It's important to note that exercise isn't being touted as a treatment for depression, but as something that may help people with sub-clinical symptoms. They have one or two symptoms of depression, but not the whole package.
> Low-intensity psychosocial interventions
> For people with persistent subthreshold depressive symptoms or mild to moderate depression, consider offering one or more of the following interventions, guided by the person's preference:
> individual guided self-help based on the principles of cognitive behavioural therapy (CBT)
NICE does not recommend exercise as a treatment for depression. This is because the evidence we have shows it does not work. It's not, as the author of the submitted article suggests, that we don't yet have good enough evidence.
Honestly I feel like you're splitting hairs here. You say that exercise is not a treatment, but at the same time say that exercise may help. Isn't a treatment something that may help? I get it, don't pretend that exercise is the magic pill that will work for everyone, especially for those at the more severe end of the depression spectrum. But, even the NICE guidance that you linked to suggests "taking regular physical exercise" (1.4.1.2) in mild to moderate depression.
People commonly use the term "depression" in a way that does not exactly match the true medical definition. People say "i'm depressed" when they should really say "i'm feeling sad today". People say exercise is a treatment, when they should say it makes them feel better. I fear your pursuit for the exact terms might prevent some people from trying a thing that would help them.
The reason is that different points on the "spectrum of depression" may be entirely different diseases.
For a hypothetical example, it would be entirely possible that people who are sub-clinically depressed turn out to be more-often-than-not lacking in dopamine (due to e.g. Seasonal Affective Disorder), where their depression is secondary to things like fatigue and lack of focus brought about by this. These people would do better with exercise or vitamin D or light therapy or a dose of Wellbutrin... but SSRIs or meditation or behavioral-activation therapy or other "things that help people who are clinically depressed" wouldn't help at all.
"Clinical depression" isn't a disease (= a particular mechanism that causes symptoms.) It is, instead, a syndrome—a name for a cluster of symptoms that get studied because we have no good tests to isolate a particular etiology (cause) in each case. Different etiologies have different best treatments.
Since we can't isolate the etiologies well enough to name them, we can at least refer to "sub-clinical depression", "clinical depression", "treatment-resistant depression", etc. as separate syndromes, such that—hopefully!—each one more closely corresponds with a particular etiology, and thus we can develop a line of treatment best suited to each.
> People in this thread are repeating the myth that exercise is a treatment for depression, when all the evidence we have shows that it probably isn't.
Thank you for clearly stating this.
Depression is not "Gee, I've been feeling tired and blue for a couple of days," but it is commonly confused with "short term, mild melancholy".
Depression is a serious illness and needs to be understood and treated as such.
Yea, I think people are confusing the effects of exercise in different cases. IMO there are really at least two groups here:
A) >= moderately athletic people with above average health and can sustain strenuous cardiovascular activity. For these people going out and exercising is a form of self actualization which IME is a pretty hard counter to depression. It's an "easy" way of being very good at something and that gives people some level of self worth. People on the upper end of this group are also competitive and tend to participate in teams or events that give them lots of social contact with like minded people which helps further.
B) The average non-athletic person sitting at home struggling with depression. They can try exercising and it might help but most of the time it's going to cause them to feel self conscious at the gym and worthless when they don't see any progress because they have no training or experience with how to work out (and most of the services claiming to provide such are garbage cash grabs). For these people it'll always be an uphill battle but from the point of view of people in A) they just look like they're not trying. In the end they go home feeling worse off than before because they didn't achieve anything and probably feel that it's yet another thing they can't do well or yet another failed attempt at self help. Even those that get some traction are a long way off from reaching that self actualization stage.
tl;dr exercise seems to be about maintaining a lack of depression rather than bootstrapping your way out of it.
Pumping the lymphatic channels, mostly. Because humans don't have https://en.wikipedia.org/wiki/Lymph_hearts, so we don't just naturally do that; we actually need to move around in order for our lymphatic system to maintain the pressure required for flow.
> how does that relate to the topic we're discussing
"Toxins" (metabolic waste and immune-system antibodies, mostly) cause tissue inflammation. Your body responds to systemic increases in inflammation by becoming depressed. Cleaning the wastes out of your body, in a way that decreases inflammation, will act to decrease depression.
Interesting—and true and well-studied—corollary: things that just suppress the inflammatory response to bodily toxins, are also antidepressant. NSAIDs (e.g. ibuprofen) are anti-depressant.
I keep wondering as I read more and experience more things if the cause of some depression is as simple as nothing to look forward to. Joining a club, taking up a hobby, visiting a church, learning a new skill, etc. all seem to help people with their condition. We're wired to connect and to hope and dream. For some people exercise does that but it just makes me tired and want to crash (even when I was in shape and playing football in school). It is a difficult issue and I worry with our technology induced isolation that it will worsen.
You routinely express obnoxiously bad psychiatric opinions on this website. What exactly is a "national expert adviser to the Mental Health Safety Improvement Programme"? Do you have a medical license? I'm betting my HN account you don't.
So many people (including doctors) seem to be set on the idea that serotonin makes you happy and therefore is the solution to depression. This is only half true, and not in the way that most think. Serotonin (if high) makes you numb [1]. But that might be the lesser of two evils when it comes to depression [2], which is why it’s become popular as a mechanism to treat it. It not a solution, it’s just masking the underlying problem by replacing one set of symptoms with another.
That is one alternative hypothesis. The reality may be even more complex than that. We don't really understand these brain systems and of course they're all tangled up in feedback loops with each other.
I do wonder though if it does make you numb if that isn't always bad. For some people depression might be related to an excess of sensitivity or some past trauma. Numbing that a bit might help them move past it and might be beneficial to their healing. Of course this might not be the case for people whose depression has some other source and it might not be the case for continuing treatment. It's possible that some people might benefit from taking certain drugs for a period of time but not forever.
It's all quite complex, individual, and not yet anywhere close to fully understood.
I think numbing might be useful if, for example, you’re currently incapable or illequiped to deal with whatever underlying thing is causing it, but its not a soltuion by itself, but rather a delaying tactic until the point when you can deal with or treat the issues.
This is one of those things that a lot of members of the public at large do not seem to know; they think that depression is defined as some sort of chemical imbalance in the brain, and it is not. Depression is defined in the DSM more or less as, being sad too often, except in cases of mourning etc. where people are often incredibly sad. It is literally defined as an overabundance of feeling.
This matters to me because I no longer have depression—I am “cured!”—because I am no longer too sad often enough to qualify for the diagnosis. I did not use medicine but developed better coping mechanisms. The cause of my depression is still around—my negative thoughts will on average trigger one or more additional negative thoughts until I am paralyzed with self-doubt and negativity. Indeed, and this is somewhat hard to explain to folks who have never had this problem, I will sometimes luxuriate in those negative emotions because they have a sort of familiarity or nostalgia, I spent so much time being so sad that it is sometimes desirable to feel unpleasant again. That sort of complicated “if you seek out sadness is it really sadness” type of question is 100% interesting and valid.
But I developed coping mechanisms to deal with those sorts of emotional overloads and recognize that they are happening and escape them, and I do not frequently return back to those unhealthy thought patterns. In that respect I am cured. The psychiatrists define depression so that that is what cured looks like: we have not necessarily addressed whatever the underlying cause is, but we have treated the symptoms.
So it is literally impossible to be depressed if you don't feel sad often enough; it is part of the definition. Anyone who says “oh I get really sad and maybe even suicidal, but I am not depressed” is making a nonclinical statement that would not be directly translatable as a clinical one.
Care to expand on the coping mechanisms you developed? Emotional regulation and stamping out rumination seems to be a wonderful life skill to develop across the entire board.
Sure, but my physicist training requires me to add the standard caveat about sample size of 1. Depression comes in many forms and what works for me and my form of depression may not work for yours. In addition there is some research that suggests that depressed people simply grow out of depression often enough; if you sent what I know now back in time to when my depression was worst there's not even a guarantee that it would have worked back then.
So there were two key developments that helped me personally.
The first was a unified theory of righteousness, manifested in five commitments I made to myself. They are commitments that I view as essential to a good or heroic life, they are interdependent and when they are in conflict they require wisdom to resolve the tension. They are commitments of love, honesty, ambition, compassion, and humility. So the idea that I had stable commitments started to anchor me: I was not totally worthless because I had understood the basic axioms for being heroic. So this is a core environmental change. I could go on and on about what each of these mean but it is perhaps not the right context or time for that just here.
The second major change was an adaptive change in crisis moments. I have a strange religious history where I started Catholic, became a fundamentalist, became an atheist, became a Buddhist, became a mystic Christian again. Somewhere in the atheist phase after fundamentalism I had started learning about Buddhism as part of a general interest in world religions and their models of heroism but before I had really started meeting Tibetan Buddhists in person. This introduced me to meditation, but that was not quite what I use: meditation is something of a constant attention-strengthening exercise, this is more of an acute stress response. The idea is that I simply try to sit still in the middle of these swirling negative emotions. My problem is that each negative thought causes, on average, more than one negative thought: this change in what I am paying attention to and how I am organizing my activity, takes that number less than 1. I would not say that it is fully zero. But the point is, that then my negative emotions behave more like others', they multiply a little bit but eventually peter out. So just by finding that eye of the storm, I can eventually gain control of my mind again.
Most "Clinical *" diagnoses are predicated on "causes problems for you or others", so probably not. Unless somebody else feels you're depressed and is really convincing.
> Definitely can speak to the exposure to light, and exercise ones.
100% agree - went for a bike ride yesterday for the first since September, I was beaming the entire ride. Forgot how nice it is to get outside the house and away from the computer.
I wrote about how lifting weights gives me a bit of a euphoric feeling, and biking does too. I love commuting by bike - I didn't realize how stressed I get commuting by car or bus in the morning until it was nice enough to bike and I got to work feeling great. I really need to live somewhere where it's possible to bike every day.
That should not necessarily be attributed to increasing serotonin though. Sunlight increases a lot of things - endorphins, hormones, nitric oxide, etc.
Let me offer a counter comment - going outside for a walk makes me more depressed. It's a quiet time that allows my mind to run wild and cause increased symptoms of depression.
Now I still do it but it's hardly a positive for me personally. Of course I'm not saying you're wrong for yourself - just that there are alternative viewpoints that should be put out there.
The way CBD interacts with your serotonergic system is very complicated. In short, there are many ways CBD may increase serotonin by activating the serotonin receptors but not causing re-uptake, thus increasing the amount of serotonin in the synapses.
CBD is a very interesting substance. My main gripe is that, to get antidepressant and anxiolytic effects, dosages are higher than what can conveniently (and affordably) be achieved with the strength of currently available drops/flowers on the market.
I used CBD for mental health a few years ago to great effect. This company https://hemp-market.eu/hemp-products/ was the only I found that made it affordable. Worth a look.
Tryptophan itself as a component of food is mentioned however, as well as tryptophan supplementation. I'd consider 5-htp and L-tryptophan to be under that "tryptophan supplementation" umbrella. The difference between 5htp and l-tryptophan is that the former doesn't require a transport molecule to get past the blood-brain barrier, so it [citation needed] converts to serotonin quicker, whereas with l-tryptophan there's a rate-limiting effect.
5-htp for faster effects,
L-tryptophan to prevent building a tolerance to the extra serotonin.
I have a seasonal depression diagnosis and lifting weights has been by far the best treatment for me. Meditation, light therapy, and vitamins/nootropics are all good on their own, they each sort of take away some of the symptoms, but I wouldn't say the depression isn't still there. But weightlifting is incredible. I feel amazing after a heavy session - deadlifting and benching especially give me a kind of euphoria. Gym fixes my lack of appetite, lack of social energy, disorganization, lack of motivation to work on my hobbies, work focus, anxiety, everything. I can't recommend lifting enough.
From the article, they mentioned that taking tryptophan or eating foods with tryptophan in them, reduces the uptake of tryptophan due to amino acid competition:
> There is competition between the various amino acids for the transport system, so after the ingestion of a meal containing protein, the rise in the plasma level of the other large neutral amino acids will prevent the rise in plasma tryptophan from increasing brain tryptophan
So possible OP took it on an empty stomach which spiked the levels in the body?
This is extremely common with niacin ingestion. If you look up a lot of pre-workout drinks (no xplode for a specific example) it's one of the most common complaints/mentions.
I haven't used it in forever but when I did sort of just got accustomed to being itchy until it wore off. I've read that it can cause liver issues, though. I just quit taking pwo's altogether.
The whole article highlights the effect of tryptophan as a serotonin precursor. Just pointing out that this might not be as novel as it seems. Also, 5-HTP is a naturally occurring amino acid classified as a food supplement, so not exactly a drug.
5-HTP is created by your body, from L-Tryptophan, which is an amino acid. Your body converts many micro-nutrients into various amino acids and hormones. Some vendors pre-convert these things so they are in a safer form to use. 5-HTP is much safer to consume than L-Tryptophan.
There is a risk of eosinophilia-myalgia syndrome (EMS). [1] There are pre-existing conditions that increase the risk of EMS that may not be evident, as liver / kidney damage is not apparent until it reaches near totality.
They are not suggesting a drug. 5-HTP is used by ravers to combat after effects of MDMA (Extasy), as MDMA depletes serotonin by releasing large amounts of it.
Surprisingly, a carbohydrate-only meal provides an immediate, drastic increase in serotonin biosynthesis. A high protein meal does not. And it's probably pretty irrelevant to clinical stuff because there have to be high protein meals in the past to get the effect.
The reasons are:
- Trp transport into CNS is rate limited by large neutral amino acid (LNAAt) transporter
- Trp has a lower affinity for LNAAt than other amino acids
- Trp, 5HTP, serotonin are strongly buffered by blood plasma proteins
So, with a high protein meal, the isoleucine, phenylalanine etc. are outcompeting typtophan at getting into the brain. With a low protein meal, insulin triggers uptake of amino acids into tissue (again, preferentially stuff that's not Trp), and Trp in blood is enriched as it dissociates from plasma proteins. Then the composition of blood amino acids is mostly Trp so it is taken up by brain tissue.
Do you know anything about how EGCG affects absorption of 5-HTP?
I've read in several places that 5-HTP is more effective when consumed with EGCG (green tea extract), but I'm not sure if this is just urban legend or if it has any real–world effects.
I have had problems sleeping for years, and used 5-HTP in the past. Like many things (e.g melatonin) I found it worked at first but doesn't seem to be anywhere near as effective as it used to be. Do you still find it effective after 4 years of use?
Do you take both, or would you mind explaining your dosage?
I see you've mentioned you seem to have developed a tolerance. Mind sharing more detail on the above such as how long you have been taking the above and the dosage used for each, as well as the notice of tolerance of each etc.?
> My guess is people with stress/gastro issues don't get the adequate serotonin for "normality".
If your gut has issues with absorbing fructose, then the free fructose seems to connect with tryptophan, which hinders the tryptophan from being absorbed.
Can you elaborate? This would be mindblowing. I have fructose malabsorption, and have had sleeping issues most of my life. Never occurred to me they could be related. Please say more.
One of the key findings is positive thinking can increase serotonin. “Self-induced changes in mood can influence serotonin synthesis.”
For those interested in a practical approach to positive thinking, check out “How Full is Your Bucket” by Tom Rath and Donald Clifton [1]. They discuss the 5:1 ratio of positive to negative interactions and how it’s the key to a happy relationship [2].
This type of article makes me realize how much a love the more and more used abstract section with a couple of lines of: Introduction, method, result and discussion.
Actually, this was tangentially addressed. It specifically mentions the fact that we are getting less bright light exposure today due to our increasingly indoor habits (versus historical contexts where humans typically worked outside more), as well as the decrease in physical activity due to the changing nature of work as well. Furthermore, it specifically highlighted the disconnect between physical labor and reward (it called it "effort-based rewards"), or in very crude terms, we run to run these days, instead of running to catch our meal.
There's certainly a good deal more to the topic you brought up as a whole, but those were a couple of interesting points from the article that I thought it addressed.
Those are reasons to want a serotonin hit, but they don't explain the huge cultural trend towards depression. Just look at 50 years ago. We were working in about the same way that we work today, in basically the same environments. Same amount of light, same lack of physical labor. How did we get more depressed in the same environment over such a short period of time?
It is believed that 50 years ago depression was less researched and therefore less diagnosed/recognised.
Also, social stigma of mental disorders was stronger and people generally kept quiet about it.
The bottom line is: it was always there, it's just that we talk about it more nowadays.
I thought the same thing, but the data does not support this view. See my other comment in this thread - if you look at the symptoms of depression/anxiety rather than specific diagnoses of it, the trends are pretty clear.
I really wanted to like that article but it does not exhibit sufficient scientific rigor. It's a little too dumbed down to be of value here, which is a shake since I think the underlying issue is quite real.
The article links to an old version of the NICE guidance. The new version of that is here: https://www.nice.org.uk/guidance/cg90
It's important to note that exercise isn't being touted as a treatment for depression, but as something that may help people with sub-clinical symptoms. They have one or two symptoms of depression, but not the whole package.
> Low-intensity psychosocial interventions
> For people with persistent subthreshold depressive symptoms or mild to moderate depression, consider offering one or more of the following interventions, guided by the person's preference:
> individual guided self-help based on the principles of cognitive behavioural therapy (CBT)
> computerised cognitive behavioural therapy (CCBT)[4]
> a structured group physical activity programme.
NICE does not recommend exercise as a treatment for depression. This is because the evidence we have shows it does not work. It's not, as the author of the submitted article suggests, that we don't yet have good enough evidence.