It's a known fact that exercise and good lifestyle are good for the mental health. But isn't the inability to maintain a good lifestyle one of the first symptoms of depression ?
- good diet with no junk food, alcohol, drugs and stimulants
- regular exercise and outdoor time
- good sleep hygiene
- regular healthy social interactions
- eliminate environmental stressors (job/financial stress, relationship stress, noise pollution, etc)
Of course, not everyone can have everything and some of those aren't 100% under your control, but ultimately it becomes your responsibility to try fix them if you want your situation to improve, since nobody else will.
Exercise is perhaps one of the easier ones but, personally, I've found it incredible to reflect on how absolutely bad my childhood "gym" classes were. At no point did we actually... go to a gym. That was never normalized for us. We sort of just learned how to do jumping jacks when we were told to, that sort of thing, and it was all structured for us. There was no habit forming, no "how to do this once there's no one around to structure it for you". In my experience, people who go to the gym get "brought in" by someone in their life who can help them build that structure. For someone missing it, well, you're truly on your own in a rather stressful environment.
Sleep hygiene is good but, again, I suspect tricky here.
Regular social interactions, another heavy lift! What do you do to build up a network of people in your life? Social structures don't just magically appear, and once again, they're usually just handed to you for most of your life and once those fall away you're in quite a spot trying to recover or build anew.
I think the environmental stressors may be the roughest, hard to say. Eliminating financial stress is something that can take decades. Noise pollution? That's really quite out of my control.
All of these are great things to work on but I suppose my read of them is "wow, being depressed seems really fucking hard if you have to do these things to get out of it".
You really don't have to go to a gym if you don't like it , or do something "hard" that many people dislike like running. You can simply walk briskly for 150 minutes a week (which is the recommended dose, and which 80% of Americans and other Westerners don't meet). That is time outside (vitamin D) + moving your entire body - less chronic pain, better joints, better bones etc. I think even this alone without resistance training (which is important) could be enough to help most people with morbidities and depression. Our machine is simply not meant to remain stationary all day and be bombarded with social media and TV, there's no wonder neurosis is off the charts.
I don't like flossing and brushing my teeth either, but yet I still do it regularly. In fact, I never met anyone who brushes they teeth out of enjoyment, but out of habit.
Similarly, the habit of exercise(and other health related activities) needs to be cultivated, you don't have to like it, you just do it because it's what's best for you.
If you take no accountability over your own actions and agency and expect life is about doing only the things you enjoy, then no amount of SSRIs or expensive therapy sessions will fix this.
I use a walking pad at home. Each night after dinner, I’ll go into that room and watch a movie (or half) on my iPad when I’m walking on it. I did over 3 miles last night (at a moderate pace), and that’s pretty typical. Not because I’m trying to work out, just because I’m into the movie and don’t want to stop. If I had friction of needing fresh gym clothes, having to drive somewhere, or thinking about if the weather is nice enough for an outside walk, I would probably be too lazy to walk most evenings. If I didn’t have the entertainment of the movie, I would probably find the exercise boring and not feel incentivised. I do it because I’m looking forward to the movie and I know I’ll feel great afterwards.
As they say, you need to design your habits for the laziest, most unmotivated version of yourself.
Also, when you are low on mental resources, don't try to do something that you dislike to begin with just because you believe it's optimal. Instead, do the thing that's potentially non optimal but sustainable. For example, start to do regular walks instead of going to the gym.
To be honest, I am kind of shocked of the comments here on HN regarding this topic.
There's nothing new here, we all know this, but he brings the point home very well. I think brisk walking is within the realm of possibilites for most people. Running and lifting - idk. I personally love it but so many people I know have such a huge psychological resistance to doing it. So I say lets get people to at least walk!
I don't need to watch a video, I can just do introspection and I know why I resit exercise. In fact, most people will watch the self help videos and learn the exact same things they already knew, if only they'd be honest with themselves about their issue and not try to avoid accountability. But it's easier to accept things when a professional specialist tells them to you, often for money.
The problem is many people want for someone to tell them that the issues they have are not their fault, so they can feel better about not doing anything to improve their situation.
> I think brisk walking is within the realm of possibilites for most people.
Walks are good except when you live in a concrete hellhole full with busy traffic. That's why I avoid telling people exactly what exercise they should do, as that depends on their health, location, financial situation and lifestyle.
Well just if anyone reads this , Liberman's point is that we are biologically programmed to NOT want to exercise unless there's a clear biological incentive - like getting food, or a social incentive - like a tribe participating in a dance or children playing. Since for millions of years we couldn't tell when the next calory of food would come - exercising for the heck of it was insanity and you wouldn't survive. You expended so many calories just gathering and hunting you mostly rested when you could. So basically our biology does not fit into the world of calory abundance we live in.
Yeah IT IS hard, I didn't say it's easy, I just said what you need to not be depressed. Whether everyone can get all those is another issue.
The thing is that in the case when you don't have all of these, adding unhealthy habits on top, doesn't make your situation better.
A lot of the time, what is diagnosed as depression is actually a very valid reaction to being in a shitty situation. I myself ended up at a psychiatrist due to being stuck in a shitty job with me being too exhausted and anxious to do anything about it. What eventually 'cured' me wasn't any of the sessions with the shrink but being laid off in a company restructuring with a nice severance package that allowed me to take a couple of months to decompress and look for a job that was a better fit.
Yes, but actually not always. If you have someone overweight because they're only eating pizza, cheetos and cola everyday and you use a magic wand to give them Thor's physique, how long will their new physique last with their diet until they devolve back into a slug monster?
Money tends to run out, very quickly for some people. If you aren't able to keep your life in order when you're poor, you'll probably squander it all quickly too if you win the lottery. Like a friend of mine said "Thank God nobody gave me a million dollars when I was a drug addict, I would have OD's in a day".
People with self destructive tendencies don't need 20 million dollars, they need therapy, a stable job, and a loving caring community, something that fewer people have nowadays.
It's similarly often not easy to solve relationship stressors or noise pollution.
SSRIs or exercise won't make your financial or relationship issues go away so you'll still be depressed unless you can fix all the issues bothering you.
The change needed was to actually have a reason to start doing any of them. For me, that started with being honest with myself. Deep down inside I knew the reason for my depression, I "just" had to be honest about it to be able to take control over it.
Once I did that I gained some motivation to do those things on that list, and so I started doing them. And slowly but surely I got out of my hole.
Every now and then I notice I'm halfway back down a hole. I stopped doing those things. Again I have to be honest with myself about why, and with that I can start the climb back out, starting exercising again, eating better etc.
Consider: there was a study about a guy who was paralyzed from the waist down, who got an implant to bypass the injury, and with a year+ of walking with the implant, could eventually walk to a limited extent without the implant.[1]
This suggests walking can be used to treat loss of ability to walk. Unfortunately, there's a catch-22 there...
...and so too with inability to make yourself do anything.
Wait, I thought those things solved depression? Why are you hedging now? Did your initial analysis suck, and you're just now realizing it? Are you figuring out that maybe this is slightly more complex than "just be happy" and that maybe you're not the only person on the planet who's ever thought about this?
Tread carefully friend, I agree this is a good list to _prevent_ the most common forms of depression, but some will think you are framing major clinical depression as a personal failing.
Some people slide into a hole of their own making. Others get thrown into the abyss by external factors. Grief, trauma, abuse, crises of repressed identity, poverty and poor prospects. Life can be brutal.
I highly, highly recommend The Noonday Demon: An Atlas of Depression (Solomon) for anyone that is interested in a comprehensive view of depression.
Yes, true, a lot of the times it is from external factors (ask me how I know), but what people miss is that even in that case, it's still on you to get yourself out since SSRIs and therapy session won't fix the situation you fell into, nor will anyone else come to get you out, unless maybe you're lucky enough to have an incredible family, community or support network.
It's still your responsibility to get yourself out even when your situation is not your fault. That's the sad truth about life, you have to play the hand you're dealt, instead of being depressed you've been dealt a bad hand. It's not fair, but that's how it works.
Yes, we all must accept responsibility in changing our circumstances. _And_ we all can accept responsibility for helping others do the same.
Some people need to hear the first part that you shared. Others need to hear the the second part that I am sharing.
First of all exercise should be seen as one of the first lines of defense against not only depression but chronic health problems (which also lead to depression). So you shouldn't wait until you are depressed to start exercising - ideally it is something you do all the time. Secondly - someone who's depressed is not keen on most things - including talking to a therapist , yet we still encourage them to do it. If you have the will power to pay hundreds of dollars a session to talk to a complete stranger, in theory you may have the willpower to walk birskly for 150 minutes a week. As a society we should simply encourage everyone no matter what age or state of mind to do that.
Some people have actual neurotransmitter imbalances, but many of us just have monkey brains that don't know how to deal with (real, abstract) modern-day stressors that trigger a fight-or-flight response.
From what I have learned from friends working in the field, meds often work as an enabler, allowing people to do some of the things that are known to improve their condition further.
If you think you suffer from depression, don't keep trying to "just buckle up", don't keep trying to "just need to take responsibility". Go talk to professionals, therapists and/or psychiatrists. Mental disorders do things to a person outside of their control.
1. Sleep less (job stress or long hours keeping you up)
2. Eat less healthy (coping mechanism for job stress, and it’s faster)
3. Have less time for the higher quality social interactions.
All of what you describe besides environmental stressors are symptoms of depression. So, to solve depression, you must first solve depression.
And even the environmental stressors are something we could work with as a society though welfare, environment regulations, etc... But how people react to them is also a symptom. There are depressive people with the best of situations, and people who enjoy life in the worst of situations. What often strikes me in documentaries about warzones, places of repression and extreme poverty or crippling diseases is how "normal" people seem to be, they enjoy themselves as if everything was fine. So, while reducing environmental stressors work, it is not the end of it.
The take may be that treating the symptoms of depression could work in treating the root cause, a positive feedback loop. But if done through lifestyle change, unfortunately, the treatment is coercion, you can't rely on the willpower of people who have none because of the disease.
If you set your goal too high you will be sad all the time. Choose a goal that you would be happy with but make sure it's a realistic goal!
How does one get rid of the excitement of the expectation of eating chips or drinking cola etc?
Try tea and seltzers, not because they’re healthy but because they’re interesting. There’s an infinite range of teas.
And learning to cook changed my life. I get annoyed with almost all delivery now because I can do better.
What absurdly thoughtless, shallow nonsense. What, specifically, is your background in depression research, that leads you to believe you've completed solved it for everyone? I'll wait. I'm sure it's fucking extensive.
>> ultimately it becomes your responsibility to try fix them if you want your situation to improve, since nobody else will.
No. This is why doctors and psychologists etc exist. Not everything is fixable by you. Sometimes you need help from other people and blaming the depressed person for being depressed is fucking idiotic.
- Regular long walks at the park - Climb stairs whenever possible instead of using the lift - Good foot care - Engage in social exercise like running clubs - Wear good quality footwear, suitable for the activity that you're engaged in.
Of course, not all paraplegics can use their feet, but ultimately it becomes your responsibility to try to improve leg strength to the point of overcoming paraplegia, by doing the things that would have helped in improving leg strength, if only you could walk.
/s
(tbf, not fully disagreeing per se, and all analogies are flawed, but the above sarcasm is to point out that this model is overly simplistic. And it can lead to hidden but very real unconscious bias and discrimination once words like "responsibility" is thrown into the mix)
Plus, the grand of majority of people would rather NOT move around and continue to eat junk food regardless. Animals evolved to be lazy.
"Intention to treat" analyses, now ... very different conclusions.
The actual amount you need to exercise, or the intensity, is not very big. The good thing with exercise is also that once you make it a habit to walk, say, 20 minutes a day, then walking 25 minutes a day becomes pretty trivial, and so on.
In my opinion the best measure of exercise is perceived effort. So while you're asking for objective answers, I think a lot of this is inherently subjective.
The benchmark you're asking for is also ill-defined. For example: How frequently to be as effective as what type and what frequency of therapy?
Based on my own recent experience I would suggest the "dog".
Edit: A motorcycle that is, unless someone has created 200mph dogs...
I mean, yes, but we already knew this. So good that this is a finding that passes replication.
Here's the paper: https://pubmed.ncbi.nlm.nih.gov/41500513/
It's a review/summary of existing research, not anything new.
The fundamental problem with studying alternatives to therapy is that "being in a study" may be as effective as therapy! It's a structural placebo effect.
For a depressed person, "Exercise guided by a researcher" is different from "trying to make myself exercise".
> Authors' conclusions: Exercise may be moderately more effective than a control intervention for reducing symptoms of depression.
> Exercise appears to be no more or less effective than psychological or pharmacological treatments, though this conclusion is based on a few small trials.
> Long-term follow-up was rare.
Nothing new:
> The addition of 35 RCTs (at least 2526 participants) to this update has had very little effect on the estimate of the benefit of exercise on symptoms of depression.
If you actually get into a sport there will be second order effects such as better diet and possibly finding others with interest in such activities as you will invest more time into it.
If I'm sweating already and warmed up, I might as well take a walk to cool down. If I'm already walking and a good song comes on, I might as well jog. If I'm feeling sore already, I might as well lift some weights to gain some strength. To boost this all, I might as well eat more protein. If moving around is kinda making me feel nauseous sometimes, it's probably a vitamin thing so I go for more veggies. Hey veggies are slowly replacing bread and other empty carbs! Then my nerd brain kicked in and developed an obsession with cooking.
On the other end of this, I was doing more housework because I was inviting people over more often and otherwise working from home. The mess became harder to avoid. I think we all did a little of that because of the cultural shift in the first half of this decade. That also meant entertaining more which meant trying to put out better food.
All the incentives aligned to break me out of a cycle of bad habits for long enough that I genuinely can't go back. My life is objectively way better and I know exactly how it got that way, so there's nothing intimidating about it anymore. The level of effort also went down as all the new habits were streamlined into a coherent lifestyle.
At the risk of sounding condescending, I think most of this is really just a matter of growing up anyway (I entered my 30s during this time period). I just wanted to share how it happened to me.
I've been diagnosed with moderate to severe depression, and I'm a trial runner and do CrossFit. It's a balancing act to find strength and feeling capable through sport without increasing insomnia and early waking, likely because of cortisol spikes.
Sport does more for me than antidepressants, which have little effect than making me feel tired all the time. I've gone through a whole battery of them with little success and I've become quite critical of them. But I'm lucky to generally like sport and eat pretty healthily; I can imagine for others that can be an extra stressor they really don't need.
So you've got to try different things and figure out what works for you.
It's even more complicated than that - you can probably click well and succeed with one therapist and get a completely ineffective treatment by another therapist and I'm not sure we even understand why that well (saying one therapist is better than the other is not always true). With it being the way it is , I think A.I actually could be another tool for people to try; not currently but once it improves enough with memory and reliability (I know many people are gonna downvote this but what's your alternative?).
https://pmc.ncbi.nlm.nih.gov/articles/PMC3188695/
Give yourself a good BDNF boost through diet and/or exercise.
Ketogenic diet even improves on schizophrenia to the point that patients go off from medication [2] [3].
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC12237970/
[3] https://www.frontiersin.org/journals/nutrition/articles/10.3...
That's my alternative.
That's why psychiatrists will suggest antidepressants or Electroconvulsive therapy (in extreme cases of depression) because clients are unable to help themselves.
Taking the antidepressant has become the dominant go to approach as it is more commercially profitable for the seller and easier to commit to for the taker.
In the UK a GP can just lot prescribe an anti-depressant. There are waiting lists for NHS therapy and paying privately is expensive.
Cite?
it's easier to just let them have their soma and say nothing