Were he around today, I could imagine referring one of my patients or a family asking about help for a loved one with depression to Vincenz Priessnitz. But he died in 1851. Priessnitz was a pioneer in alternative medicine, where diet, exercise, and non-medicinal interventions (like hydrotherapy, namely baths with robust currents and minerals added), were provided to people with depressive illness, among other disorders.
Practicing in Austria (in a region that is now part of the Czech Republic), Priessnitz gained fame throughout Europe, the UK, the New World, and as far as New Zealand for curing his patients by combining baths with vigorous exercise, adequate sleep and proper diet. Exercise consisted of long walks in fresh air or sometimes (the season permitting I suppose) walking barefoot in fields of grass.
What do they say? What goes around, comes around? Especially, what we could call 'the walking cure.'
Several recent studies, a mere 150 or more years after his death, validate Priessnitz's contention about exercise. More general support for the medicinal, or health, value of exercise was reported in a review article on 29 studies that showed that attention, memory and speed of mental functions were substantially improved in individuals who engaged in aerobic exercise (1). More specific, anatomic brain volume increases were found in people with schizophrenia who exercised aerobically (2). General mental health has been shown to be associated positively with how vigorous and frequent adults exercise (3).
But my favorite is the work of Drs. Dunn, Trivedi and their colleagues in Texas and Canada who demonstrated the salubrious effects of exercise on depression (4). Before I describe their work, I want to stress, as I have elsewhere, that if you or a loved one has severe depression, or depression with suicidal ideas or loss of reality (called psychotic depression), get thee to a doctor. Alternate treatments like exercise or evidence-based psychotherapies, like cognitive-behavioral and interpersonal therapy, are highly effective for mild to moderate depression but for more severe depressive illness -- which can be life-threatening -- medication is generally needed. When illness is severe, alternate treatments become complementary treatments, which is to say they can add, or complement, the action of medical interventions.
But back to the 'walking cure.' The work of Dunn and Trivedi showed that exercising three or more times a week to the level recommended by the American College of Sports Medicine and other public health consensus reports improved symptoms of depression. They called this the "public health dose" of aerobic activity, which means vigorous exercise (walking, running, stationery bicycle are all good) for at least 30 minutes at a time, several or more times a week. No differences were found between those that exercised three times versus five times a week. But those who did not get the "public health dose" (either because they were in a group that did less exercise or were controls, people who did not engage in the treatment but were monitored as a comparison group) did not have the clear improvements in depression that those that exercised did, judged by significant reduction in symptoms or full remission of their condition.
You don't have to start at the "public health dose." Like with most treatments, wise counsel is to start low and go slow. Begin with short walks, or time on an exercise machine. Do it twice a week, and then get to three or more times. Find the right time for you: some people prefer to exercise in the morning, some in the late afternoon or evening (when our muscles are more warmed up and flexible). Work, school or home schedules, of course, may make it plain enough what times are possible.
How does exercise work? We don't know for sure. Release of neurotransmitters instrumental to mood regulation (like serotonin and norepinephrine) or pain control (like endorphins) may play an important role, or perhaps reductions in stress hormones. The discipline and self-mastery of committing to a task and doing it faithfully helps with self-esteem and self-confidence. We may not know the mysteries of the neurophysiology and neurochemistry of exercise, but we know it works!
What does not work, however, is not exercising. It can be hard to exercise even if you are not depressed. Exercise takes time, and for people not used to it can produce aches, pains and fatigue. But those 'side-effects', if you will, go away soon -- replaced often by a feeling of well being, clearer thinking and improvement in mood; some people even lose weight. For people who are depressed, doing almost anything can seem too great a task, or they feel that their condition is hopeless or that they do not deserve to feel better. That is where family and friends come in. Exercise that is done with others, or encouraged and supported by others, is more likely to happen. Priessnitz had a captive population, so if you were at his spa or under his care you got up and walked -- not negotiable if you want to get better, he might have said.
The question for a person with depression, then, is what are you willing to do to feel better, to be able to feel energy and hope again in your life? What do you not only owe yourself, but what do you owe your loved ones, friends and others who rely on you at home, work, school and in your community?
The answer may be old-fashioned, but not out of style.
References
1. Smith, Blumenthal, et al: Psychosomatic Medicine: 72:239-252, 2010
2. Pajonk, Wobrock, et al: Archives of General Psychiatry: 67:133-143, 2010
3. Medical Sciences Sports Exercise: December 1, 2010
4. Dunn, Triveti, et al: American Journal of Preventive Medicine 5:28:1-8, 2005
............................
The opinions expressed herein are solely my own as a psychiatrist and public health advocate.
Dr. Sederer receives no support from any pharmaceutical or device company.
Visit Dr. Sederer's website at www.askdrlloyd.com - for questions you want answered, reviews and stories.
Treating Depression Without Drugs
Depressed and Coping: Treating Depression When Medication Fails ...
Johns Hopkins: Depression|Anxiety: treating depression and anxiety ...
Depression Treatment: Therapy, Medication, and Lifestyle Changes
Depression (major depression): Treatments and drugs - MayoClinic.com
That is a meaningless statement. Illnesses are apart of the human condition.
"we can get that this entire area of study is about ego-centrism."
Is it really ego-centrism to value oneself? Hardly.
"The best therapy is a program that encourages people to be more altruistic and less self-centered."
Right, because people who have major depression are just selfish jerks. How dare they.
"suffering from chronic bouts of depression needs to focus on the needs of others."
No, people with major depression need to focus on their own health needs before they can even BEGIN to think about the needs of others. What you are advocating sounds like co-dependency to me.
Tom: Nice play on words. However, you're not getting the distinction. We seek to eradicate illness. To seek to erradicate sadness is folly. There are better ways to help people to handle their emotions than maintaining perpetual drug induced euphoria.
An: Is it really ego-centrism to value oneself? Hardly.
Tom: Nice try, but that's not what I said. To value oneself is healthy. To focus on oneself to the exclusion of all others is not.
An: Right, because people who have major depression are just selfish jerks. How dare they.
Tom: We are all selfish by nature; sometimes we have to be for self-preservation. It's a matter of degree. "Major depression" is non-descript term, but I don't dismiss or or pass judgment on people who need help. You are mischaracterizing my prior blurb. However, I still maintain that it is more helpful to get a severly depressed individual to pay some attention to others rather than encouraging one to continue being obsessed about one'self.
An: No, people with major depression need to focus on their own health needs before they can even BEGIN to think about the needs of others. What you are advocating sounds like co-dependency to me.
Tom: Focusing on one's own health needs and caring about others are not mutually exclusive.
i dont know what your experience with depression and mental illness is (depression IS a mental illness, sadness and melancholy are normal human emotions, depression, in the clinical sense, is when these negative emotions reach an extreme both in severity and longevity.)
you seem to have an over simplified [perception of this. (which i understand, but it is incorrect)
some depression is situational and often clears up on its own (or with therepeutic support either from a professional or loved ones) and is triggered by events in the persons life.
other depression is physical, and the result of a chemical imbalance in the brain that cannot be fixed merely by focusing elsewhere.
both of these are different from the negative emotions experiences as part of the 'human condition'
sorry for the wordiness. just trying to make sure im being clear
thanks, Kathy
of serious depression. Dr. Sederer clearly points out that someone with serious or life
threatening depression needs further treatment than walk therapy. That said, I have seen
many people really benefit from the simplicity of a regular walking schedule. thank you
again Dr. Sederer for pointing out a simple inexpensive health increasing way to help with
depression.
For those of us who have been lucky enough not to suffer from depression a walking
program is at the top of my list for proactive mental wellness.
I excersise listening to Hooked On Classic cd's.
The music is lively and really makes me want to get up and move !
You can listen to samles of Hooked On Classics at Amazon to see if it is something you might enjoy.
Having a dog won't cure depression, but they sure are a comfort, and a motivation to get out and walk! Never met a dog that didn't enjoy a long walk! :)
That's my two cents. I don't suffer from depression but have dealt with anxiety for several years.
http://kimcrawfordmd.com
How many is too many, Dr. Kim who is not in the field of mental health?