Running From Depression
A recent study by Cruz et al, “Anxiety and Depression in Cystic Fibrosis,” (Semin Respir Crit Care Med 2009; 30: 569-578) came across my desk the other day. Oddly, I was in the middle of creating a talk about exercise and was on the exact slide where I talk about my favorite book on the subject of exercise, Spark, by Dr. John Ratey.
Ratey is a psychiatrist at Harvard and one of his areas of expertise is the neurochemistry of exercise. I read this book when it first came out and have practically forced most of my clients and several family members to do the same.
The Cruz study points out in grave detail the increased prevalence of both anxiety and depression in people with cystic fibrosis, noting that these have important consequences, including poorer disease outcomes and lower scores on measures of quality of life. Depression especially wreaks havoc on adherence. It makes sense, really. When you are depressed, it is very easy to blow off treatments. When you don’t care, why bother? When you are consumed with anxiety, a trip to the gym is not the first thing you think about doing.
After these grave facts are discussed, the authors conclude that better screening for depression and anxiety should be done on patients with CF, and treatment given to those with symptoms, including medication or therapy (or both). I would add one more tool to the bag, one that in fact would also likely work as a preventative measure. And…it’s free (a big plus these days).
If Ratey is to be believed (and he gives sound reasoning and research to back up his material), the BEST time to head to the gym or lace up your walking shoes is when you are blue and don’t feel like doing anything. The reason is that exercise acts as an antidepressant. In fact, exercise is nature’s perfect antidepressant…with no side effects. The reasons are complex, but I am going to try to simplify:
First and foremost, to call “depression” a disease is like calling a “cough” a disease. A cough is a symptom that something is wrong. Perhaps you have asthma. Maybe you are choking on a marble. It could be that the air is extremely polluted and all sentient beings are suffocating. The bottom line is the cough tells you that something is wrong. The underlying cause is yet to be named.
In the same way, depression is a symptom. Many things can cause depression: pain, stress, medications, trauma, addiction, AND altered neurochemistry, to name a few. Just looking at the last one, the brain’s chemistry can be messed up in completely different pathways and yet the final result can look similar. This is why a medication that blocks the re-uptake of serotonin may work on me, but not you. Someone else may only respond to a medication that increases Dopamine…or Norepinephrine. The names are not important. What is important is to understand that the whole thing is very complex.
And yet, one thing that we all can do at some level, exercise, seems to be able to jolt the brain back into balance. It seems to regulate the neurotransmitters that antidepressants target….all of them…and at just the right dose.
Almost immediately when starting to exercise vigorously, norepinephrine is elevated. This is the wake up and get going chemical that also works mysteriously on boosting self-esteem. Also, dopamine, the brain’s attention system and regulator of feelings of well being, is elevated. Finally, the well-known chemical serotonin, important for mood, self-esteem and impulse control, bumps up. And to add frosting to this cake, endorphins are made within the brain upon exercise, and we all know what endorphins do…
So that’s the chemical story. But there is an architectural one as well. Exercise causes release of something called BDNF (brain-derived neurotropic factor), which Ratey calls “Miracle-Gro for the brain.” This, and other neurotropins cause the brain to a) make new cells, and 2) create and foster new connections between brain cells. As he explains, depression is caused not just by a lack of neurotransmitters, but also by a lack of connections within the brain itself. BDNF fixes this. Exercise releases BDNF.
Yes we are at high risk for depression. And yes, depression is very bad for compliance with a complicated medical regimen. Sure, we could take another pill or two or three (and some of us may need to) to combat depression. But one easy thing to try right now is to move. Every day.