Just because a thing is true doesn't mean you can apply it. There are vast numbers of active ingredients discovered or developed that are effective in curing many deceases but there aren't "drugs"/pills with it because we haven't found a delivery mechanism for them to be effective where they should in the human body.

Going back to the subject: Have you ever been clinically depressed or dealt with people in that predicament? Getting up from the bed is already a huge win for that day, let alone exercising and doing it consistently and regularly. Even taking medication regularly can be a hit or miss.

So, yeah the prescription is easy to write and thank god it's real and effective, but that's only ~5% of the work.

I have depression, clinically treated with SSRIs. My exercise regimen now is 8-10 hours a week of swimming, cycling, and running. I find that the exercise helps lift my mood a lot, but also if I lose my ability to exercise it is far less catastropic to my mental health than if I stop taking the SSRIs.

My exercise volume varies throughout the year because of physical health concerns (sickness, injury, combination of the two), and I notice it and will become mopey, but it's far from the crippling anxiety and depression that sets in if I miss my SSRIs for a few days.

But this is just anecdata, treat accordingly.

Aren't depressions coming with side-effects like inability to do anything at all? The block is somewhere else to overcome before even thinking about exercise and the brain might have a good reason to block it (e.g. some local energetic/metabolic failure and the brain forcing a "safe mode" to prevent further damage). It's like telling to people with endothelial damage that exercise would do them good when in fact it would cripple them further (e.g. from long covid).

What do you mean exercise isn't treated like real medicine? Doctors have been trying to advocate for people to be more active to help with basically every major health issue for decades. People complain about "ThEy JuSt WaNt To SeLl YoU pIlLs" as if it's not the people who want to solve their health issues by just taking the correct combination of magic pills.

You can be sold exercise too. Physical therapy exists. Personal trainers exist. Gym memberships, gym influencers, gym culture, and gym products all exist. It's not the inability to sell you a product that stops people from exercising.

It should be encouraged but even accounting for side-effects, taking a pill is easy. From personal experience, when I'm heavily depressed, I can barely get out of bed or eat. Forget exercise.

You will find your answer in DJ Shadow's "Why Hip Hop Sucks In '96":

https://www.youtube.com/watch?v=yKf40CLF9MU

Personal experience: Exercise did not help with my severe depression. Out of sheer desperation, I started exercising and eating way better. My health improved significantly, dropping 75 pounds.. but the depression still remains. I was just as depressed after 6 months of daily walking (3-5mi/day) as I was before. Left the house depressed, returned home depressed.

All that to say, I think IMO exercise can help improve general daily mood, but it did not really do anything for my overall depression.

Exercise helps my ADHD, but it requires quite a bit of sequential cognitive processing to actually get to the point of starting it. Adderall makes this initial part much easier. I expect something parallel is happening in those with depression.

I believe forced exercise actually is counterproductive in terms of the facts that exercise usually has on depression, at least in animal models that have looked at the differences in forced versus voluntary exercise. There's a whole literature out there I believe.

Classic case of causality inversion. “People in remission of depression have a higher exercise rate” is the much more precise, much less sensationalist and much more honest take current studies.

Has anyone looked into mental health, inflammation and keto? I looked into it a while back and it seemed promising.

I spent a while reading a bunch of papers on it. First of all, keto lowers inflammation. Inflammation harms cognitive function, especially executive function. Also, a bunch of neurological disorders are associated with mitochondrial dysfunction, and keto acts as a "backup" metabolic pathway. (i.e. if your glucose engine is "misfiring", you can burn fat instead, and in some cases that makes the problem go away.)

The trick is adherence. Carbs are very addictive! I was never able to make the diet stick. (Turns out bread is very tasty...)

But from all I've read, it seems like it would help with a bunch of issues I have. So I thought it would be worth mentioning here, in case it helps someone.

Has anyone's doctor ever not ask them if they exercise during a checkup?

Every checkup for me has started with "what is you diet and exercise like?"

One day, my psychiatrist had brought her new dachshund puppy to work, and she invited me to pick him up. He promptly licked all over my face and then fell asleep in my arms.

I joked to her that puppies beat SSRIs any day of the week, that she should write prescriptions to take to the animal shelter. And it's probably true! Unfortunately, I don't live the kind of life that's compatible with a pet.

Personally, I'm grateful that doctors mostly stay in their lane, although I would hope a good therapist might recommend physical activity to someone who needs it.

And as to what kind of exercise to recommend -- the advice I've heard is that the best kind of exercise to do is what you enjoy and will therefore stick to. Brisk walking three times a week for 20-30 minutes might work great for some people. But if someone finds that a tedious chore, they're probably not going to stick to it.

> Start with brisk walking three times a week for 20-30 minutes at an intensity where you can still talk.

When people talk about exercise as a treatment for depression, i never imagined they meant such small amounts.

I've always thought the hard cure to depression was to rip the person completely away from their lifestyle and give them an entirely new, physically active job, witness security program style.

The studies that show this are generally aggressively biased against people who do physical labor for subsistence and are worn out or exhausted to the point of depression.

If studies showed that African women who walk miles and miles collecting water somehow are less depressed than women with local water, I'll be more sold that exercise does something special..

Exercise really is a wonder drug. The best of the best!

If only doctors could prescribe it and have people adhere to the prescription.

If only American culture weren't so car-centric and our daily lives involved some natural amount of exercising. We've built a society where only the privileged few can walk or bike to work. It's just too easy these days to barely move in our normal life. Drive to work, drive to the store, drive the kids places... you literally have to specifically schedule exercise (and ironically, many people will drive to the gym to walk on a treadmill).

everybody gets paid to recommend pills and other treatment (directly or indirectly). Nobody gets paid to recommend exercise. You can't gate exercise behind a control mechanism and mark it up 1000X production cost.. the list of why goes on and on...

I totally use exercise to keep on top of slightly wobbly mental health.

I heard the practice referred to recently as "Outrunning the darkness", which is glib but kinda describes why I am typically either at work, caring for my kids, or out on a bike.

That said, I very much sympathise be all the accounts by people for whom days are made palatable, and exercise is made possible, by taking prescription medication.

In some places it is. Some people can indeed be "prescribed" (it's not a prescription, it's a referral) exercise and a low-cost arrangement is made with a local gym and appropriate fitness coach. In the UK, such schemes have historically been 12 to 16 weeks and the costs are jointly met by the NHS and the participant (much as with prescribed drugs).

> When we look at higher-quality evidence and direct comparisons, exercise performs similarly to, but not dramatically better than, established treatments. Overhyping it risks damaging credibility in this important area of mental health.

I get where he's coming from, but at the same time, if we can achieve even roughly the same result with exercise as with medication, that's a ridiculously huge win. Side effects of antidepressants are usually uncountably many, whereas for exercise it's (just) injuries and it's pretty well understood how to prevent them. Granted depression is a thousand different diseases in a trench coat, but even if we can ameliorate some forms with exercise, that would still make it considerably more available and approachable.

Exercise doesn't need to be complex or intimidating. Starting out with going for a short walk counts as exercise. You could even do it while you have the patient with you on an appointment, go walk out and about with them. Depression is a complex beast and the more tricks we have up our sleeves to fight it, the better.

If you're depressed, trying to make exercise happen can be the hardest thing in the world for some. But for those that it isn't, it could help a lot.

Exercise helps symptoms of depression. Yay!

Also, when fat people eat less they lose weight.

As with any intervention, the devil is in the details. The author doesn't really provide any.

If the fix was easy we wouldn't need doctors to provide it.

   > So why isn’t it treated like real medicine?

Because exercise is free, pills are not.

Surprisingly I've found some stigma attached to it - because people can get "preachy" about exercise I guess.

Placebo also works so why aren't healing crystals and essential oils treated like real medicine?

I remember reading that Dancing blows aware meds and exercise. So why isn't that treated like real medicine?

People do not discipline.

There’s a good argument for making joining a gym or buying exercise equipment prescription only. A lot of people can injure themselves if they don’t know what they’re doing.

Maybe we could use flock cameras to enforce prescriptions for walking on the sidewalks.

Exercise is to medicine, what sex is to psychology.

Mr dr tells me every visit I need more exercise.

>Exercise works for depression. So why isn't it treated like real medicine?

Clinical depression is a serious mental illness, it causes great suffering, broken relationships, and far too frequently, death by suicide.

A person suffering to such an extent frequently will seek treatment (if they don't, well we don't generally pursue people with medical conditions) from a trained, licensed professional for evaluation, and the extent to which the patient gets out of the house and interacts with people is part of the assessment. Exercise will be among the suggestions that will be encouraged.

However, you don't need a prescription to exercise, so it's not treated like medicine, but it is recommended. If you are prescribed medication or exercise, if you don't take it or do it, there generally isn't a compliance system that kicks in (unless the courts have become involved)

I've experienced what this guy has experienced. I don't think that's unique. Being an athlete who gets injured and has mental health suffer because they lose their sense of identity and purpose is not anywhere near the same thing as clinical depression. It's a poor term in a way. You can be depressed or feel depressed and those are perfectly legitimate uses of the term, but it's not "depression," not in the same way. It's closer to grief. It's a response to loss.

In any case, I'm not exactly up to date on the state of the art in terms of standard of care, but as far as I understood the role of a psychiatrist, it is specifically to write prescriptions. Exercise is not a controlled substance. You don't need a prescription to do it. Any doctor or even just a clinical therapist, counselor, anyone with a license to listen to you and make recommendations, can recommend exercise. And I'm sure they do. If you make it to a psychiatrist, it's because the less controlled options didn't do the trick.

I'm happy to force depressed people to exercise. Pay me and I'll make you do it. At the same time, I expect to see zero serious requests for this service. That's revealed preference.

Around the internet you can find tons of people griping about GLP-1s, saying "diet and exercise make you lose weight, they have to, the First Law of Thermodynamics, etc. etc. How come doctors don't prescribe those?". And the answer is "diet and exercise are not a cure, they are a proposed treatment plan with a dismal success rate". To treat something as medicine, we want it to work in the real world of fallible humans, not in the imaginary world of perfect regime adherence that internet commenters dream up when they want to get snarky.

It's exactly the same thing here: exercise is not a "cure" for depression, it is a treatment plan that has good odds of success if stuck to, and it is frequently not stuck to. Turns out that depressed people are even less likely than the median person to stick to an exercise plan, and the median person is already pretty fucking bad. So the field gravitates to treatments which are achievable even if imperfect.

The article goes into this not at all, it just closes with some blather about supervised programs and gym access, which is like yelling louder at a fat person to "eat less, dammit!". Good luck with that treatment, I'll take the drugs which work.

I mean one thing is that exercise is good for your general health, so maybe there's a reluctance to tie it to specific conditions like depression.

Because exercise is free and 'real medicine' for depression is a $25b industry