Former 2:24 marathoner, now in my late 40s and hoping to maximally flatten the curve of my slide into senescence and mediocrity • Magazine writer, book editor and author, and commentator on the sport of distance running since 1999 • Adviser and confidant of other perambulators • Paradoxical hater of exercise fanatics • Chihuahua whisperer Sentence-fragment impresario

Monday, March 12, 2018

Why exercise is underutilized in fighting depression (warning: it's a bummer)

Scott Douglas is a longtime denizen of the running-writing world. He wrote a chapter for Run Strong -- the contract for which I wouldn't have landed without his help in the first place -- and if it weren't for his active assistance and passive encouragement over the years, I would have contributed far less than I now have to the pantheon of published blather about running and a few other things (the fact that most of this material is of negligible utility isn't the point).

More than anything else, Scott is intensely thoughtful and committed to a reality-based view of the world, regardless of the consequences such an ethos might engender. (Case in point: he's a seminary graduate who has identified an atheist.) This, not the fact that I have solid personal reasons to like him, is the primary reason I appreciate his work.

Today he has a piece in Slate attempting to answer a question I've asked a great many psychiatrists and psychologists going back to my own days as a medical student in the 1990s: Why don't mental-health clinicians more strongly encourage exercise?

The answers I most often get can be reduced to a resigned "We don't think we'd see compliance" and are usually tailored to the audience-of-one (me) in some way: "What you do is great, but not everyone can run marathons."

I completely agree with the second part of this; even when I was a serious runner myself, I never thought that running marathons was really a wise idea for most people. But marathons, or even daily running, are to physical exercise what dragsters, stock cars, and Indy cars are to automobiles: a very small, unnecessary element in a much larger and wide-ranging whole. When you're not in good shape but are at least ambulatory, a walk around the block constitutes exercise, with the attendant endorphin release to prove it. (One of the few things I like about coming back from a long layoff is how great I feel for a half-hour after running three miles at pace a few humans have held for over twelve hours.)

As for the "people won't listen anyway" claim, this is already an issue with medications and individual therapy. It's also hard to imagine a real a downside to at least recommending some form of exercise to people in counseling and following up with them about it in subsequent visits. After all, aren't healthcare workers supposed to recommend exercise anyway? (As Scott notes, most docs these days don't exercise much themselves and as a rule aren't familiar with the U.S. government's exercise guidelines. And thinking back on my own days as a student, I'm pretty sure I was treated exactly one lecture on exercise physiology in my cardiology course, and maybe another in the general physiology course that preceded that one.)

Scott points out that in a primarily private-insurance healthcare model, drugs are more of a reflexive go-to than they are in countries where the government picks up the tab for everyone's care. In a single-payer system, providers have incentive to favor lifestyle modifications over more expensive treatments wherever possible; this obviously doesn't always offer the nest medical option, but where health economics mesh with sensible treatments, the U.S. would be wise to take notice.

As Scott hints at, it's important to not slide into either-or thinking on this issue, as people are inclined to do on all manner of subjects (and, with a mentally disordered commander-in-chief now in the middle of every news story, appear to be doing with increasing vigor, e.g., "Build that wall!" vs. "No! OPEN BORDERS!"). That is, if you're prone to depression and running regularly, you may not get all the relief you need from exercise alone. (In the past year, the lives of two elite American distance runners, Gabe Proctor and Jonathan Grey, ended in suicide after longstanding battles with clinical depression.) And if you're taking an antidepressant to good but less-than-magical effect -- thereby echoing the experience of pretty much everyone who uses and endorses these drugs -- starting or resuming an exercise habit is not a good reason to drop your SSDI wholesale.

On the matter of "material of negligible utility," my latest Motiv Running piece deals with two-a-days. I'll have another this week on half-marathon training, and if things fall into place I will soon have a regular named column for Motiv as well. Overall, I'm having a lovely time lately churning out an increasing amount of work that includes advice I strongly believe is helpful, yet have no intention of putting to use myself anymore.

I will be taking my annual trip to New England to watch the Boston Marathon and engage in related and unrelated activities. A few things about this year's edition are different: I will be driving instead of flying, and I have no plans to enter any races when I'm around.

Finally, this seems like an opportune time to interject a PSA about the comment section here vis-a-vis mental health. Thanks to the energetic manner in which demonstrably unbalanced people flock to portions of the Internet where I may be found, I manually approve all comments made to this blog before they become visible. (This also happens to be the Blogger default, or was last I checked.) If I didn't do this, the spaces below my posts would consist almost entirely of a shit-splatter of sometimes-angry, sometimes-genial nonsense. And whenever an especially flagrant offender is overcome by remorse, a precarious state of comparative sanity, or perhaps incarceration, a new one arises to take his or her place, thereby potentially setting up a demented relay race of incoherent verbiage. So as of this moment, I will be more stringent about which comments pass muster. There are plenty of other Internet sites available for untrammeled yodeling for when something ignites the neurochemical munitions dump inside your head. I  have my own powder kegs, but I try not to litter the personal blogs of other people with fifth-degree lunacy.

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