Motivation is fleeting but routine persists.

When there is something that you want to do regularly (exercise, doing the final boring part of some sideproject, cleaning the house...) you remove willpower from the equation and set a day and a time.

For example, everyday from 18 to 19 I work on my sideprojects, or saturdays from 16 to 18 is house cleaning time. There is no question if I want to do it, it is set at that time and I have to do it, period.

The nice thing about routine is that the first times it is hard, but after some repetitions your mind (and body) begin to get used and it transforms into a routine and then it's like it's written in stone. That time period of that day X is for Y and it is what it is.

Routine can be used for bad things but also for good things.

We have a certain amount of "willpower" that can overcome motivational barriers. This willpower is limited, though. It's very helpful to have clear guidance on where to allocate this very limited resources, especially in situations where people are otherwise struggling.

All of which is to say -- these exhortations can play a useful role. :)

I also question the universality of it. No amount of exercise changed my depression or made life any less miserable. Anti-depressants finally helped me get past the trauma I was unable to properly process otherwise.

That may be true if you're severely depressed, but I think it can save you if you're starting to get depressed. That's what happened to me at one point, and an online comment saved me.

I was like 60% depressed but on my way there. I just took my first computer science class in college but I was overly ambitious when I participated in an undergrad CS research. The stress and imposter syndrome was shoving me to the downward spiral.

I posted some gloomy thoughts on an online forum. It was long ago, but I remember the post contained how I could kind of relate to the villain while watching the movie The Dark Knight Rises.

Some online person advised me "lift weights". I had never tried seriously lifting weights, but I was living in a student apartment 10 minutes away from the student gym, so I decided to give it a try. I can't forget the sensation when I did a set of bench press. After a period of amassing so much stress, each rep felt like I was reaching my hand into my brain, directly scooping out the waste and tossing it away.

I became much more active after that, and successfully finished the research and the degree.

It's like how homelessness is more reversible for people who became homeless less than a year ago, and why organizations focus on those groups.

I think the real exhortation is to develop a multi-pronged strategy for managing depression. I didn't feel like my depressed life got durably better until I had both exercise and therapy, and there are still times where things aren't going well with no clear discernible reason. I suspect that adding a low dose of medication on top would help.

Every additional coping mechanism you add, that works well for you, provides defense in depth.

Well... sure. I've had trouble with anxiety and it's actually an incredibly anxiety provoking thing for me to go to therapy. But I read enough information telling me that therapy is good for anxiety so I finally went. I think there's people out there who need to know that exercise is helpful for depression, even if the depression makes it difficult.

Much like the sibling comment I started walking around the local park before spending more time hiking. I live semi rurally though and wouldn't want to walk in an urban environment.

I normally feel much better after walking and cycling. Also I think doing something repetitive like walking allows you to think, tune out of other things.

It doesn't have to take deep discipline. I started my routine by just going for short walk after dinner everyday and it built up from there. It's intimidating to have to start at gym for 60 minutes 3x/week. Just do whatever little you like - a few pushups, a walk, a dance and stop when its not enjoyable. It tends to naturally build up.

Also the bad times can be a great time to build good habits. I’ve tried and failed to develop an exercise routine many times, but it wasn’t until I was laid off for 6 months that it finally stuck. I had a friend who went to the gym every day in the middle of the day so I didn’t really have a reason not to go. 6 months was long enough for the habit to stick and fast forward years later and I still have the habit. It’s been so good that I regularly think about how good it was that I had the opportunity to be laid off.

You can also have a "deeply-disciplined routine" and get thrown out of it and hit depression because exactly by that one impact.

Source: Myself.

its amazing that we haven't found anyone dualwielding the skill of therapist and personal trainer. we already have things like sex surrogacy (https://www.webmd.com/sex/what-is-sexual-surrogacy) so its not like it would be that weird by comparison.

I think we also approach exercise the wrong way. And IMO this is true with sleep too (which also impacts depression). We're using the wrong metrics.

The most important thing to get started with working out is just to start doing some exercise. You can start on one push up a day or something. It's all about creating momentum and habit.

Once you do it, then you can increase the time and the intensity and optimize exercise and all. But doing sport should be about doing one push up a day and thats it. About starting as slow as you can.

Sleep is the same in that we try to sleep as much as we can, and get as much REM and deep sleep, and these are not the right metrics for most people. The most important is just to go to bed and wake up at the same time everyday. That's it.

People are obsessed with trying to go to sleep at some point in time. Don't. Go to sleep when you're tired, wake up sleep deprived at the right time, the next evening it'll be easier to sleep at the right time

One thing that worked well for me is I switched my transportation to almost exclusively bicycle. Do I always want to exercise? Do I always want to get on my bike when it's below zero in active weather? No, not always. But if I want to get where I'm going that's my option and I get the exercise in the process (and save a buttload of money too)

“Action precedes motivation.” ― Robert McKain

This seems to work for me at least. If I start trying to reason with myself why I should get out of bed at 5am to go to the gym rather than excuse XYZ, I will talk myself out of it.

If I simply start "moving" and start doing "stuff" without engaging my brain, things happen and within a short space of time, I'm pumping iron and feeling great.

Nail on the head. I know that exercise will make me feel better, but during a period of depression/grief I could not even get out the house.

> Exhortation to develop those good habits in the good times, I suppose.

This is what medication for more severe cases of things like depression is supposed to offer: an opportunity to learn, usually through therapy, to cope with the condition in a healthy way.

My two cents on this topic is to create short term, superficial incentives to help create the practices that yield the long term incentives. For me this is paying extra for a gym with a hot tub, sauna, and cold plunge. Now I derive relaxation from the workout, but before that I also received a lot of support from the knowledge that the amenities afterwards were waiting for me.

I'm not a big believer in discipline.

That is true. And motivation is not a fixed variable. It is possible to get increased motivation by a better plan, resulting in increased self efficacy.

From studies like this, maybe more awareness and perhaps funding to solutions providing smaller steps

Shameless plug, I am building one: Low friction mini games, social, squats/situps/pushups. Feelgoodcrew.com

True, but the same is true for therapy. Finding a good therapist isn't easy, and having depression certainly doesn't make it easier.

I always wondered if this kind of research was just finding that depressed people motivated to exercise are already in a recovery mindset

i think what is missing from this narrative is not whether or not people have a routine, it is that exercise elevates your mood away from the depressed state, therapy encourages you to question your thoughts and decisions through out your day that might lead you away from a depressed state. to put it a different way, whats the point of exercising every day if you continue the thoughts and habits that are less than satisfactory to you without any self awareness?

This is 100% true, and what I'm about to describe isn't an attempt to falsify it: took me 11 years and 3 cities to figure it out.

You don't have to exercise so much as get moving.

I'm the best I've been in 37 years, and it's because in August I started forcing myself to just keep walking whenever I went out to have a cigarette. I was in Boston, and would end up ~nowhere and exhausted.

Then started doing random stuff: "might as well walk to Harvard Square instead of the bike path again" "might as well go to a bookstore instead of somewhere random" "I should use the skate park, I don't fit in*, but I miss rollerblading from middle school"

Then my dog died, 2 days later I severely sprained my ankle at the skate park and couldn't walk anywhere substantive for a couple weeks. By the time I'm able to do a sustained 10m+ walk it's winter.

Went to visit California as a not-tech-employee for the first time, so I saw San Luis Obispo and Los Angeles for the first time. And the same habit kicked in, in SLO I ended up hiking for the first time on what I find out later was not a real trail, end up hiking every day that week.

Get to LA and it's nothing like I would have thought. Egalitarian, tons of stuff to do, and Waymo is a godsend. Whenever I get antsy there's somewhere to go and a way to get there.

2 weeks later, I got an apartment in LA, moving away from Northeast for the first time in my life. I could see me just spending another 4 months decaying in Boston until its barely warm enough out to take a 30m walk, and I'm tired of that cycle..

All that to say, I'm fit, I had a great career in high school sports, I played basketball occasionally, but couldn't really get active consistently. Treadmill was never stimulating enough to keep my attention on anything other than being bored. In retrospect, I really wish I heard this old saw ~all of us know and heard it as "moving around" instead of exercise.

(n.b. this was all under active mental health care x medications spanning a decade+. It's not that the mental health care was useless, I don't think I could have done what I did without it. But it couldn't "fix" me on it's lonesome, only enable me to get moving.)

* in retrospect this was wrong, plenty of newbies, and one of the most welcoming social environments I've been in. just people out there all trying to do the same thing and supporting each other.

Once exercise becomes a habit, it's very easy to do even on days when your mood is terrible. A strict routine (initially) is the trick to making things easier forever.

You definitely want to build that habit when you're at your best.

Motivation generally follows action, not the other way around.

I hear ice swimming also works.

If you are or you know some that is depressed one of the best things you can do is start exercising with someone.

It's a standardized mean difference, which I believe can roughly be interpreted as: "treated groups had 0.67 stddev lower depression score than control groups."

That's a pretty substantial improvement - consider someone who's more depressed than 75% of the population becoming completely average. (Because the 75th percentile is about 0.67stddev above the median.)

It means nothing, standardized effect sizes have no clinical meaning here, they are purely statistical. To measure if these kinds of changes matter, you need to determine the Minimal (Clinically) Important Difference [1-2]. I.e. can clinicians (or patients) even notice the observed statistical difference.

In practice, this is a change of about 3-5 points on most 20+ item rating scales, or a relative reduction of 20-30% of the total (sum) score of the scale [1-2]. Unfortunately, anti-depressants are under or just barely reach this threshold [3-4], and so should be widely to be considered ineffective or only borderline effective, on average. Of course this is complicated by the fact that some people get worse on these treatments, and some people experience dramatic improvements, but, still, the point is, depression is extremely hard to treat.

Unfortunately, this also means that if exercise is only nearly as effective as therapy for depression, it may mean that the benefits of exercise are not actually really clinically observable, if measured properly and not just based on arbitrary statistical significance.

EDIT: There is less data on MCIDs for therapy, but at least one review suggests therapy effects can be in the 10+ point range [5]. But the way the exercise study is presented, with standardized effect sizes, we have no idea if the results matter at all [6].

[1] Button, et al. (2015). Minimal clinically important difference on the Beck Depression Inventory - II according to the patient’s perspective. Psychological Medicine, 45(15), 3269–3279. https://doi.org/10.1017/S0033291715001270 [https://www.cambridge.org/core/journals/psychological-medici...]

[2] Masson, S. C., & Tejani, A. M. (2013). Minimum clinically important differences identified for commonly used depression rating scales. Journal of clinical epidemiology, 66(7), 805-807. [https://www.jclinepi.com/article/S0895-4356(13)00056-5/fullt...]

[3] Hengartner, M. P., & Plöderl, M. (2022). Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evidence-Based Medicine, 27(2), 69-73. https://doi.org/10.1136/bmjebm-2020-111600 [https://ebm.bmj.com/content/27/2/69.abstract]

[4] Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should antidepressants be used for major depressive disorder?. BMJ evidence-based medicine, 25(4), 130-130. https://doi.org/10.1136/bmjebm-2019-111238 [https://ebm.bmj.com/content/25/4/130.abstract]

[5] Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of affective disorders, 159, 118–126. https://doi.org/10.1016/j.jad.2014.02.026 [https://pubmed.ncbi.nlm.nih.gov/24679399/]

[6] Pogrow, S. (2019). How Effect Size (Practical Significance) Misleads Clinical Practice: The Case for Switching to Practical Benefit to Assess Applied Research Findings. The American Statistician, 73(sup1), 223–234. https://doi.org/10.1080/00031305.2018.1549101

Exercise is great for addressing feelings related to being physically inactive. It won’t address other mental health issues, such as learning to control your emotions & fostering healthy relationships.

> Depression can be caused by a chemical imbalance and no amount of exercise or talking about it will fix it.

This is a debatable. As far as I understand things: 'chemical imbalance' has no tests to confirm that's actually true, That's just a story they tell to relax people.

Which is orthogonal to the point that antidepressants can work for some people.

We don't know how depression works. It very well may be many little things dressed in a trench coat.

https://www.sciencedirect.com/science/article/pii/S266656032...

https://www.nature.com/articles/s41380-022-01661-0

https://www.neurocaregroup.com/news-insights/the-death-of-ch...

Exercising can help. It's not bad advice or inappropriate to suggest it. People shouldn't suggest it as if it's a cure all and certainly shouldn't suggest you just need to buck up, but the study is showing it can really help.

Context: I'm "using" SSRIs, talk therapy, psychotherapy, strength training and endurance training -- all in parallel right now.

Jim Carey had the best way to think about this: “I believe depression is legitimate. But I also believe that if you don’t exercise, eat nutritious food, get sunlight, get enough sleep, consume positive material, surround yourself with support, then you aren’t giving yourself a fighting chance.”

"Chemical imbalance" theories of depression (e.g. "serotonin hypothesis") have been scientifically discredited for well over a decade now.

EDIT: For a recent overview, see https://www.nature.com/articles/s41380-022-01661-0

Usual antidepressants (reuptake inhibitors) have specific chemical and clinical effects. Some forms of depression, mostly with stress, respond heavily, others, like refractory and bipolar, show no effect. It's like saying a knife cannot cut an arbitrary material. It depends. Studies of ADs must start to differentiate at least a few subtypes of depression.

Yes, exactly. I have exercised daily (either weight training or cardio) for nearly 20 years. I've also had anxiety and depression for that entire stretch of time.

Exercise was how I stayed mildly sane for a good majority of those years, but when I started taking medication it was like the entire world changed. I wish I had started earlier in life. It helped me to become a lot more introspective as well, being able to better examine why I was feeling the way I did.

There are some things that no amount of exercise or "healthy living" can fix, that's unfortunately just the human condition. It's nothing to be ashamed of.

> Depression can be caused by a chemical imbalance

And yet many other times, it can be caused or exacerbated by situational and psychological factors, including "being stuck at home all day".

> One of the most frustrating things when your really low is people giving advice like do exercise to feel better - please don’t do this.

Worse, antidepressants actually cause significant harm to many people who take them, often without even improving their depressive symptoms. This is very bad, and I would say significantly worse than giving general advice that might be inapplicable to some people.

There's no one-size-fits-all solution, and some people probably are legitimately just in need of more motivation to go running or biking or whatever else will get them the exercise they need.

I support people taking antidepressants if it helps them.

But I have to say the "chemical imbalance" theory either means no more than "depression responds to an antidepressant (sometimes)" or it is false/meaningless. Neither neurologists nor psychologists have a sufficiently detailed understanding of the workings of the brain to make such a claim.

Again, I'm glad drugs work for you. I would note that there three ways drugs can go for people; working with few problems, not working, working but with significant physical and/or psychological side-effects. Especially, taking any substance daily for the rest of one's life can stress the organs responsible for digesting/processing regardless of whether than substance is otherwise a great fix.

So I think we need to look beyond a glib "this fixes it for everyone" rhetoric even if this fixes it for you (and yeah, some of my friends should at least drugs, I'll admit).

that $5K deductible though...

The hypothesis of chemical imbalance causing depression is mostly discredited.

https://www.ucl.ac.uk/news/2022/jul/analysis-depression-prob...

You are assuming everyone has someone to take long walks with and speak their innermost vulnerable thoughts/feelings with. A therapist is a paid person to achieve this same outcome.

and people wonder why i call psychiatrists legal drug dealers - what incentive does a psychiatrist have to fix someone , when they could make 10x more money keeping that person dependant forever

I don’t think that conclusion follows. These results don’t mean “barely effective.” They mean that, on average, people who get therapy or exercise end up noticeably better off than people who don’t. When researchers translate the results into intuitive terms, therapy typically moves the average person from the middle of the pack to around the top 30 percent, and exercise to roughly the top 35 percent. That’s the same general magnitude of benefit seen with many approved medications, including antidepressants themselves. Depression trials have large placebo effects, which makes the numbers look smaller, but that doesn’t mean the treatments are doing almost nothing.

Psychotherapy is similar to pharmacotherapy in effect size but longer lasting after discontinuation. Given that the latter has been approved, it's safe to assume psychotherapy would be approved if it were a pill.

Anecdotal obviously, but from my experiences and those in my friend-group, therapy seems actively harmful in many circumstances. Therapy can be an enabler of bad behavior, helping to build a new fancy framework of excuses just as easily as it can help you land somewhere better. How long has it been since you've seen something bad (maybe it was just slightly selfish, maybe it was something worse and chronic) waved away as "self-care"? Or if you've lost faith in people or communication generally, then you're not going to feel better by going through many rounds of therapist mismatch and at some point you've aggravated problems rather than fixing them. Fortunately for the industry, measuring the harm is just as difficult as measuring the benefits. The advice to "just exercise more" may not help, but at least it really can't hurt.

I think the major problem we have is we are lumping depression and anxiety into the same category.

Some people probably do have issues quickly resolved by SSRIs. Others are magically fixed by bupropion while it spikes anxiety in others. Others have major trauma that they have to work through and many therapies (like internal family systems therapy, as one example) are great at handling that. Others are stuck in cognitive distortions and merely learning about them and handling them (through cognitive behavioral therapy) can be life changing.

But if you have major trauma in your past, exercise is probably not going to do much. If you are heavily overwhelmed and your body is stuck in perpetual flight or fight) exercise and meditation might be a giant help.

But right now the practitioners are aware of this, but it's really hard to double blind test these divisions until people can do the analysis first. And at that point, you've basically already started therapy.

The problem is that the same is true for many medications and other treatments, but if you're in the "lucky" minority (a pretty large one) for whom there's some relief... it's worth the try. It's not like choosing bleeding and emetics instead of chemotherapy for cancer, it's just the best we have right now to treat a complex system that we barely have the earliest understanding of.

Did you get the "brain zaps" when coming off the SSRIs? How long did it take?

I wonder if there’s some survivorship bias. E.g. did they only study people who started and maintained a routine vs. everyone who started a routine but couldn’t stick with it due to depression symptoms

Observation bias. Those who succeed to drive themselves to do an effort, are already out of the depression. Try doing 7hrs sports a week and falling into depression: You won’t have the energy. It’s not sports that gets you out of depression, but sure it’s a stage on the way back and you gotta constantly give it a chance.

You sound like a couch potato, like me.

Try HIIT 1 minute walking, 1 minute running

stimulating for the brain, safe, fun and an easy way to ease into running.

Have you tried lifting weights (different pace than HIT)?

hey friend, I'm glad to hear you found a way to improve things. It's not easy.

I also notice my mind better after workouts.

I'm not sure this is the type of depression being talked about here. It's unfortunate that we have conflated periods of being sad / down with clinical depression. I have no doubt that reading a book or cleaning the kitchen or accomplishing a goal can help with feeling down or general sadness, but clinical depression is a whole separate beast without such easy a fix.

No, it’s more specific - doing something physical.

Cleaning dishes yes, reading a book no

Don't underestimate the meaning and relationships people had in those times, hunting together to feed your family, farming with your community and interacting with animals etc.

I think physical activity, even just going on walks makes one feel change is possible. If something sucks and I sit home all day on YouTube, then it continues to suck. If I can change my environment, do things outside, see new people and find myself if different situations, then the thing that sucks starts feeling like maybe it also could change.

For example I doubt exercising in a basement just by yourself on 1 machine is likely to materially help with depression. At least not as much as going out doing a variety of things, or playing a game of basketball at the local gym/community center.

I did a summary here: https://www.chestergrant.com/highlights-from-spark-how-exerc...

It's in my top 15 books that changed my worldview.

Some key highlights:

1. In 2001 fit kids scored twice as well on academic tests as their unfit peers.

2. German researchers found that people learn vocabulary words 20 percent faster following exercise than they did before exercise, and that the rate of learning correlated directly with levels of BDNF.

3.Specifically, every fifty minutes of weekly exercise correlated to a 50 percent drop in the odds of being depressed.

Is the huge risk being involuntarily committed?

If so, that is a risk that is very dependent on local laws. I would be much more cautious about seeking mental health care in Florida, where the Baker Act makes it very easy, than in Connecticut [0]. The risk of being involuntarily committed also, of course, has to be balanced against the risk of forgoing mental health care when you need it and then injuring or killing yourself.

[0] https://psychiatryonline.org/doi/10.1176/appi.ps.201900477

It may be worth looking into childhood trauma if that's something that may be applicable. I had a similar experience, after losing 35kg over 3 years I felt and looked great on the onsite, even having to overcome back surgery during that period as well, felt like I'd conquerered the world. I thought I'd "done enough work", but as I found out, sometimes there is work to be done on the inside as well.