For Depression, Prescribing Exercise Before Medication

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“There are some people who say all they want is medication,” she said. “But they are the ones who are suffering tremendously and have a difficult time accessing their mental life. They want things fixed, and fixed right now.”

She said some of her patients are lured by the drug ads they see on TV— charming little spots that make it look like a gloomy day is nothing an SSRI can’t handle.

“It’s evocative to see a commercial where your world could change from black and white to color,” she said.

Beth Salcedo is a psychiatrist near Washington, D.C. People in this perpetual type-A convention of a town tend to have too much work, too-lofty aspirations, too high a rent, and too little time left before their evening networking event starts.

“I think it’s difficult to convince people to spend half an hour a day on exercise when they have kids, a job, and it can take months to see the benefit,” she said.

Some patients claim they can’t make time for the gym or are adamant that they can’t afford to sleep more than six hours each night. And lawyers who work 16-hour days are not going to sit through long counseling appointments no matter how many peer-reviewed studies you wave at them.

“What do you do? Do you let them walk around depressed?” Salcedo said. “Or do you offer them a treatment that they’ll accept? Everyone has to do the thing that works for them.”

And despite its merits, exercise is not nearly as portable or painless as a tablet.

Salcedo had one patient whose mood entirely depended on her workouts. The hitch was that her exercise of choice was swimming—and the only pool she had access to was outdoors. “In the spring, fall, and winter, it wasn’t so easy,” Salcedo said.

Depressed patients are also more likely than most to feel unmotivated, so even the best-laid exercise treatment plan can be thwarted by a few days of staying in bed for an extra hour.

“Depressed patients have apathy or a lack of energy. Or they have anxiety disorders so they’re not going to go to the gym. Or they’re afraid to be seen jogging across Monument Avenue,” said Joan Plotkin Han, a staff psychiatrist at Virginia Commonwealth University in Richmond. Still, she pushes it with her more intrepid patients. “I don’t want to be that intimidating or threatening, but I’m a nag. And I will nag them.”

Of course, sometimes exercise works as a multiplier, augmenting the effectiveness of an existing treatment, including drugs or therapy, or simply by helping the patient regain agency in their lives. Many patients recover from depression faster when the disease is attacked through multiple approaches simultaneously.

Ginsberg said exercise didn’t cure him, but it did give him the energy to sort through the origins of his inner turmoil. And Brittany did eventually go on SSRIs to halt her nightly panic attacks—but now that yoga has her anxiety under control, she’s tapering off the drugs once again.

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