Today, I swallowed my first antidepressant tablet ever, and I feel guilty. I currently read a Dutch book on antidepressants, in which psychiatrist Bram Bakker, among others, states his point of view. His opinion is that a stepped-care approach to depression means that people should first be steered towards exercise rather than antidepressants. Now I happen to take my antidepressant for anxiety, but I am well aware that exercise works for that, too.,/p>
I am not fit, and I am rather sedentary. I used to take daily walks on institution grounds, but I don’t anymore. I went to fitness class once and was overloaded even though a nurse accompanied me. Does this mean that I call for my own mental health problems?
Bakker forgets the barriers to exercise that some people encounter. Due to the construction going on, I cannot take walks on grounds unaccompanied anymore. I cannot navigate the busy gym during fitness class. If I want to bike, I need to go on a tandem. I cannot participate in my institution’s running therapy program. None of this is due to anxiety. All of it is due to my disabilities, and the barriers to access that stand in the way.
Bakker caters his running therapy mantra to depressed but otherwise healthy people. There are many reasons why people with disabilities or chronic illnesses who happen to be depressed, are unable to participate in running therapy and other exercise programs. The “exercise for mental health” mantra is a slap in the face of these people. I know. Will anyone now remove the barriers to exercise that I encounter, so that I can relieve my anxiety without having to take antidepressants?
If it helps- I used to exercise really regularly. Every day. Doing weights every other day to give my body a break because you’re supposed to. Still as depressed as ever.
I think being as healthy as you can is a good idea (I don’t mean temporarily able bodied- I mean doing what your body needs to be healthy), just because if your body has what it needs to function right it has an easier time fighting off other things and that can help you feel better and it’s a good idea in general if you can.
But, yeah, I’d take the “EXERCISE FOR MENTAL HEALTH!” stuff with a grain of salt. Or a pound- whichever. I’ve tried pretty much everythng people have suggested for depression (exercise, journal, get more sunlight, socialize more, blah blah blah) without any long-lasting effects.
Thanks for writing this, Astrid, it really woke me up to something I hadn’t thought about before! (Way to be oblivious to my own privilege, I know.)
I know exercise can sometimes help with mental health, but it’s downright silly to suggest it as a primary solution, even for the currently (physically) able. It’s not uncommon to get injured when exercising…and then you can’t exercise as much or in the same way, and you’re back to square one.
There’s also an element of classism in the “exercise for mental health” mantra. Sure, exercising might be cheaper than medication, but there’s also the need for time and space to exercise. And those needs are most likely to be met if you’re not working three jobs to make rent and if you live in an upscale neighbourhood. That, and who’s ever heard of health insurance covering the cost of running shoes?
That’s a good point. Also, you need access to a trainer or someone who can show you how to do exercises PROPERLY or else you can seriously injure yourself if you do it wrong. I think health insurance may cover those- but not always. For people who can afford joining a gym and getting a private trainer and have the spare time to work out regularly- that’s great. For those who don’t- not so much.
I agree with you Astrid; so many of these kinds of suggestions are meant for the TAB population. And even then, they don’t work in all cases. It’s getting to the point that when I hear another “expert” give advice about a health issue, I think “I doubt very much you’ve tested your theory on someone with my neurology. In fact, I’m sure you haven’t.” Then I just do what works for me. After all these years, I’ve got a pretty good handle on what works and doesn’t work for my mind and body.
Don’t feel guilty about taking meds (I did when I started). You’re doing what you need to do to function, and if medication is the best solution, go with it. If you find another solution that works well for ya, then that’s good to.
The old ‘you don’t need to take medication’ line bugs me, because it was medication that got me back to being a functional human being–I wasn’t in a position to start therapy soon, and exercise (had the option occurred to me) wouldn’t have helped at that point either because of an unrelated issue. Medication wasn’t my ideal, but it worked–it was more important to me to be able to function than to stay unmedicated. I still want to get off the medication someday, but my guilt in the meantime is gone. It has helped me, and I will NOT feel guilty for it.
There’s an additional concern here: According to my Danish sources exercise is only useful for light to moderate depression episodes, not the heavy ones.
So if you’re diagnosed with moderate, like I was, you might get that pressure to exercise, but who’s to say that your diagnosis is correct? And where exactly is the line drawn between moderate and heavy depression? It’s a sliding scale after all, and like all moods, depression fluctuates as well.
Additionally, I’m having serious doubts as to WHY exercise aids with depression. Sure it releases endorphins (or however it’s spelled in English), but why does it do that? Because that’s what exercise does? Or because of the meaning your brain attaches to exercise? I haven’t seen any studies of this.
Either way, my depression was dx’ed as moderate and I was told to exercise. I already knew that my mood gets worse when I exercise, and I told my shrink this, but she refused to believe me, until I had agreed to exercise regularly for two weeks. When I then showed up with clear physical signs of being worse she finally believed me, but I first had to hazard my own mental health to prove it to her, despite the fact that I already knew.
But it ought to have helped because my dx was moderate depression. What I didn’t know until much later, though I suspected, was that I had my additional dx of Asperger’s. So how many people are made worse because of useless exercise, all because a deeper diagnosis is as yet undiscovered? I dunno, but I am not exactly full of trust in the medical establishment.