Exercise PLUS 5 natural ways to fight your depression.
In mid-August in Lowell, Massachusetts, orange marigolds pop up from postage-stamp yards, many of which are protected by stone Madonnas. I know this because 22 years ago, as my twin sister lay dying in a hospital not far away, I ran on those sidewalks, my feet pounding into the grief I felt was everywhere. My husband ran beside me, and together we watched Lowell wake up, passing pajamaed boys sitting on porch steps licking the jelly off their toast.
On August 13, 1981, my sister, Deane, a psychologist, was shot in the head by one of her patients, a paranoid schizophrenic who apparently feared what she—and the other doctor he killed outright—could reveal. That day Deane had planned to board a plane to Knoxville, Tennessee, for a ten-day visit with me. Instead, she would spend those days unconscious, her brain no longer active, her heart readying itself to stop.
The first morning after our arrival in Lowell, my husband Dan and I returned with my parents and brother to the hospital,journeying into what we had learned the night before was to be a vigil over my sister's death. We were told simply, "She will not live," a sentence that became etched on my parents' cracked faces, a sentence the doctor would repeat more graphically later and for which we would hate him. What we gleaned from him was plain: Deane had only a few days left to live.
We sat for hours in a room the nurses had set aside for us. There we met Deane's friends and took phone calls and read the cards that came with flowers. When we left at night, we went to dinner—sort of—and slept, or tried to, in our motel rooms.
For terror was doing a number on me, leaving me sleepless and without appetite. At times, I wondered who had died: Deane or me. On earth we had shared souls, and now I could only wonder if I were soulless, my heart floating with her's in some universe I couldn't see. I grieved for her severed life and my long one without her.
Running to Cope with Panic and Sadness
But, every day, I would swing my legs out of bed and lace up my running shoes. It wasn't clear to me at the time, but now it seems as if running was my weapon to outstrip the terror. Running let me slap that energy to the ground, releasing me for a time from panic and horror. I remember pushing myself to the limit, lungs bursting, as if ahead were a person I was trying to catch and subdue. I felt each thud on the earth offer me power.
I didn't understand how it worked, but somehow after my run each day, as I headed with my family to see Deane, I felt for an hour or so that perhaps I could do this, perhaps I could ease my sister into another world.
My sister's death, however, was not my first experience with overwhelming sadness—or with exercise as an antidote. As far back as my late teens, I had suffered from the more generic depression that winds through my family—from my alcoholic grandfather to my mother, who began drinking after my sister's death. Then, as now, I seized on exercise to ward off not only immediate despair but the knowledge that my genes could get me, too.
On bleak New York days, I ran in circles around the Barnard College indoor track. Later, as a college teacher with stage fright, I used running to blow the acid off a day with smart-aleck students, diminish the sense of failure I felt, or simply relieve the pressure of the next day's preparations.
I can still picture the Tennessee creeks and the staring cows I passed on those therapeutic runs. I learned over time that that's when I could solve problems and shed the day's harness. I was free of cares, and when I got back home, somehow the worries I'd left the house with had become, if not puny, at least manageable.
Exercise Relieves Stress and Depression
It turns out such resilience isn't just happenstance. Researchers have known for years that exercise relieves stress—and increasingly they've discovered it can relieve depression as well. In fact, some experts think it may be as effective as drugs, minus their side effects. "Exercise has some benefits that medications don't," says psychologist Andrea L. Dunn, vice president for behavioral science research at the Cooper Institute in Dallas, Texas. "It strengthens the heart and lungs. And it helps regulate appetite and sleep, both of which can be a problem for people who are depressed."
James Gordon, founder and director of the Center for Mind-Body Medicine in Washington, D.C., has been treating depression with exercise and other nondrug approaches for 30 years—with great success. "I used to run a ward in a mental hospital, and the patients would sit around smoking, in a terrible mood," he says. "But when I got people playing touch football and basketball, their moods improved. It was just common sense to me. Human beings are meant to move. It gives people a sense of control, releases anxiety, and creates discipline."
That's particularly important for people who suffer from the kind of depression that isn't associated with grief or some actual event. Poor sense of self, irrational guilt and remorse: These are the core symptoms of depression, says Michael Babyak, assistant clinical professor of behavioral psychiatry at Duke University in Durham, North Carolina. Battling them is like boxing at shadows. "Depressed people have trouble giving themselves credit for anything," says Babyak. "But following an exercise program produces a sense of mastery and achievement."
And Babyak's proved his point. In a study he conducted at Duke, 156 depressed patients were given one of three treatments: aerobic exercise, medication, or a combination of the two. At the end of four months, all three groups showed a significant reduction in depression. But after ten months, the exercise-only group's spirits were clearly the highest of the three groups. "And among all the patients," says Babyak, "those who engaged in exercise during the follow-up period tended to do best."
Researchers don't really know how exercise works its magic, though they're closing in on some answers. Most agree that the physiological changes brought on by working out—in both aerobic exercise and strength training—likely affect mood.
Animal studies, for instance, show that exercise increases the production of serotonin, the mood-regulating neurotransmitter targeted by Prozac and other antidepressants. And a recent British study suggests that a natural stimulant produced by our bodies, phenylethylamine, or PEA, may be responsible for the euphoria that runners sometimes report. In a study of 20 young men whose PEA levels were measured both before and after working out on a treadmill, all but two had elevated PEA post-exercise. (Endorphins, the body's natural painkillers that were long touted as the juice behind "runner's high," may still be involved, but are no longer thought to be key mood-elevating triggers.)
Clearly, there are psychological factors at work as well. My own experience suggests that exercise can help hold an embattled psyche together. In the year after my sister's death, I headed each morning to a two-hour aerobics class, where in a group of 30 women I jumped and stretched and sometimes wept. I knew no one in the class, and I told no one that I had lost my twin sister. And yet the class and the women in it gave me a social toehold. Outside that room, I felt set apart by death and sadness. But inside, I was the same as anyone else. And the class gave me someplace to go. The June before my sister died, I'd received a writing grant, and I had been happy to leave teaching. But now the solitude and introspection that accompany writing were too painful.
Babyak isn't at all surprised by this palliative effect of exercise. "Getting involved in some kind of community setting provides social structure and support," he says, "something to look forward to." Certainly in the years since my sister's death, exercise has given me a kind of social life I find liberating and pleasantly distracting, yet refreshingly free of obligation.
Researchers haven't established what intensity and frequency of exercise is most helpful for alleviating depression. (Dunn and her colleagues have just completed the first study on this subject but can't yet discuss results under review.) Most experts believe that even 30 minutes of moderate exercise three times a week boosts mood.
I'm happier with hour-long workouts five or six days a week. But some studies suggest there may be a point at which exercise becomes counterproductive. For example, competitive swimmers who practice for three or four hours at a stretch begin to show signs of depression.
I'm in no danger of that excess. But this past fall, as I entered the low-light season when my depression is always worst, I decided to resume running local races—an activity I've done sporadically over the years. At one race in late October, I found myself surrounded by families in Halloween costumes. Two men were dressed as Nike sneakers. One family dressed as identical clowns. A minister gave an invocation comparing us to flying geese, a quirky yet uplifting metaphor, and we all sang the national anthem.
The three-mile run, much of it uphill, felt hard. But when I finished, I realized yet again that the feeling of peace and calm I had at that moment was the reason I run. I picked up a bottle of water and walked through the crowd talking to people I knew. I sat on the bleachers and watched as even 80-year-old men stepped up to receive their prizes.
Everyone around me seemed happy. No one had a cell phone out, and no one seemed in a hurry to leave. I picked up a flier for the next race and knew I would enter it. For, as my 17-year-old son once told me to remember, "Stress ain't my address."
5 Natural Ways to Fight Depression
No one suffering from depression should attempt to manage it alone. Counsel from a practitioner is crucial to understanding the particular nature of your depression and which options might work best for you. Often an approach involving several therapies may be helpful. Below are a few treatments to consider.
Meditation
This relaxation technique, which has been practiced for thousands of years in the Far East, involves sitting quietly and allowing your body and mind to relax by focusing attention on a word, on your breathing, or simply on the present moment. Researchers have found that meditation works by lowering levels of stress hormones and lactic acid and by slowing the heart and breathing rates. A 2001 study at Thomas Jefferson University in Philadelphia found that patients who meditated 20 minutes every day for eight weeks substantially reduced their depression, anxiety, and some of the physical ailments associated with their condition, such as insomnia and fatigue.
Getting Started: Find a quiet, comfortable place to sit. Close your eyes and focus on a word or an image, take deep breaths, and relax your muscles. When your mind wanders, return to your focus. Do this for 10 to 20 minutes twice a day. Classes in meditation are often offered at community or yoga centers. Books, audiotapes, and videotapes on meditation are widely available as well.
Nutrition Therapy
Anyone who's felt grumpy right before lunch knows how much nutrition can affect mood. And in fact many practitioners believe that nutrition can play a key role in addressing depression.
Diets low in carbohydrates, for instance, lower the brain chemicals tryptophan and serotonin, both of which are known to affect mood. Low levels of B vitamins, which nourish the nervous system, may contribute to the blues as well—as can too little calcium, iron, magnesium, selenium, or zinc.
Getting Started: Consult a nutritionist or a naturopath before making any drastic changes in your diet. For more information, contact the Center for Mind-Body Medicine, 202.966.7338; www.cmbm.org.
Herbal Remedies
The most prominent of these is Saint-John's-wort, an herb used for centuries to treat mild to moderate depression. Experts believe it works by preventing nerve cells in the brain from reabsorbing serotonin, the neurotransmitter targeted by antidepressants. Saint-John's-wort is sold in capsule, tea, and extract form.
Last year, a major National Institutes of Health study found no difference in effectiveness between Saint-John's-wort, an antidepressant, and a placebo, but many researchers believe the study design was seriously flawed. More positive is a 2002 review of 34 studies involving 3,000 patients. In those, 500 to 1,000 milligrams a day of the herb appeared to be as helpful as prescription antidepressants in treating mild to moderate depression.
Another option is S-adenosylmethionine, or SAMe, a cellular substance that boosts serotonin levels. Several small studies suggest its effectiveness, but it's extremely expensive—up to $20 a day compared to $6 a month for Saint-John's-wort.
Getting Started: A typical dose of Saint- John's-wort is 300 mg three times a day.
Acupuncture
Researchers believe this ancient Chinese therapy stimulates the central nervous system to release chemicals such as endorphins, serotonin, and norepinephrine, which likely lift depression. Although research on acupuncture and depression is scant, in a 1998 University of Arizona study of 11 depressed women, more than half improved significantly when treated with the needle therapy.
Getting Started: Treatment is appropriate for mild depression only and usually requires a half-hour to hour treatment one to three times a week. To find an acupuncturist, contact the American Academy of Oriental Medicine, 888.500.7999; www.aaom.org.
Cognitive Therapy and Hypnosis
Cognitive therapy involves working with a psychotherapist to eliminate negative thought processes and attitudes. In the last 30 years, 325 studies have found cognitive therapy effective in treating a range of mental ailments, including depression and anxiety.
Hypnosis is often used as an adjunct to this therapy. Proponents believe that it helps patients refocus thoughts and perceptions by accessing the part of the brain that controls concentration. In one 2002 British study of 21 patients, four to six weeks of training in self-hypnosis improved mood and reduced depression and anxiety.
Getting Started: To find a psychotherapist who uses this combined approach, contact the American Society for Clinical Hypnosis at 630.980.4740; www.asch.net.
Source: Alternative Medicine
next: Nutritional Therapy for Depression
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