In a recent column, I mentioned the results of Mary Howerton’s doctoral research. Mary is the former director of the Mecklenburg County Bar and a member of the Lawyer Assistance Program Board. Her doctoral research, concerning the quality of well-being of lawyers in North Carolina, revealed that over 27% of the lawyers in her study showed symptoms of depression. The study group showed no differences in levels of depression between males and females, and no difference in depression between types of practices, including private practice, corporate counsel, government/public-sector, judiciary, etc. There was, however, a greater rate of depression among younger lawyers.
While an increasing number of younger lawyers appeared to be stressed, there is mounting evidence that the most effective antidote to depression is especially suited to the younger generation – exercise. A growing body of literature shows the importance of exercise to combat depression, as well as, providing tips on the best way to implement an effective exercise program. In addition, anxiety disorders, including those which can be temporarily debilitating, such as panic attacks, may also often be effectively addressed through exercise. The efficacy of exercise as a treatment for anxiety is particularly important in light of the fact that, unlike the most common medications for depression which are not addictive, many of the first response medications for panic attacks, such as Xanax, are highly addictive. The use of addictive medications to treat panic attacks can lead to a second disorder – addictive disease.
A number of studies have now been conducted that confirm the positive affect of exercise to prevent and to ameliorate depression. In addition, there are meta-studies, that is, studies of studies that have been made, corroborating this finding. One of the most important studies comes from Duke University which compared the anti-depressant effects of jogging with those of Zoloft, a well-known anti-depressant medication. The study showed that after about four months patients that were being treated by either approach were doing equally well. The medication which, for some can have negative side effects, offered no particular advantage over the regular practice of jogging. The study also demonstrated that even a combination of medication and jogging did not provide any better outcome than just jogging alone.
Perhaps what was most significant about this study was a look at the participants’ outcome one year later. This data showed a major difference between the two types of treatment. More than a third of the patients that had been treated with Zoloft had relapsed, whereas 92% of those who had continued with their exercise program were still doing well. There are several theories about why this is true. One suggests that when an outside medication is taken to replace or augment a neuro-transmitter that is naturally made in the brain, that taking the medication may alter the psyche’s natural propensity to achieve internally a neuro-chemical balance by decreasing creation of those internal neuro- chemicals which are already in short supply. In other words, the organism’s natural propensity to make the appropriate neuro-chemicals for good healthy brain metabolism may diminish or atrophy over time if those chemicals are brought in from the outside. On the other hand, any type of exercise helps to re-invigorate the organism and to get those brain functions working more effectively which may not have been operating as effectively as needed.
There are other things we know about how exercise affects the emotional brain. There is the effect of endorphins. These are the brain’s natural feel-good chemicals. In fact, these molecules resemble opium and its derivatives such as morphine. Endorphins, like the painkiller morphine, work quickly. They are the brain’s mechanism for allowing us to feel an immediate sensation of good feeling when we meet a loved one we have not seen for some period of time. The problem with morphine and other derivatives of opium, is that when used often, not only does the drug become addictive, but the brain receptors become inured to the effects of morphine. One’s internal, endogenous endorphins are not made and there is a need for an increasingly larger dose of the drug in order for the same affect to be produced. The result of this is that brain receptors become less and less sensitive because of the over-stimulation caused by the morphine and the regular pleasures of life lose their power and potency to make one feel good. Even the pleasure of sex is often reduced to nothing in opiate drug addicts.
If there is an appropriate internal release of endorphins, one’s mood is elevated and one is less likely to be depressed, In addition, the more the natural mechanism of pleasure is stimulated by exercise, the more sensitive the mechanism becomes to that pleasure. In other words, while external chemicals like morphine raise the pleasure threshold until it’s almost impossible to be reached, the increase of positive internal neuro-chemicals lowers the pleasure threshold so it is much more easily achieved. People who get regular exercise then actually experience more pleasure with the little things in life, their relationship with their spouse, their cats, the taste of food, their hobbies, meeting their friends in the courthouse and on, and on, it goes.
The fundamental definition of depression is the absence of pleasure. Thus, the release of chemicals to enhance the experience of pleasure brought on by exercise is exactly the appropriate antidote. A side benefit is that stimulating the emotional brain in a natural process also produces a healthier immune system. It promotes the type of cells that are most aggressive in fighting against infections and diseases like cancer. As you would expect, we see exactly the opposite occurring in those who are addicted to opiates, whose immune systems eventually collapse.
Exercise also strengthens another physiological mechanism related to our emotional health. We have two branches of our nervous system: the sympathetic system which helps rally us almost instantaneously to deal with a threat; and, we have the para-sympathetic nervous system which allows us to become calm. Studies have shown that regular exercise gives greater flexibility to these two systems. This means that the para-sympathetic system, the psychological break on nervousness or anxiety, is healthier and stronger. This is important because the stronger the para-sympathetic nervous system is, the greater balance there is between the two branches of our nervous system, and the greater potential for the system to function naturally as an antidote to anxiety. For depressed or anxious individuals, it is as if their sympathetic nervous system is always being stimulated and, like a developed muscle, it gets larger and larger. Exercise, on other hand, seems to stimulate a development of the para-sympathetic nervous system so that it can maintain a degree of strength to balance the sympathetic system.
Depression is a serious mental illness that can be fatal. Anyone concerned that they may have depression should consult with a skilled psychiatrist. Still, why do we have so many people getting on anti-depressant medication rather than exercise régimes? Exercise usually costs nothing. It has no negative side effects. And, the random studies show that it is just as effective as anti-depressant medication. In spite of these pros, sometimes it seems like nothing could be harder than to integrate a regular exercise routine into our daily lives. This is even more true when one is depressed or anxious. However, there are some good pointers to be gleaned from the research which can make this transition easier.
The first is that you do not have to get a lot of exercise. What is important is its regularity. Various studies have determined that the minimum quantity needed to affect the emotional brain is 20 minutes of exercise, three times a week. The duration seems to matter, but not the distance covered nor the intensity of the effort. So, the starting premise is not to feel overwhelmed, that getting on an exercise program will require an enormous amount of time. Even as small an amount as 20 minutes a day has been shown to have a positive affect. The benefits on other hand, of course, do go up proportionally to a certain point with the amount of exercise obtained. Five sessions a week are better than three, and an hour of exercise is going to be much more effective than 20 minutes. Still, the key factor here is that one should start with a program that is not overwhelming.
The second important factor is that the exercise should not be done in a manner to make it exhausting. You should be able to sustain the effort to the point where you can still talk while you’re doing it, but not sing. One bad approach would be to feel that one had to engage in an hour of running on a treadmill, get overly tired and out of breath, and then give up altogether. The secret is to begin gently and let your body be the guide for the intensity of the exercise. The objective is to reach a state of well-being that maximizes the release of the endorphins in your system. To do this, one must be close to the limit of the expenditure of energy that your natural metabolism provides without going over that limit; that is, without going over the line that creates the feeling of exhaustion. As your capacity expands as a result of exercise, you will have the opportunity to increase the duration and the intensity of your workout. Interestingly enough, the research does not indicate any difference in the positive effect between aerobic exercise such as running, bicycling or swimming, which tends to produce shortness of breath and what is called anaerobic exercise, such as weight training.
Another interesting factor from the research into exercise as a way to ameliorate depression, is that group exercise is even more effective than individual practice. This should be no real surprise. You don’t have to have read the research on mob psychology or completely buy into Carl Jung’s theory of the collective unconscious to realize that when people are doing something together, our collective singularity of intention helps reinforce our individual purpose. In addition, a group approach can help motivate you on days when you just don’t feel like getting out to do your exercise. Group exercise also serves as an antidote to isolation which can be a causative factor in depression.
Finally, one of the most important aspects of undertaking an exercise program is to choose an exercise which you enjoy. Often times the more the exercise is involved in a game, the more fun it is. Regular basketball pickup games or tennis illustrate this type of regular exercise. If you end up at home on a stationary bike or stair stepper, try watching a movie while you are engaged in your exercise routine. The advice would be, choose an action film and keep it playing for as long as you are exercising. As soon as you finish exercising, cut off the film and restart at this point the next exercise period. Action films are better than a drama or comedies. They tend to prevent boredom while you are exercising, and if you stop the film when you complete your routine, then there’s some incentive to start again.
If you are already taking anti-depressant medication, go ahead and get established in a regular exercise program for several weeks, and if your mood is good and if you do not have a history of major depressive episodes, and you believe that you can sustain your exercise program, you may want to talk with your psychiatrist about a trial period to see if you can stop taking your medication. If, on the other hand, you have become concerned that you may be depressed and are considering asking a doctor for medication, you should not avoid seeing a good psychiatrist, but you may want to have that physician monitor your use of exercise as a way to address your depression or anxiety issues. One of the things that makes us all feel more able to cope with life, is if we feel we can readily control some of those things which could cause us harm. Being able to exercise to restore and reinvigorate one’s normal neuro-chemistry is a great way to take control back into your own hands. This, in itself, can often have a positive effect on well-being.
-by Don Carroll
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