Exercise: The Natural Antidepressant

How does exercise help with mental illness?

I read one of my favorite writers, John Leake. He recently published a Substack titled Who Says You Can’t Run Away From Your Problems?

His article made me remember how exercise helped me through a difficult period during medical school. The first two years of workload is immense; the grading scale was so hard that it was failing if you got anything below 80%. Every waking moment of my life was about studying. In 1993, when I was at Eastern Virginia Medical School in Norfolk, VA, I suffered a mild bout of what I thought was depression. I’d never been depressed before this. In retrospect, it was multifactorial—being far away from the security of home and my parents, sharing an apartment, studying non-stop till 1 am on a regular basis, waking up at 6am, and then getting time in the operating room because I was thinking about becoming a surgeon. The East Coast winters froze my bones. I was used to living in the mild California winters. I remember going to see a psychologist who was available to medical students. Apparently, this was common. He was a fascinating man and told me that this would all pass once I got into my third year of medical school. For the most part, he was right. But that was months away.

My true journey back to complete mental health, like Leake, was when I started running again. I knew very well that exercise could help depression because when I was just 20 years old, I ran cross country for Victor Valley College. I had a teammate who confided in me that he was running because he suffered from major depression and attempted suicide, and the only thing that seemed to help him was long-distance running.

Because of my intense studies, I took a hiatus from cycling and running to keep up with the workload of medical school. I remember the liberating feeling of running 3 miles again, no matter the temperature. After some weeks of running every day, I felt my lighthearted spirit and optimism returning. Two months later, I felt like someone lifted the fog and could see my aim again. Before I knew it, my third year of medical school came around.

I remember the thing that got me through those rough times was running and cycling. I even took it a step further. One of my favorite things was to drive 3 hours to my friend’s house in Great Falls, Virginia, near DC, to study in the cafés near Dupont Circle, and enjoy life around me. Then, I would go on long bike rides at Potamic Park – Haines Point. Sometimes, there were hundreds of cyclists in the group, and we would go very fast, and it was a great workout.

Climbing Maui

About six months ago—right around my 55th birthday—I began to feel overwhelmed by the multiplicity of life-events. I started my PhD at the University of Paris, I was helping with some things in the RFK campaign, I wrote part of the Amicus Brief for the Skirmetti vs. US case, and I am still trying to maintain my fitness. This certainly puts some stress on daily life.

This gravely affected my sleep, and the experience of being sleep-deprived amplified all the stressors with which I was contending. By the time Christmas arrived, I needed a break. In December, I flew to Maui for a research trip and to work on my fiction novel. Shortly after arriving, I rented a bicycle and psyched myself to climb the Haleakala volcano. This is an epic climb, starting at a sea elevation all the way to 10,023 feet. Thanks to my friend Donne Arnoult, my friend at Maui Cyclery, I rented a nice Pinarello Dogma. We used to race bicycles together long ago when I was in excellent Cat 1 cycling shape. In fact, I have a 2013vphoto of myself climbing Haleakala in less than 3 hours. I knew that wouldn’t be the case this time around.

We left as a group after New Year’s to tackle the mountain. After about 5,000 feet of climbing, I could feel it was just not going to happen. For whatever reason, my legs were not going to let me climb fast enough to get to the top. Sometimes, it’s good to know when to stop and live to fight another day. The ride was still epic, and we grabbed a great cappuccino at the Makawi Center afterward.

The fact that I wanted to climb the mountain still gnawed at me. I knew I could do it, but I just needed to go at it alone and persevere. So, the weekend came, and the weather looked favorable. You always have to check the weather when climbing Haleakala because it does snow up there! The temperatures can drop to zero, and if it rains, the conditions are miserable.

After a good breakfast, I started up the mountain. At first, I was climbing at a decent pace. Then, after about 2 hours, the pace decreased, and the grade increased. Not a good combination. I calculated my pace and estimated the ride would take 2 to 3 hours. I continued to climb into the clouds. That feeling never gets old. Haleakala is one of the only places in the world where you can truly climb into and above the clouds. I continued to climb and made sure I ate and drank. With about 15 miles to go, I hit a bad spot and had to rest briefly. I thought to myself that this is not good. I continued, and with about 10 miles to go, I had to stop again; the legs were not responding. I was riding slowly. Remember that the altitude sucks the energy out of the legs and that the oxygen concentration up there is about 15%. I continued and could finally see the top and the sky laboratories to watch the cosmos. I finally reached the last mile, where the grade increased to over 14%! This is after 4 hours of climbing. That part was brutal, and I needed to pause a third time; the experience at this point started to feel deeply religious like something up there was trying to tell me something. I mustered up the energy to finish it out and climb to the sign that said “top of the world, 10,023 feet.

Back to exercise and mental health:

Mental health problems continue to present a global challenge and contribute significantly to the global burden of human disease. Depression is the most common psychiatric disorder and is thought to affect 121 million adults worldwide. There are piles of medical literature on the therapeutic benefits of running. Just one example is a 2023 paper titled Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders that document the benefits of going for a daily run.

There are many reasons why exercise helps depression. One of the main reasons is that it increases a protein in the brain called Brain Derived Neurotrophic Factor or BDNF. This protein is consistently low in depressed and suicidal individuals. Exercise increases BDNF in dose response. I write about this in my Revolutionary Ketamine book.

If you are my age or older and you have not vigorously exercised for a while, it’s a good idea to get a physical examination that includes an EKG and stress test before you embark on your running adventure. Also, consider a Coronary Artery Calcium scan (CAC) to add to your preventative workup. These tests can be covered under insurance if you have a primary care or cardiologist on board. Otherwise, these tests are very affordable if you ask for a cash price. For example, the CAC scan usually runs about 150 dollars if you pay upfront in cash. However, someone does have to prescribe it for you. Here’s an article I wrote about the CAC scan. This is especially the case if you received any COVID-19 vaccines and / or had COVID. If your constitution will allow it, your goal should be to train hard, which produces a marvelous endorphin rush.

And so, if you are feeling blue, consider buying a pair of running shoes and hitting the pavement. It will be painful at first, but if you stick with it and train hard, you will almost certainly feel better in just a few weeks.

Refs

https://pmc.ncbi.nlm.nih.gov/articles/PMC3516810/