPA
Clinical professor of psychiatry and the behavioral sciences
Keck School of Medicine
University of Southern California