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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on April 7, 2006, at 16:09:08
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by linkadge on April 7, 2006, at 15:11:47
> Not to say that I don't believe you, but in order for me to believe that a long term aerobic exercise program has (and would always have) zero impact on every domain of your illness is hard for me to believe.
I have a problem with those claims made that exercise is as effective as pharmacotherapy for treating bipolar and endogenous depressive disorders. If it were, I doubt we would see so many people visiting this website looking for advice and support. I also doubt that we would have so many people visiting psychiatrists and taking antidepressants. It's not like exercise is the best kept secret in psychiatry.
- Scott
Posted by linkadge on April 7, 2006, at 16:56:49
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by greywolf on April 7, 2006, at 15:58:44
I don't think that limits to its effectivenes have ever been clearly estabished.
I don't think when it can and cannot help has been clearly established either. I would like to see one clinical trial that shows that exercise has no effect on major depression. We do have clinical trials showing that major depression can beneifit from exercise though. I personally know of a guy who failed ECT, and is having success with exercise and CBT so go figure.
Doctors will always favor pills. My father's doctor prescribed high blood pressure pills and cholesterol pills without ever mentioning that diet and exercise changes can significantly reduce the need for these medications.
I agree with the doctors statements insofar as to not make the patient feel guilty for his or her own condition, but I don't agree with the doctors claims that severe depression cannot benifit from exercise.
Again, western medicine like magic bullits, wheras a wholistic approach may yeild superior results.
Linkadge
Posted by ed_uk on April 7, 2006, at 17:24:29
In reply to Re: Drugs versus Psychotherapy - Backlash? » linkadge, posted by SLS on April 7, 2006, at 16:09:08
Hi Scott
>I have a problem with those claims made that exercise is as effective as pharmacotherapy for treating bipolar and endogenous depressive disorders. If it were, I doubt we would see so many people visiting this website looking for advice and support. I also doubt that we would have so many people visiting psychiatrists and taking antidepressants.
It seems that exercise is an effective AD for some people, but by no means all. No one is claiming that it's a cure-all for depression!
Regards
Ed
Posted by linkadge on April 7, 2006, at 17:27:15
In reply to Re: Drugs versus Psychotherapy - Backlash? » linkadge, posted by SLS on April 7, 2006, at 16:09:08
>I have a problem with those claims made that >exercise is as effective as pharmacotherapy for >treating bipolar and endogenous depressive >disorders. If it were, I doubt we would see so >many people visiting this website looking for >advice and support. I also doubt that we would >have so many people visiting psychiatrists and >taking antidepressants. It's not like exercise >is the best kept secret in psychiatry.
Why is obesity on the rise? Clearly the use of exercise is declining. I don't believe that everybody on this site has given what proponents would consider a fair trial for exercise.
*As effective* is also hard to quantify. For instance, in the zoloft vs. exercise clinical trial in MDD, zoloft produced vastly superior results in the first few weeks. However, the margin decreased slowly over a month or two. Shortly after this, the exercise group was winning on almost every parameter. This continued for the duration of the trial. So while medications may seem to be ahead at first, we need to look at the longer term picture. Antidepressant poop out for a lot of people with major depressive disorder. When the drug solution is as hazy as it is, then a closer look at alternitives may seem to be benificial.For some, exercise will not be as effective as medications, but for others it will be. But in terms of sevaritly, I don't think that exercise just stops at a certain level. The same thing goes for SJW. I think a lot of drug companies wanted us to believe that it was only effective in mild to moderate depression. Over in Europe there are a lot of trials showing it is helpfull in severe depression.
Bipolar disorder is a different story. Exercise is not an antimanic agent. Bipolar depression can (not always) respond to exercise, just like it can (not always) respond to drugs.
Linkadge
Posted by SLS on April 7, 2006, at 17:30:11
In reply to Re: Drugs versus Psychotherapy - Backlash? » greywolf, posted by linkadge on April 7, 2006, at 16:56:49
> I don't think when it can and cannot help has been clearly established either. I would like to see one clinical trial that shows that exercise has no effect on major depression. We do have clinical trials showing that major depression can beneifit from exercise though. I personally know of a guy who failed ECT, and is having success with exercise and CBT so go figure.
Was he depressed or was he depressed?
I still think we have a problem in the identification of what we are trying to treat. ECT and antidepressants will probably fail every time when treating someone whose depression is entirely psychogenic.
I experienced a brief depression during the time my depression was in remission.
Better said:
I expererienced a brief psychogenic depression during the time my endogenous bipolar depression was in remission. Yes. A girl dumped me. I got depressed. It felt entirely different than the depression that was in remission. Not only that, but it resolved completely once I processed the event psychologically.
A depression is not a depression is not a depression.
What exactly are we talking about when we use the word "depression"?
- Scott
Posted by linkadge on April 7, 2006, at 18:04:18
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 17:30:11
Think of it another way. Huntingtons disease is a genetic disorder. That means that without treatment the disease will progress and take over. (Ie, it is endogenious). But, mice who posess HD genes actually benifit from exercise. Yes, that is an endogenious geneticly based disease being modified by the application of exercise.
Ie, mice who possess the Huntingtons gene benifit both symptomatically, and physiologically from exercise. It can delay the progression of many symyptoms. Exercising HD mice loose ballance much later, and also retain weight and brain volume much longer than mice who are sedintary.
I guess my argument is that the disease may be biolocial and endogeniously driven, but one cannot therefore deduce that exercise will have no impact on the course of illness.
It is funny because like in depression and other neurodegeneritive disorders, HD mice posess abnoramlly low levels of BDNF, and exercise can attenuate this decline. Depression and suicidal ideation are big problems in Huntintons. Perhaps due to the way that the disease interacts with the BDNF gene.
www.hdlighhouse.com discusses many agents that can modify the course of Huntintons. They discuss how diferent agents modify BDNF, and how they affect the progression of HD positive mice. They have found that DHA (fish oil) treats Huntintons, Lithium treats huntintons, Exercise treats Huntintons, and how many other agents affect the course of degeneration.
So for somebody to say that exercise cannot treat a depression that is endogeniously driven, may not be accuate at all. Some of the research I believe in (with depression) is how it relates to genes that affect BDNF. One potential gene found in bipolar families 22q. 11 (or something like that) is associated with dramatically decreased BDNF. Bipolar depression is associated with dramatically decreased BDNF.
Exercise alone (in many studies) acutally increases BDNF more than an antidepressant alone.
So if we see recurrent depresson as perhaps degeneritive, then perhaps exercise can modify the long term course of illness.
Linkadge
Posted by linkadge on April 7, 2006, at 18:18:48
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by linkadge on April 7, 2006, at 18:04:18
But, what is the common denominator between fluoxetine, and tianeptine? Enhanced BDNF expression / attenuation of stress induced BDNF supression.
Linkadge
Posted by Phillipa on April 7, 2006, at 18:59:34
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 17:30:11
Good question what is in your opinion depression.? Love Phillipa
Posted by SLS on April 7, 2006, at 19:42:14
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by linkadge on April 7, 2006, at 18:04:18
I appreciate the wealth of studies to be found on Medline reporting the efficacy of exercise in the treatment of depression in humans. I can't account for it. I must call into question the validity of their designs. These studies must be flawed because exercise doesn't work for me. ;-) They don't seem to be well-controlled, and the selection criteria are almost never divulged.
Thesis: Exercise is as effective as pharmacotherapy in the treatment of moderate to severe MDD.
If you ask me, I think all of the studies on Medline reporting parity between treatments in humans represent wishful thinking. Either that, or perhaps they are representative of a backlash against drug therapy. Either way, I don't believe they reflect real-world treatment outcomes.
I wish I had the armament to be able to refute the thesis, but I really don't have the energy to perform the research necessary to produce a cogent argument. Maybe someone else does. Either way, I know what does and doesn't work for me, and I know that exercise doesn't. n=1 Not much of a start, I know.
I guess this is a cop-out. Sorry.
Backlash. I can feel it. Ouch.
- Scott
Posted by SLS on April 7, 2006, at 20:09:56
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by Phillipa on April 7, 2006, at 18:59:34
> Good question what is in your opinion depression.? Love Phillipa
Hi Phillipa.
You caught me on a bad day. I don't think I could do a better job of describing MDD than the DSM. This comes pretty close, though.
http://www.mentalhealth.com/dis1/p21-md01.html
For me: loss of interest; apathy; anergia, psychomotor retardation; anhedonia; reduced libido; impairments of memory, concentration, and cognition; leaden paralysis; muscle weakness; breathlessness; dizziness; feeling cold; loss of smell and taste; reduced appetite; dry mouth; clumsiness; indecisiveness; social inhibition and anxiety; (That's it for now)
- Scott
Posted by Caedmon on April 7, 2006, at 20:30:24
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 19:42:14
You're right Scott, there isn't a way to do a placebo version of exercise. (Well, maybe those ab roller devices could work? Heh.) And I do think that different types of depression respond differently.
From the perspective of a patient, exercise is sometimes a daunting prospect when depressed, and when I'm *really* depressed it's almost impossible. But when I'm recovered, I exercise. It's not just the mental health aspect, I mean there are a million reasons to exercise. It's just good for you. There's very little downside to it.
I mean, the worst thing that could happen is you end up healthier. I wish I could say this about most psych meds.
- C
Posted by linkadge on April 7, 2006, at 21:02:38
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 19:42:14
When doing a little web searching, I found that many of the sites that downplayed the AD effect of exercise had effexor-xr adds on their sidebars.
Linkadge
Posted by linkadge on April 7, 2006, at 21:10:51
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 7, 2006, at 21:02:38
This is the study I was referring to.
http://www.additudemag.com/ourkids.asp?DEPT_NO=303&SUB_NO=19
Linkadge
Posted by linkadge on April 7, 2006, at 21:23:02
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 7, 2006, at 21:02:38
All studies attempting to *sses the efficacy of exercise for depression will be flawed based on the fact that they can't be blinded.
But, research into the area is not nonexistant.
http://www.medicalnewstoday.com/medicalnews.php?newsid=34197&nfid=rssfeeds
Linkadge
Posted by SLS on April 7, 2006, at 21:57:18
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 7, 2006, at 21:23:02
I just don't think it is justified to have someone with severe depression (MDD) forego all other treatments and commit to a trial of exercise that lasts for weeks or months. That's what we are talking about here. We aren't debating the desirability of exercise in general. We are not even speaking about the efficacy of exercise as an adjunct to other treatments. The question at hand is whether or not exercise alone is as effective as pharmacotherapy in the treatment of moderate to severe major depressive disorder or bipolar disorder. Right now, I don't think it is.
- Scott
Posted by SLS on April 7, 2006, at 22:14:29
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 7, 2006, at 21:23:02
> All studies attempting to *sses the efficacy of exercise for depression will be flawed based on the fact that they can't be blinded.
>
> But, research into the area is not nonexistant.
>
> http://www.medicalnewstoday.com/medicalnews.php?newsid=34197&nfid=rssfeeds
Maybe I'm reading this article wrong, but it seems that parts of it bolster my argument:"It's also possible that exercise's effect on mental health is an illusion, says the Harvard Mental Health Letter."
"Even controlled trials on the subject often have problems, such as insufficient follow-up, the difficulty of correcting for the effect of expectations, and the fact that people who volunteer for exercise studies are not necessarily typical."
- Scott
Posted by Sobriquet Style on April 8, 2006, at 6:06:09
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by greywolf on April 7, 2006, at 13:05:49
>It refers to the multitude of "get out and enjoy the fresh air" and "mind over matter" folks who think simple lifestyle changes will cure serious mental illnesses.
In that respect, i'm glad to say we are not the ones which need help, treatment and education. :-)
~
Posted by Sobriquet Style on April 8, 2006, at 6:22:49
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 21:57:18
>I just don't think it is justified to have someone with severe depression (MDD) forego all other treatments and commit to a trial of exercise that lasts for weeks or months. That's what we are talking about here. We aren't debating the desirability of exercise in general. We are not even speaking about the efficacy of exercise as an adjunct to other treatments.
I thoroughly agree. Like I said in my previous post I wouldn't forego other treatments eg medication, in favour of exercise alone. I do support, for myself, exercise as an adjucnt treatment. Really though, I can't say i'm starting an exercise routine as a treament for bipolar disorder. Its more from an holistic health point of view to gain an increased sense of well-being, which in turn if that can aid in the smallest sense to helping me with the illness, then thats a bonus. At the very least I'll feel more pleased with myself when I look into the mirror for self esteem and reduced fat!
I want to finally mention that I have reviewed your website with extensive medication information. I think on your main website I came across photos of yourself with an excellent toned physic. Alot of hard work must of gone into that training, very impressive and a supurb psychic! :-)
Best of luck with starting up risistant weight training again. I've just started myself, the first few days were the toughest, but now the aches and pains are slowly beginning to subside..
~
Posted by SLS on April 8, 2006, at 6:43:10
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by Sobriquet Style on April 8, 2006, at 6:22:49
> >I just don't think it is justified to have someone with severe depression (MDD) forego all other treatments and commit to a trial of exercise that lasts for weeks or months. That's what we are talking about here. We aren't debating the desirability of exercise in general. We are not even speaking about the efficacy of exercise as an adjunct to other treatments.
>
> I thoroughly agree. Like I said in my previous post I wouldn't forego other treatments eg medication, in favour of exercise alone. I do support, for myself, exercise as an adjucnt treatment. Really though, I can't say i'm starting an exercise routine as a treament for bipolar disorder. Its more from an holistic health point of view to gain an increased sense of well-being, which in turn if that can aid in the smallest sense to helping me with the illness, then thats a bonus. At the very least I'll feel more pleased with myself when I look into the mirror for self esteem and reduced fat!
>
> I want to finally mention that I have reviewed your website with extensive medication information. I think on your main website I came across photos of yourself with an excellent toned physic. Alot of hard work must of gone into that training, very impressive and a supurb psychic! :-)
>
> Best of luck with starting up risistant weight training again. I've just started myself, the first few days were the toughest, but now the aches and pains are slowly beginning to subside..How many times a week do you intend to work out? I found that it takes a little longer (LOL) for the body to recover after age 40. I think I might start at 2-3 a week. I might walk or run on the off days. Linkadge said something important along another thread. It is possible to overtrain such that it becomes counterproductive for mood enhancement. I tend to perform each set of exercise until I reach momentary muscle failure. It is intense, but very efficient. That's why the 2-3 times per week to start with. If I find that I get the "itch" again, which I doubt, I'll then split my routine and workout 4 times a week. Anything more will produce a state of overtraining in which the rate of progress is diminished. There must be a balance between intensity and volume.
- Scott
Posted by Sobriquet Style on April 8, 2006, at 8:01:36
In reply to Re: Drugs versus Psychotherapy - Backlash? » Sobriquet Style, posted by SLS on April 8, 2006, at 6:43:10
>How many times a week do you intend to work out?
At the moment 3, i'm aiming for 4 and doubt i'll go higher than that.
>I found that it takes a little longer (LOL) for the body to recover after age 40.
LOL I can imagine. I've quite literally been very unactive for nearly 2 years. On previous attempts on the weights, I'd do some (for one day) my muscles would ache so much after afew days of them recovering I wouldn't continue. This pattern went on for quite afew months - train - stop - train - stop. Absolutely pointless! Fortunately, I re-started reducing the level of weights, now I've gradullly increased them to a half respectable level and things are going good.
>I think I might start at 2-3 a week.
Thats sounds like sensible idea. I need to refresh my knowledge, but I'd certainly say that to start off with go very slow, listen to your body and only increase when you feel ready too. If memory serves me right when you get into an established routine, it maybe that after 3 days of doing no weights, you can lose alot of the effort you gained previously. I may well be wrong, I need to seek some information soon for when I see some improvements on how to stabilize my progress or increase it in a sensible way.
>I might walk or run on the off days.
That sounds like a good idea..
>I tend to perform each set of exercise until I reach momentary muscle failure. It is intense, but very efficient.
Me too. At present i'm using a method i've used before similar to boxing training that has worked for me in the past. I'll do intense lifting for a specific area for a few minutes. Then change to a differnet area, then change again eg abs, then afew mintues on a skipping rope. Keep this in rotation for about 30mins. I've also got a machine for aerobic exercise. I'm using free weights and a bench press. Fortunately this is all at home so my gym costs are cheap :-)
>Anything more will produce a state of overtraining in which the rate of progress is diminished. There must be a balance between intensity and volume.
For sure, finding that balance is crucial.
I hope to find ways of sustaining my interest levels with the training, so that it doesn't feel like a chore. I'm thinking of introducing swimming possibly at a later date, and possibly taking photos to keep track of my progress, so that when I feel like giving up I can see the, hopefully LOL, huges benefits i've made.
~
Posted by greywolf on April 8, 2006, at 10:24:31
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by Sobriquet Style on April 8, 2006, at 8:01:36
If you're starting aerobic exercise, I'd recommend going to the Runner's World website. They usually have links that outline a realistic training program geared toward where you are physically when you start it. At first glance, you think "wow, they don't even have me running a couple miles for 8 weeks," but when you think about it, the very slow pace of their beginning programs make a lot of sense.
Posted by SLS on April 8, 2006, at 10:33:09
In reply to You just know I have an opinion, right? » SLS, posted by Racer on April 6, 2006, at 12:57:07
Hi Racer.
I'm sorry I didn't get around to responding to your post. All I can say is that you hit the target better than I did.
- Scott> Lucky for you, I don't have time to go into it right now...
>
> Briefly, though, I think there are a couple of factors that are probably coming into play:
>
> 1. CBT probably is part of it, although I'm gonna back away from offering my opinions on that. I'd ask how long after the end of CBT treatment the assessments were done, and I'd look very, very closely at the pre-treatment baseline. Oh, and I'd do another follow up study a year or two later, to see how much LASTING benefit CBT had.
>
> 2. With SSRIs so heavily advertised to consumers, and a few changes in the world that really do affect functioning for a lot of people, I think taking a pill seemed perfectly reasonable to a lot of people for a long time. This is where my longer opinion comes in, but it's basically that a lot of the people on SSRIs in the past decade have really and truly needed non-medication interventions. They needed the things that talk therapy -- actually, more like coaching in life skills -- can provide.
>
> 3. I do think there's a wider range of what's being called depression in these studies. The studies I've read have been pretty consistent on the matter, really: for MILD depression, talk therapy can be as effective as medication. For moderate depression, talk therapy can be pretty helpful, as can medications, but both together are optimal. For severe depression, though, all the studies I've seen have consistently said that medications really are required, but talk therapy can be a very valuable adjunct.
>
> Then again, you know I have opinions... So many, in fact, that I have to give them away to all who'll take them...
Posted by linkadge on April 8, 2006, at 10:54:02
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 21:57:18
I would never tell sombody who is benifiting from medications to stop in them in favor of exercise, I am saying that before somebody takes an antidepressant exercise should be tried / and considered for those who aren't responding to drugs as an alternitive or adjunctive.
Linkadge
Posted by linkadge on April 8, 2006, at 10:55:42
In reply to Re: Drugs versus Psychotherapy - Backlash? » linkadge, posted by SLS on April 7, 2006, at 22:14:29
Just because a study design is flawed doesn't imply directly that exercise is innefective. It just means that its effects have not been fully explored.
Linkadge
Posted by SLS on April 8, 2006, at 11:10:15
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 8, 2006, at 10:54:02
> I am saying that before somebody takes an antidepressant exercise should be tried
This is precisely where we are in disagreement.
> and considered for those who aren't responding to drugs as an alternitive or adjunctive.
If one can exercise, I agree that it makes sense to do so.
If you were to prescribe exercise for someone who is severely depressed, how would you administer it? How many weeks do you allow to elapse before declaring it a treatment failure?
- Scott
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