A common refrain I hear from my patients’ loved ones — and especially from parents of teenagers with depression — is that if their child or spouse would just get up and work out they could stop being depressed. “Dr. Fink, please tell my daughter that if she just came out of her room and went for a walk (or a run or played tennis or rode her bike) she would not be depressed.” “Maybe my husband would not have to depend on medicine if he got on the treadmill.” “Exercise cures depression, right”?
I wish it were that easy. While the benefits of exercise (or any physical movement) should not be diminished or understated, exercise is not a cure-all. Exercise alone cannot put severe depression or bipolar depression into remission. It can be a critical part of recovery, but it is not a magic bullet.
It is also true that when a depressed person rejects or resists or simply cannot bear the thought of exercise these are responses that are deeply rooted in the depressive brain circuits. Being told that they could cure themselves if they just “tried harder” adds insult to an already deeply injured sense of self. Shame about not doing what they or other people say will help them can trigger more feelings of helplessness. Resistance to being told what to do is an adolescent headline anyway. A depressed teenager may often feel even more anger and resentment at being told to do something that they are one hundred percent certain they do not want to do.
I try to approach this very difficult paradox from a few different angles:
- Acknowledge that both things are true at the same time; a person can feel that movement is impossible and be well aware of the likely benefits of movement at the same time.
- I try to avoid defaulting to “Exercise” as the “prescription” because it can carry the tone of high school gym class, calisthenics, or other punitive interventions — especially when someone can’t really stand up off the couch for very long, let alone “exercise.” I prefer “movement” or I try to find other language that the person living with depression finds more appealing or at least neutral. Language is important in problem solving.
- I remind the group or individual that even small periods of movement — even one minute of intense movement — can have health benefits. And even beyond that, standing up and walking around the room gives some benefits over lying or sitting still for extended periods. Bring the starting point into reach. Set goals that are small (sometimes extremely small) steps from where the depression has taken you or your loved one.
- I encourage looking for types of movements that feel bearable or even wonderful, but at the very least not terrible. One person may find yoga insufferable while another finds doing a single sun salutation pose a vast improvement over depressed stillness. Being outdoors may be essential for some but may be far too much sunlight or activity for another. Sometimes kids with depression have avoided movement since an early age, so finding something that feels good can be a real challenge.
Moving your body is crucial for health improvement and maintenance. It is important for recovery from many illnesses. Moving our bodies is a natural action that usually feels good. But when it doesn’t — or when it is hard to even imagine it feeling good — see if there is a place to start the tiniest bit of “action.” Doing, rather than not doing. Finding joy and pleasure in movement can be a key part of recovering from depression, bipolar depression, and other forms of mental illness, but it may be best to begin with the tiniest of steps.