Everyone gets depressed from time to time, and often it passes and our mood brightens again. But when struggling with clinical depression, your mood can be depressed for weeks, months, or even years, resulting in real loss of functioning and quality of life.   Almost 1 in 10 Americans is affected by depression every year, and 17% of us will experience a major depressive episode at least one time in our life.  Additionally, depression is a major cause of disability, with an annual cost of about $40 billion in lost productivity and treatment costs (Craft & Perna, 2004).  

Many people will visit their primary care doctor for help with depression, and are often prescribed medication.  While this may be very helpful for some, research has shown that depression can be even better alleviated when counseling and exercise is also part of the prescription (Craft, 2014). This powerful combination can help people with depression recover and get back to fully enjoying their life again.

Depression Drags You Down

When you are feeling depressed, exercising may be the last thing you want to do.  Getting out of bed, going to work, or caring for your kids is difficult, and getting on a treadmill or even  walking around the block can seem impossible.   Daily life can start to become unmanageable if the illness really gets a foothold.  All of our emotions, including depression, communicate to us and to the people around us.  Depression tells your body to slow down, stay in bed, isolate from others, and generally shut down. According to the National Alliance on Mental Illness (2014), people living with clinical depression often experience things like:

• Changes in sleep. Many people experience difficulty in falling asleep, waking throughout the night and/or awakening an hour to several hours earlier than desired in the morning. Other people experiencing depression will sleep excessively–for much longer than they used to.
• Loss of energy. The loss of energy and profound fatigue often affects people living with depression. Mental speed and activity are usually reduced, as is the ability to perform normal daily routines. If you are living with depression, you will likely find that you respond to your environment much more slowly.
• Poor concentration. The inability to concentrate and/or make decisions is a scary aspect of depression. During severe depression, many people cannot follow the thread of a simple newspaper article or the plot of a 30-minute TV show. Major decision-making is often impossible.
• Changes in appetite. In the midst of depression, people may experience a decrease in appetite, and sometimes, noticeable weight loss. Some people eat more, sometimes resulting in weight gain.
• Lack of interest. During depression, people feel sad and lose interest in usual activities. You might even lose the capacity to experience pleasure. For instance, eating and sex are often no longer appealing. Formerly enjoyable activities seem boring or unrewarding during depression and the ability to feel and offer love may be diminished or lost.
• Low self-esteem. During periods of depression, people dwell on memories of losses or failures and feel excessive guilt and helplessness. “I am a loser” or “the world is a terrible place” may take over and increase the risk of suicide.
• Hopelessness or guilt. The symptoms of depression often come together to produce a strong feeling of hopelessness, or a belief that nothing will ever improve. These feelings can lead to thoughts of suicide.
• Movement changes. People who are depressed may literally look “slowed down” and physically depleted or, alternatively, activated and agitated. For example, a depressed person may awaken very early in the morning and pace the floor for hours (Depression Symptoms, 2014).

These symptoms can rob a person of joy, and destroy their quality of life.  In severe cases, people with depression can also experience increased thoughts about death and even suicidal thoughts or suicide attempts.  Depression can be debilitating, and we must use every tool we have to combat this illness.  We don’t know what causes depression, but the general consensus in the academic world is that it is caused by a combination of genetic, social, and environmental factors (Depression Symptoms, 2014).  The good news is that we have a variety of effective interventions to help people recover, including medications, counseling/psychotherapy, exercise and healthy eating.

How Counseling Helps

Very often, medication is combined with counseling for the treatment of depression, and this is a great treatment combination.  Medication helps with the biochemical issues that may be contributing to the depression, while counseling helps people to identify thinking patterns and other factors that may contribute to depression, and develop coping skills to decrease the impact of depressive symptoms.  Counselors can help you to:

• Identify life problems that contribute to depression, and develop strategies to solve or improve these problems (e.g. relationships or employment problems).

• Develop realistic goals for the future, and discover the strengths that have helped you cope and overcome challenges in the past.

• Identify and challenge negative or distorted thinking patterns that might be adding to feelings of depression, hopelessness, and helplessness that often accompany depression.  Depression can color everything, and lead to negative and pessimistic thinking.

• Replace negative thinking patterns with more positive and realistic thoughts and beliefs that improve outlook, self-esteem and hopefulness.

• Regain a sense of happiness and enjoyment in life, and learn skills to avoid unnecessary suffering if depression strikes again in the future.

Having one episode of depression greatly increases the risk of having another episode. There is some evidence that ongoing counseling may lessen the chance of future episodes or reduce their intensity (Depression, 2014).

How Exercise Helps

Combining exercise with counseling can offer even better outcomes for people struggling to pull out of depression.  A number of studies have examined the relationship between exercise and depression, and many have found that exercise is very effective in decreasing depression and anxiety, and improving self-esteem (Dowd, 2004). Research also shows that the benefits of exercise can be long-acting.  In one study, participants who exercised not only experienced decreased depression during the 12 weeks of the study, but went on to maintain the benefits for 12 months after the study, compared to those who didn’t exercise (Craft, 2004). 

In another study, exercise actually proved to be more effective in the treatment of depression than medication in men and women over 50.  The subjects in the study were treated with either an antidepressant (Sertaline 50-200 mg)) or brisk walking/jogging 3 times per week. After 16 weeks, both groups experienced equal symptom reduction, as measured by the Beck Depression Inventory.  Additionally, the exercise group experienced a lower rate of relapse of depressive symptoms than the medication group (Dowd, 2004).

So, we know it works, but how does it work? According to Dr. Kate Hays (2003), there are a number of ways the exercise benefits people with depression.   People who get regular exercise often report the “feel good” effect.  Exercise positively affects brain chemicals (noradrenaline, serotonin, and dopamine) and has a positive impact on brain processes like self-esteem, thinking, sleep, distraction, and sociability.   Craft, et al (2004) also states that exercise may also help alleviate depression in these ways:

• Makes steroid reserves more accessible to counteract stress

• Reduces muscle tension and alleviates fatigue

• Increases body temperature, which can have a sedative/calming effect

• Releases endorphins that can bind to the opioid receptor in the brain, having an analgesic effect (many people also report physical pain, along with the emotional pain of depression).

• Increases self-esteem, self-efficacy and feeling of self-sufficiency

• Distracts from daily stress, depressive thinking, and anxiety

• Provides an opportunity for positive interactions with others and with nature

• Can be a form of biofeedback that can help you regulate your own autonomic (nervous system) activity

Clearly, there a number of benefits to be gained by adding exercise to counseling for the treatment of depression.  Additionally, we all know that exercise is great for our overall health, and our waistline!  Any exercise is great, and important to find something you like to do, so you are more likely to stick with it.  If you are considering adding exercise to your treatment regime, Dr. Hays (2003) suggests following these guidelines:

• Exercise should be aerobic in nature, or use rhythmic abdominal breathing.

• Exercise would be built into your daily routine, and done about the same time each day

• Generally, exercise that is not of a competitive nature is best when used for treating depression

• Exercise should be moderately intense, and see your doctor first before starting a new exercise routine, if you are over 50, or have any health conditions.

• Exercise should last 20-30 minutes

Getting started can be the hardest part, especially when you are still in the grips of depression.  Counseling can offer support for your exercise goals, and it’s essential to be patient while you are healing.  Depression is a serious illness, and it takes time to recover. Counseling and exercise may just be the treatment combination that can help you recover more quickly, and get back to enjoying your life.  

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Craft, L. L., PhD, & Perna, F. M., PhD. (2004). The benefits of exercise for the clinically depressed. Retrieved July 5, 2014, from http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC474733%2F

Depression and how psychotherapy and other treatments can help people recover. (2014). Retrieved July 7, 2014, from http://www.apa.org/topics/depress/recover.aspx

Depression: Symptoms, causes and diagnosis. (2014). National Alliance on Mental Illness. Retrieved July 5, 2014, from http://www.nami.org/Content/NavigationMenu/Mental_Illnesses/Depression/Depression_Symptoms,_Causes_and_Diagnosis.htm

Dowd, S. M., PhD, Vickers, K. S., PhD, & Krahn, D., MD. (2004). Exercise for depression: It really does help—here’s how to get patients moving. Current Psychiatry, 3(6). Retrieved July 6, 2014, from http://www.currentpsychiatry.com/home/article/exercise-for-depression-it-really-does-help-heres-how-to-get-patients-moving/e0c362094713f8777613e19d6adc050c.html

Hays, K. F., PhD. (2003). Working it out: Using exercise in psychotherapy. NYSPA Notebook, 18. Retrieved July 6, 2014, from http://www.apadivisions.org/division-31/publications/articles/new-york/hayes.pdf