The Real Happy Pill Page 9

  Counteract the din with exercise

  Today, we produce as much digital information over two days as we’ve done in the entire history of humanity up to the year 2003. We are drowning in the data generated from our computers and smartphones, a stream that doesn’t appear to be slowing down anytime soon. Meanwhile, our brain, which we expect to handle this incredible overload of information, has hardly changed at all the in past several thousands of years.

  It isn’t particularly surprising that our concentration wanes occasionally and that we need all the help we can get to accommodate this flow of information. The knee-jerk response to this issue cannot just consist of more diagnoses and more prescription medication. We should also look at our lifestyle and see what changes we can make to improve our concentration.

  Research clearly indicates that what truly puts our extra “mental concentration” gear to work is physical exercise, not diet supplements or apps with cognitive exercises. Physical activity makes us better equipped to meet a world that looks less and less like the one we evolved for. It’s in this light that you should look at training and its effects on concentration. I hope that this chapter has helped you realize—whether you’re suffering from ADHD or not, whether you’re a kid or an adult—what good movement can do for your ability to focus.

  TOO MUCH COUCH-SURFING IS DETRIMENTAL TO YOUR THINKING

  You have probably seen the headlines about how spending a lot of time sitting can increase your risk of acquiring a whole host of illnesses. In fact, physical inactivity has even worse consequences: you’ll think more slowly and poorly. American scientists followed just over 3,200 young Americans for twenty-five years, during which time information was recorded about how physically active they were and how much time they spent in front of the television. In addition, different psychological tests were performed to gauge their memory, concentration skills, and cognitive processing speed (i.e., how quickly they could think).

  The tests clearly indicated that the test subjects who were sedentary had inferior powers of concentration and memory. They also thought more slowly. The difference was huge. The results from subjects who sat for long periods of time and watched TV for at least three hours a day were especially lousy. The expression “boob tube” is indeed very meaningful!

  Much of this book is about the immediate effects exercise has on your brain, but in this case the results were very gradual, since the individuals were followed over a period of twenty-five years. It shows how important physical activity is for our mental abilities, even over the long haul. Being sedentary too much not only makes you unfocused, anxious, and depressed; it also makes you think slower because it impairs your cognitive skills.

  Exercise and physical training help ADHD sufferers to concentrate—and it works for the rest of us, too. We are, after all, all perched somewhere along the ADHD spectrum.

  THE RIGHT PRESCRIPTION FOR IMPROVED CONCENTRATION

  Go for a run instead of taking a walk. If you move more strenuously, your brain will release more dopamine and noradrenaline. Ideally, your heart rate should reach 70 to 75 percent of its maximum capacity. If you’re forty, that translates to a reading of 130 to 140 bpm. If you’re fifty years old, your reading should be at least 125.

  Exercise in the morning. To target concentration, it’s better to work out early in the day, or at least before noon, to let the effects last through the remainder of the day. The effect will taper off after a few hours, and most of us need to focus during the day, not in the evening.

  Train for thirty minutes if you can. You should be active for at least twenty minutes, but thirty minutes is better to enjoy the full benefits.

  Keep up the workouts! It takes a while for the effects of exercise on concentration (as well as on stress and general well-being) to take place, so don’t give up! You must be patient to reap these rewards.

  4. THE REAL HAPPY PILL

  If you are in a bad mood, go for a walk. If you are still in a bad mood, go for another walk.

  HIPPOCRATES

  One November evening a few years ago, a colleague at the hospital’s emergency department where I worked asked me to see a woman in her forties. I was given a brief history, which only contained a few sentences: “Previously healthy woman. Extremely fatigued for the past twenty-four hours. Tests and CT (Computed Tomography)—also CAT—scan normal. Depression?”

  The woman told me that she was feeling overwhelmingly tired that day. She was convinced that she had contracted some unusual disease and refused to believe that the results of all the tests recently performed on her had come back normal. “You must have missed something,” she said. At first, she didn’t understand what I was getting at when I asked what her life had been like recently, but then she explained that the past year had been very demanding. She was unhappy at work because her workload had not only increased, but her tasks had also become less and less clear. She and her husband had also bought a house, which they were in the process of renovating. That she had a lot on her plate, professionally and personally, was nothing new. This was the normal run of things for her, and it had never affected her before.

  This fall, however, everything was different. She felt increasingly more exhausted. She became more and more withdrawn and didn’t bother to keep up with friends. She used to enjoy horseback riding—she had ridden competitively—and reading, but she had not been to the stables in over a year and could hardly remember the last time she cracked open a book. The urge wasn’t there anymore, and she couldn’t focus long enough to read.

  That morning when she woke up, she could hardly get out of bed. It was as if she had become paralyzed by her lethargy, and eventually her husband brought her to the emergency room. My colleague, who first saw her, thought it might be an infection, but the blood tests were clear. Even a CT scan of the patient’s brain was completely normal and didn’t reveal anything suspect. The woman hesitated when my colleague suggested that she meet with a psychiatrist. After all, what she was suffering from was physical! Besides, she had never had any mental problems in her life.

  This woman suffered from depression, not from some obscure malady that the physicians had missed. Once she realized this, she asked me how it could be treated. I explained that she had to slow down her commitments a little bit, maybe even take some time off work or work fewer hours, and that we could give antidepression medication a try. There was also therapy. Her mother had taken antidepressants but they had undesirable side effects, so the patient didn’t want to take any pills; she was also hesitant about therapy. Was there anything else she could do? I explained that exercise had the same impact on depression as medication, but it would require that she take up running for at least thirty minutes at a time, and preferably three times a week. It would take several weeks to take effect, but once it did, the outcome would be on par with that of antidepressants.

  In her case, running three times a week was not a realistic goal, so we decided that she should start off with regular walks. She only managed ten-minute increments in the first few days, but gradually the walks got longer, and then faster. She was still tired when I met her at the hospital three weeks later, but she did have the energy to jog slowly, fifteen minutes at a time.

  As the weeks went by, my patient upped her efforts. Four months after her initial visit to the ER, she was running three times a week, often close to an hour at a time. The transformation in her well-being was remarkable! She explained that she not only felt and slept better but also functioned better all around. Her short-term memory and concentration had improved. Her anxiety over trivialities was gone, and she didn’t overreact as much to stress, whether work-related or at home. She had resumed horseback riding and reconnected with her friends. In addition, she had dealt with her situation at work and gotten clearer instructions on what was expected of her. According to her family, the difference was striking—“Mom is back.”

  What made her especially happy was that she herself had set in motion these changes by getting ou
t there on the running trail. It took a Herculean effort at the beginning, but it became easier after a while. As this was due to her very own efforts, it did wonders for her self-esteem.

  ONLY SICK AND EXHAUSTED, OR DEPRESSED?

  Most of us will feel down and glum at one time or another. However, you are depressed if you are sad week after week, feel despondent when thinking about the future, and no longer find contentment in participating in the activities you typically enjoyed. How depression expresses itself varies from person to person: some feel so exhausted that they can hardly get out of bed in the morning, while others feel so anxious that they can’t sleep at night. Some lose their appetite and weight falls off them, while others become hungry and quickly put on weight. There are many types of depression, but they all have as common denominator the enormous suffering they cause in those who are afflicted by it.

  Today, almost everyone knows that you can treat depression with medication. Many are also aware that exercise is good for one’s well-being, but most don’t know just how big an impact it has, and that training is, in and of itself, an antidepressant. It is a medication without any side effects and that in most cases makes everyone feel better—whether you just feel a bit blue or you’re in the grip of a deep depression.

  Training is, in and of itself, an antidepressant. It is medication without any side effects, which in most cases makes everyone feel better.

  Training works on all types of depressions

  It’s often challenging to properly define what constitutes depression; many of us can feel out of sorts for a while without being depressed. A list of nine criteria is used to diagnose depression: exhibiting a depressed or irritable mood; losing interest in things that used to be fun; inability to sleep well at night or sleeping too much; restlessness or an inability to sit still; fatigue and loss of energy; feeling worthless or guilty; having trouble concentrating; losing or gaining a lot of weight; and having recurring thoughts about death or suicide. At least five of those nine conditions should be met in order to diagnose depression. But what if you only check four of the criteria on the list? You may feel completely worthless, and everything seems futile. Your appetite is almost gone, and your sleep is lousy. It’s obvious you’re not feeling well, but it is not, clinically speaking, depression. This example illustrates the fact that psychiatry is not an exact science. Basically, these are all subjective experiences. Neither blood tests nor x-rays can tell if you’re depressed or not. We use these checklists (which you can find online) in the psychiatric profession for lack of a better method, and they should be considered a means of help and not the absolute truth. Like ADHD, depression is a large gray zone.

  If we prescribe an antidepressant to someone who is not suffering from depression, the medication typically has no effect. However, the effects of exercise are measurable, even for people who are simply down in the dumps and not miserable enough to be diagnosed with depression. Regardless of the level of depression, training makes everyone feel better, as the negative thoughts ebb away and self-esteem gets a boost.

  Many of my patients are surprised when I tell them that running has the same effect as antidepressants, since few have heard of this. It’s normal to wonder why so many don’t know that regular runs can be just as effective as pharmaceuticals in the fight against depression. Most seem to harbor the belief that “if it were true, wouldn’t everyone know about this already?” The reason for this widespread ignorance is very simple—it boils down to money.

  PROZAC VERSUS TRAINING

  On December 29, 1987, the powerful American government agency, the Food and Drug Administration (the FDA), decided to approve the sale of the medication Fluoxetine, making it the first new type of antidepressant available in the United States in almost two decades. This pharmaceutical became an enormous success even though it was introduced at a time when many still weren’t convinced that depression had biological roots, or even that it originated in the brain. Fluoxetine was marketed under the name Prozac, and in short order it became not only one of the most widely sold drugs in the world, but also one of its best-known brands ever.

  Thousands of articles and several books, among them the cult memoir Prozac Nation, were written about this new pill. The rapper Jay-Z sang about it, and even the character Tony Soprano, of TV’s The Sopranos fame, was on Prozac.

  Fluoxetine prevents brain cells from reabsorbing serotonin, thereby increasing the amount of active serotonin that is still available between the brain cells. Fluoxetine belongs to a group of pharmaceuticals called selective serotonin reuptake inhibitors (SSRIs). Within just a few years, several similar drugs were released in the marketplace, and they all became hugely successful and were taken by millions of people all over the world. But as sales skyrocketed, it became obvious that about one-third of the users saw no effects, and another third experienced only limited relief—even though they felt better, they were still depressed. Many users experienced side effects such as sleep disturbances, dry mouth, nausea, and low libido. Some of the side effects were only temporary, but they were still unpleasant enough that some people stopped taking the medication before it had time to become effective.

  Doctors, scientists, and not least those who suffered from depression, began to wonder if there were other treatment options that didn’t involve pharmaceuticals. It’s not surprising that they chose to look into physical activity. As early as 1905, the psychiatric journal The American Journal of Insanity—a title that would not cut the mustard today—published a scientific article about the connection between exercise and how we feel.

  At the end of 1980, we began to systematically compare the effect of training to that of medication on depression. The objective was to find out whether training could provide the same effects as pharmaceuticals.

  Naturally, this research was not funded by pharmaceutical companies—businesses that would have had no commercial interest in seeing if training could cure depression—but by medical schools. This explains why the studies’ budgets were a great deal smaller than the budgets provided by pharmacies when a new pharmaceutical is under development.

  A breakthrough happened when American psychologist James Blumenthal gathered 156 individuals—a large group, given the field—who all suffered from depression. Blumenthal randomly assigned the subjects to three different groups. One group was given Zoloft, one of the most widely prescribed antidepressant drugs. Another group exercised for thirty minutes, three times a week. The last group both exercised and took the medication.

  Four months later, it was time to check the results. It was found that most of the test subjects felt so much better that they couldn’t be considered as being depressed anymore. The most important outcome of all was that just as many participants in the exercise group got better as those in the group that took Zoloft. In other words, regular physical activity turned out to be as effective as pharmaceuticals in the treatment of depression.

  Regular training is as effective as pharmaceuticals for treating depression.

  Exercise is healthier over the long term

  Despite his study’s sensational results, Blumenthal didn’t rest on his laurels. He decided to keep track of his test subjects a little more to see if the positive effects of exercise lasted longer than four months. That makes sense, since one emerges from depression in a fragile state, often without realizing it—many feel great and believe that everything is back to normal, even though it’s easy to sink back into depression. The ice under our feet is much thinner than we think.

  As it happens, fascinating observations were made at a check-in with the people from the three groups six months later. During that time, the participants were not assigned to groups but could choose for themselves what they wanted to do. Some opted for exercise, others chose therapy sessions, and some took medication. Who fared better? Well, those who exercised appeared to be the least likely to relapse: less than one in ten, or 8 percent of the group, became depressed again over that six-month period. On the other hand,
the rate of depression in the group who took medication was more than one in three, or 38 percent of the group. Thus, exercise didn’t merely provide the same shield against depression as medication; it offered stronger protection than medication.

  That going for a run should reveal itself to be as effective as a best-selling antidepressant pill, which costs billions to develop, seemed almost too good to be true. Is it indeed the case that exercise produces even better results in overcoming depression, over the long term, than medication? Yes, this is exactly what the tests proved. The results were nothing less than astonishing and were, of course, reported on in the papers, but did they garner the same media exposure as the antidepressant medication? No, they got nowhere near the same level of attention.

  Billions of dollars have been spent on the marketing of antidepressant pharmaceuticals. In contrast, how much has been spent on spreading the word about how training has the same effect? In all likelihood, very few dollars. Of course, there aren’t the same inherent commercial opportunities in that type of information. No one is interested in touting physical activity as widely as a pill that can bring in a lot of money, especially when pharmaceutical marketing budgets are pretty much unlimited. This is why so many people don’t know the amazing effect training has on depression.

  More proof of the benefits of exercise

  Blumenthal’s results aren’t unique. Recently, some scientists decided to compile the papers they could find on exercise that is used in the treatment of depression. There were hundreds of scientific studies from the 1980s onward, from which they selected the top thirty. As many as twenty-five of those studies showed that training provides protection from depression. It’s unusual to find such a large set of positive results in these situations. It looks like research has finally caught up and shown in black and white that exercise is an excellent means to treat depression. Even though running seems to produce the best outcome, the compendium of papers indicated that even walking is helpful in preventing it. As little as a twenty- to thirty-minute daily walk can stave off depression and make you feel better!