An Introduction To Depression
Depression is hard to put into a box and clearly define. Each person, and each client I have coached with depression, will display symptoms of sadness or depression in their own way. I have never seen two people live with and deal with depression in the same way. It is unique to the person, and in that vein, should be approached in a way that suits the individual. Much like that of a fitness or nutritional programme, there is certainly not a ‘one size fits all’ approach to depression and exercise. In this article, I’d like to discuss the roots of depression, its causes, signs and symptoms and how it relates to exercise in the gym, studio or even at home. I also want to use this article to raise awareness of depression and to help those suffering with it, or even those who know someone who is, look at the illness with a little more compassion and consideration.
Initially, it’s important to differentiate between when we are just having a ‘bad day’ or feel simply fed up and when we are actually suffering from depression. It’s fair to say, at some point, everyone will experience moments in life when their mood is low, naturally leading to feelings of misery and sadness, but for a lot of people, these feelings often pass with no lasting effects. For others, these feelings can become a common or even daily occurrence and start to have a deep impact on daily life. We should never look at depression as being trivial, nor use it as a simple label by which to coin a ‘bad day’. The truth; depression is a very real illness with very real symptoms. It might be mild, bringing our general spirits down, or it can be so severe that the person questions the point in living altogether.
Let’s make this clear; depression is NOT a sign of weakness. Some of the most mentally strong people I know are strong precisely because they have suffered from the symptoms of depression. With the right treatment and support, the majority of people suffering with depression can make a full recovery, and I personally believe that good nutrition and regular exercise can have profound and direct effect on that road to recovery.
Triggers for depression are extensive and varied, such as illness, bereavement, redundancy, childbirth and self-isolation. Life-changing events in general could trigger depression. It may be the case that the individual has a family history of depression, which may increase the likelihood of them suffering from it. Having said that, it’s worth noting that sometimes there may be no obvious reason why someone becomes depressed.
Possible Causes Of Depression And Other Health Problems
Chemical Imbalance – Some research suggests that an underactive serotonin system, something that causes neurons to fire less serotonin, could be a possible cause of depression. Treatment for this would include antidepressants to aid in increasing the levels of neurotransmitters in the brain. Even so, the brain remains a very complicated part of our anatomy. Antidepressants work by changing brain chemistry, which often leads to an assumption that depression can be caused by changes in brain chemistry. This is assumed it can be corrected through drugs. The truth is that evidence for this is still quite weak. If brain chemistry changes do happen, it’s still to be proven it’s due to depression or its cause.
Childhood Experiences – Difficult childhood experiences have been suggested as a possible cause of depressive episodes in later life. This could be a result of abuse, whether physical, emotional, neglectful or even sexual. Some researchers also suggest that experiencing a higher number of lesser challenges in life could have a bigger impact on the possibility of depression over experiencing just one major event. Childhood experiences can have a monumental impact on a person’s self-esteem and how they learn to cope with their emotions. As a result of this, it can make that person less able to deal with the curveballs that life throws at them, leading to depression in adulthood.
Life Events – A traumatic, stressful or unexpected event could trigger depression in some cases. It isn’t necessarily the negative experience itself that can cause the depression, but how the person deals with the experience instead. For example, if someone is already experiencing a low mood and doesn’t have a support network in their life, depression could develop.
It may be that the person is experiencing other mental health issues alongside depression. Trying to cope, especially without the appropriate support, with other mental health problems such as PTSD, eating disorders or anxiety, can be a trigger for depression. Alongside this, poor physical health can also lead to an increased risk of developing depression. It is inevitable that some health problems will directly affect a person’s mood. These may range from life-threatening illnesses, to obesity, to low blood sugar or even hormonal problems.
Where medications for illness are prescribed, it’s important to remember that depression may be a side effect of the medication itself. Issues like this may see the individual turn to recreational drugs as a coping mechanism, which in turn, may worsen the depression. Whilst a poor diet, lack of exercise, lack of sleep and other more general health aspects may not be a direct cause of depression, they can certainly lower a person’s mood making it more difficult when suffering with depression. I am yet to see a client who has not increased their mood through good nutrition and regular exercise.
Genetics – Some research suggests that there may be a genetic link between parents and children that could be a possible cause for depression. There is yet to be an identification of any specific depression gene, but even so, the more genetically similar an individual is to someone with a mental illness, the more likely it is that they could also develop the same illness. Remember though, this doesn’t mean that someone is guaranteed to inherit depression. There is still much research to be done here. Linked in with this, though not directly due to genetics, it is possible a person could learn the behaviour and ways of coping with issues from the people around them, both growing up and as adults.
Postpartum Depression – This form of depression is something that parents can experience after the birth of a child. It is a problem that affects more than 1 in 10 women within the first year of giving birth. Postpartum depression can also have an affect on the father of the child or any other partner of the mother. Depression during pregnancy itself is also common and is known as antenatal depression. The cause of postnatal depression isn’t yet completely clear, but there are a number of factors that may make an individual more likely to develop the illness.
Possible causes of postpartum depression may include a history of depression or mental health problems earlier in life. Other causes could be down to having no family or friends around to support the person, a difficult or toxic relationship with a partner or even recent stressful events, like the loss of a loved one. Further struggles such as physical or psychological trauma, stress and exhaustion can also be possible causes.
Seasonal Affective Disorder (SAD) – This is a form of depression that changes alongside the annual seasonal pattern. Often, people refer to this type of depression as ‘winter depression’, as symptoms are usually more prevalent during the winter months. Even though the exact cause of SAD is still unknown, there is a link to reduced exposure to sunlight during shorter days in the autumn and winter months. A key theory on the cause of SAD suggests that the hypothalamus stops working as effectively due to the lack of sunlight. In turn, this then affects the body’s internal clock and levels of serotonin, the hormone that can affect appetite, sleep and mood. Seasonal changes can also disrupt the balance of melatonin levels in the body which can directly impact mood and sleeping patterns.
Mood Disorders – There are a lot of different diagnosable mood disorders which are categorised as depressive disorders by the International Statistical Classification of Disease and Related Health Problems (ICD-10) produced by the World Health Organization (WHO). This is used in many countries, including the UK, to help diagnose patients.
Signs, Symptoms & Diagnosis Of Depression
Depression as an illness is a very complex condition and doesn’t present itself as one single symptom alone. A given person may be struck with a lack of enthusiasm and motivation, energy or even a general interest in life. Sometimes, somebody suffering with depression may experience all of these symptoms simultaneously. Though these three primary symptoms may seem easy to spot at face value, the fact is that everyone is different. People live such varied lifestyles and live through an even wider range of experiences. Due to this, there is almost an unlimited number of ways that depression can manifest itself.
An individual’s experience can range from feeling hopeless to tearful or having extended periods of being unhappy to losing interest in the things that they might usually enjoy. Quite often, anxiety can go hand in hand with depression, with physical symptoms of such including a lack of appetite, feeling tired, bad sleep and general aches and pains within the body. The person may also feel a dip in libido and sex drive.
For a vast portion of those suffering from depression, during difficult times, they tend to experience feelings of low mood, stress and anxiety. These feelings can improve over a relatively short period of time, which would normally suggest that they aren’t the root cause of depression. When symptoms persist for weeks or months and start to interfere with social, family and work life, then it would be worth contacting a GP as this could be a sign of depression.
At times, it can be hard to realise that something wrong is going on. This is down to the gradual development of depression over time. People may try to deal with symptoms of depression on their own, not really appreciating that they have depression in the first place. Sometimes it may be down to close family, friends and colleagues to identify the issue.
There are a few key ways in which health professionals will describe the level of severity in an individual. Mild depression is described as the person feeling persistently low in spirit. This will have some impact on their daily life. Moderate depression will often include more symptoms and have a significant impact on the individual’s life. Severe depression will be the point at which the sufferer will find it almost impossible to get through daily life and may even have suicidal thoughts. It has been observed that some people with this level of depression may also have psychotic symptoms.
Psychological Symptoms – persistent sadness or low mood / low self-esteem / guilt / intolerant and irritated by others / little enjoyment in life / anxiety / suicidal thoughts / difficulty making decisions
Physical Symptoms – changes in appetite or weight / aches and pains that can’t be explained / lack of sex drive and physical contact / lack of energy / constipation of the bowel / changes to the menstrual cycle / bad sleep / posture
Social Symptoms – difficulty to bond with family and family life / work life productivity / become introverted and avoid social situations / interests and hobbies are neglected
Evidence to support physical performance being affected by depression is currently lacking. When considering exercise and depression together, it is often the side effects on any medications taken as a treatment that will change the physical performance of the individual.
Individuals should consider consulting their GP if they experience these symptoms for the majority of the day, every day, for a period of two weeks or more. It is important to reach out for help if you think it may be necessary, especially if these symptoms of depression are not improving and affecting work or relationships. If a person is having thoughts of suicide or self-harm, it is vitally important to reach out to a healthcare professional. Remember, these people are in their job to help you, hold no judgement and set you on a manageable course of recovery. These are some of the ideas I like to make sure my clients know. It doesn’t matter where you are, or where you’ve been, it only matters what you do moving forwards.
There are no physical tests that can diagnose depression, and instead the GP will more than likely ask a series of questions relating to general health, feelings and mood. It may be the case that blood tests are taken, but only to rule out other conditions that may display similar symptoms, such as an underactive thyroid. The diagnosis of depression does unfortunately rely on the individual giving an open and honest account of how they are feeling. Remember, any discussions are strictly confidential.
Recommended Exercise For Depression
Cardiovascular Exercise – Before starting any regular cardiovascular exercise, it is important to be aware of any potential physical conditions that an individual might have as they could be a factor in the presentation of depression. The primary focus here should be on the duration and frequency of the exercise in order to improve upon the programme’s adherence. Improving the intensity of the exercise can be a key focus once the person has gained a little confidence and has shown some regularity in their training. It is recommended that a person suffering with depression should exercise 3-5 times a week, breaking down around 150 minutes of moderate exercise over that period. A great place to start would be to meet national guidelines and keep it nice and simple to build up a stable routine. This would breakdown into 5, 30 minute sessions. Exercises that use large muscle groups and contain continuous activity such as walking or cycling are recommended. It would be wise to keep the movements repetitive.
Resistance Exercise – Training muscular strength is a brilliant method for working on and improving confidence. Having said this, if a person is looking to improve their body image, or rather, the way they look, then endurance and hypertrophy training may be better suited. When training with resistance, the way in which it’s carried out will ultimately depend on an individual’s goals. Personally, I don’t think the aesthetic benefits of exercise should hold more sway than the physical health benefits. The reality is, physical image is subjective to the individual and observer, actual health isn’t.
Keep the resistance training simple and free from complex techniques. It’s good to feel a sense of achievement here and make sure that the person feels and sees that they are making progress. The exercises used may need to be adapted to suit any given conditions. It is recommended to train around 2-3 times per week, working with loads at around 50-70% of the person’s 1RM. 2 sets per exercise here would be ideal, with around 10-20 repetitions. Initially, sessions should be around 30 minutes long, working up to 60 minutes as the individual becomes grounded and regular in their routine. Full body workouts are ideal. This ensures that all major muscle groups are exercised regularly throughout the week. Just remember, make sure the exercises are easy to perform, and aim for around 8 exercises each session. If you are new to resistance training, get in touch with me to make sure you are doing the right exercises. No two programmes should be the same, especially if you are just copy and pasting from the internet.
Flexibility & Mobility Exercise – The reality here is that the science tells us that there are no obvious changes to be made to flexibility and mobility programmes when suffering from depression. These can be carried out safely in the same way as healthy populations. I would personally recommend positions that focus on relaxation and postural development.
Other Recommendations
Depression is a stand alone condition that doesn’t contain any inherent physical issues. Even so there are a few things to consider. If an individual is on medication for depression, it is important to know how that medication may alter the body’s physical capacity. The impact of anti-depressant medications can mean that the depression may present itself alongside other mental illnesses. Different medications may have altering effects on the body which will need to be noted when committing to regular exercise. Beta-blockers will suppress exercise heart rate and antidepressant drugs may contribute to weight gain, insomnia and dizziness. Anti-psychotic medications may accelerate dehydration and anti-anxiety medication could cause drowsiness.
If you are starting your own journey with exercise alongside depression, please feel free to get in touch. It is crucial to know that you are not on your own with this and that reaching out for help is perhaps the most important and hardest step of the process. Having someone to support you can help to alleviate any fears or doubts you may have in regard to exercise. It’s important to know you are able to work out in a safe and supportive environment.