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Is anyone reading Johann Hari's new book on depression and anxiety?


mommymonster
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I recently bought Hari's new book, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions. Is anyone else reading it? I'm finding the book absolutely fascinating, but it is really challenging my inner "story" about depression/anxiety.  I can read a few pages and then I get frustrated, have to spend some times with the footnotes, have to process, and then can go onto the next few pages. I haven't finished the book (I'm about a third of the way through), but I'm interested to hear others' thoughts? 

 

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I have not read it yet but it looks interesting and I will add it to the books I will read. I did read recently in another book that the previous belief about serotonin or dopamine levels causing depression was not true. I do think for a lot of people it is caused by social disconnection. Some people may need meds but it is best if combined with other methods.

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I may take a look.  I always like seeing who reviews the books and it's an interesting selection of individuals giving it praise.  I'll leave it at that.  And then the first review I see on the page says, "At last something new that FEELS true." 

 

Do you think that the author's conclusions are based upon the *stories* he encountered (that the description calls "experiments") or the social science from experts he talked to (since he's not an expert other than also suffering from depression)?

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I haven't read it, but I did read the Amazon preview. It seems like a tremendous step backwards to me. You're not really depressed, you just need to exercise more! 

 

I'm not saying exercise and other variables have no bearing on anxiety and depression. I am saying that there is great potential harm is saying that people don't need medication, and in returning to the dismissive attitude that used to be so common. Giving people a sense of shame about taking antidepressants is a tremendous negative, and he seems quite gung-ho that medication is not needed and not useful. 

 

Also, his personal story seems quite dubious. 

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I haven't read it, but I did read the Amazon preview. It seems like a tremendous step backwards to me. You're not really depressed, you just need to exercise more!

 

I'm not saying exercise and other variables have no bearing on anxiety and depression. I am saying that there is great potential harm is saying that people don't need medication, and in returning to the dismissive attitude that used to be so common. Giving people a sense of shame about taking antidepressants is a tremendous negative, and he seems quite gung-ho that medication is not needed and not useful.

 

Also, his personal story seems quite dubious.

I have only read the first three chapters...

 

So far, his main claim is that the effectiveness of antidepressants as been misrepresented (mainly be pharmeceutical companies). He also has discussed the problems with diagnosis of depression. So far, nothing he has said is either new or scandalous.

 

He also has not said anything dismissive or negative towards those with depression or taking antidepressants.

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I haven't read it, but I did read the Amazon preview. It seems like a tremendous step backwards to me. You're not really depressed, you just need to exercise more! 

 

I'm not saying exercise and other variables have no bearing on anxiety and depression. I am saying that there is great potential harm is saying that people don't need medication, and in returning to the dismissive attitude that used to be so common. Giving people a sense of shame about taking antidepressants is a tremendous negative, and he seems quite gung-ho that medication is not needed and not useful. 

 

Also, his personal story seems quite dubious. 

 

I totally agree.

 

As far as the personal story . . . yowzer. You stated it very kindly. 

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I haven't read the book, but I did read an article on the subject that was either written by him or was a summary of his work.  As someone who has struggled with depression for most of my adult life, I am glad that someone is looking into the disconnect between what pharmaceutical companies have claimed all along and what many people experience.  I have long believed that antidepressants were never as effective as claimed by the so called research.  My experience has borne that out ... placebo effect in the beginning, but no lasting change and a decline, often worse than when I started.  On a couple of them, I experienced suicidal ideation that hadn't been there before.  But, no one ever believed me because that isn't what the literature (promoted by pharma repts) said.  They just said I needed a stronger dose (which led to the suicidal thoughts and plans that hadn't been there prior to taking meds.)  Therapy was so passe.  Writing a scrip took less time. 

 

I am not saying there aren't people who have been helped by SSRIs.  But, in their zeal to embrace a new "cure", many doctors shoved aside some proven methods to get to the bottom of the problem.  SSRIs were given alone instead of with complementary therapies that dealt with the entire problem ... social, situational, coping methods, destructive thought patterns, etc.  And exercise.  The hardest part of the "exercise" therapy is getting a depressed person to do it.  

 

I don't believe in throwing the baby out with the bathwater.  Meds can be helpful but they are not a cure-all.  Nonmedical therapies can be helpful, but they should not be used to shame or condemn people suffering depression as weak.  I think there needs to be room for both.  

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... And exercise. The hardest part of the "exercise" therapy is getting a depressed person to do it.

 

In his book Spark, John Ratey speaks of the effects of exercise on depression. One point he makes is that it is more successful for someone who initially engages in exercise in a group setting.

 

This has me wondering - do many psychiatrists (or other antidepressant-prescribing practitioners) have exercise equipment on site? So, like physical therapy, a patient could start with supervised exercise therapy in a gym like setting, but with scheduled appointment times for accountability? I realize a doctor will likely suggest joining a gym or something, but seriously, like you say, getting started can be the hardest part for someone struggling with depression. I wonder if exercise-as-medicine would be more successful if there were a high level of (affordable!!! or insurance-covered!!!) support in the initial phases to help build an effective habit of activity.

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Because it's cheaper. Meds are cheaper than therapy. So much cheaper.

 

Until we help people access therapy - decent, evidence based therapy - I don't think we should be shaming people for taking meds. (You didn't say that, obviously..just speaking generally).

Oh, we absolutely should not shame people.  But it is so validating to see that there is finally some acknowledgement that there are people like me, for whom meds are not only ineffective, but dangerous.  And that I truly NEED therapy.  Now if we could figure out a way to deal with the social disconnect and loneliness ... 

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My problem is while poo pooing one set of scientific studies as poorly constructed you can't promote another set of poorly constructed scientific studies. I suspect we are in the leeches and bloodletting stage of medicine where brain health is concerned. I suspect what works for each person may be individual and unique. I seldom trust anyone with "the" answer. Meds, counseling, exercise, gut health, meditation...sorting through it all trying to feel better would overwhelm someone who felt well, let alone depressed.

 

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I may take a look.  I always like seeing who reviews the books and it's an interesting selection of individuals giving it praise.  I'll leave it at that.  And then the first review I see on the page says, "At last something new that FEELS true." 

 

Do you think that the author's conclusions are based upon the *stories* he encountered (that the description calls "experiments") or the social science from experts he talked to (since he's not an expert other than also suffering from depression)?

 

So far he has used a combination of personal stories (his own and others) mixed with findings from social scientists.

 

I haven't read the book, but I did read an article on the subject that was either written by him or was a summary of his work.  As someone who has struggled with depression for most of my adult life, I am glad that someone is looking into the disconnect between what pharmaceutical companies have claimed all along and what many people experience.  I have long believed that antidepressants were never as effective as claimed by the so called research.  My experience has borne that out ... placebo effect in the beginning, but no lasting change and a decline, often worse than when I started.  On a couple of them, I experienced suicidal ideation that hadn't been there before.  But, no one ever believed me because that isn't what the literature (promoted by pharma repts) said.  They just said I needed a stronger dose (which led to the suicidal thoughts and plans that hadn't been there prior to taking meds.)  Therapy was so passe.  Writing a scrip took less time. 

 

I am not saying there aren't people who have been helped by SSRIs.  But, in their zeal to embrace a new "cure", many doctors shoved aside some proven methods to get to the bottom of the problem.  SSRIs were given alone instead of with complementary therapies that dealt with the entire problem ... social, situational, coping methods, destructive thought patterns, etc.  And exercise.  The hardest part of the "exercise" therapy is getting a depressed person to do it.  

 

I don't believe in throwing the baby out with the bathwater.  Meds can be helpful but they are not a cure-all.  Nonmedical therapies can be helpful, but they should not be used to shame or condemn people suffering depression as weak.  I think there needs to be room for both.  

 

I completely agree with everything you have written here. I was hoping he would have more to offer but really nothing I have read so far is new.

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This sounds like your standard "I'm a writer, how can I monetize my personal life" thing.
But it's not like he's a doctor revealing new information.  He's just synthesizing what we already know with the hook of his own personal story.

Maybe it'll help someone. I hope it does. But, I don't feel any special need to check it out.
However his other book, Chasing the Scream, looks interesting, and it also touches on pharmaceuticals (as part of the larger illegal drugs story).  Hmmmm.

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I watched an online talk with him last night. he emphasized that he is not against antidepressants at all but we need something more. We cannot ignore the social aspects of people's lives and that rises in depression in society are caused by loneliness and disconnectedness so the way to make people less depressed has to happen at a society level, not just an individual level. He told a nice story of a community that came together and how it made the people happier. I found nothing to disagree with in what he said. He also said that he was not really saying anything new or anything that was not intuitive to us all.

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I watched an online talk with him last night. he emphasized that he is not against antidepressants at all but we need something more. We cannot ignore the social aspects of people's lives and that rises in depression in society are caused by loneliness and disconnectedness so the way to make people less depressed has to happen at a society level, not just an individual level. He told a nice story of a community that came together and how it made the people happier. I found nothing to disagree with in what he said. He also said that he was not really saying anything new or anything that was not intuitive to us all.

 

I think that this is an element that is swept under the rug constantly.  Again and again research says that many kinds of depression are associated with lack of social supports, and the way we are choosing to structure our society.

 

There is some reason to think, for example, that postpartum depression - which does have a chemical-hormonal element - is almost entirely prevented by the right kind of community environment.  And yet I constantly see it being pointed to of an example of depression that is chemistry based and so requires a chemistry fix.

 

I think maybe that's a fallacy that a lot of people just accept - if it comes from brain chemistry, altering that with a drug is the solution.  But the reality of how the brain works is just more complex than that.

 

My sense here is that psychiatric care is kind of a machine, a lot of it pill based but even what isn't is based on a very mechanical sort of approach.  There is zero sense of connection to questions that I see as closely related like community walkability, community institutions, etc.  

 

And I find it odd that we accept that a healthy lifestyle can be preventative in other medical areas, but it seems to be a bit of a taboo to talk about depression that way, even though we are saying it too is of the body.

 

So generally I am in favour of books that get people talking about these things.

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Oh, we absolutely should not shame people.  But it is so validating to see that there is finally some acknowledgement that there are people like me, for whom meds are not only ineffective, but dangerous.  And that I truly NEED therapy.  Now if we could figure out a way to deal with the social disconnect and loneliness ... 

 

Have you gotten the genetic testing?  My dd has and it turned out that she can only be on really cheap old anti-depression meds.  She and my son looked like medication-resistant depressives but nobody tried them on the tryptillines.  All other types of anti-depressants either would not work or would cause dangerous side effects like you describe.  My dd has been on a very low dose of nortryptilline for a month now and she said it is helping some though not all the way.  But she is on 1/4 the normal dose for anti-depression.  So we are going to find a psychiatrist at her school or in the city her school is in to slowly titer her up.  I think we need to find an older psychiatrist so that he/she would be familiar with the drugs. 

 

But yes, yes, yes to what Sadie said.  We need research.  You all do know it is fairly recently (less than 50 years) that we have gotten out of Freudian psychiatric model.  ANd less than 20 years since we started finding genetic causes. 

 

I am not interested in reading his book.  I am not a depressive but what does he say about anxiety?  Because exercise does not help me at all with anxiety issues. 

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My experience of it with dd is that it is a machine, and one that doesn't work particularly well, because it's reactive, not proactive.

 

I wouldn't say that a healthy lifestyle is ignored though, at all. Sleep hygiene, exercise, social connection and behavioural change seem to be recommended all the time.

 

In two years of being in and out of hospitals as a support person, I'm yet to hear anyone say 'meds are the answer'.

 

It's just that there is little affordable support to initiate and continue those things. Whereas prescribing a med, taking a med, check ups for the meds - that's all relatively inexpensive, and takes very little time/energy. 

 

People with a moderate to severe depression need way better access to way better care than most can currently afford. 

 

I was thinking of prevention more than reaction, and on the level of society.  So, we might say we need to reduce pollution to help people with lung disease, so we need to talk about cars and public transport.

 

I don't seem to see similar discussions around mental health.  Though I guess we don't do much around pollution either, when it comes down to it.

 

On an individual level I have seen a lot of push back against people saying that things like exercise are important and effective - not medical people so much as ones who consider it to be shaming to point to things people can control.

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On an individual level I have seen a lot of push back against people saying that things like exercise are important and effective - not medical people so much as ones who consider it to be shaming to point to things people can control.

I’ve exercised regularly for the past thirty years (pretty much my entire adult life). I’ve also had a few episodes of anxiety that required medication. When I “push back†on the notion that exercise is helpful I do so based on my own personal experience. I never found it one bit of use in making me feel better when I was in the midst of an anxiety episode. Now maybe it kept me from feeling even worse. That would be difficult/impossible to judge. But from personal experience I sure couldn’t recommend it as being helpful at all. Although of course it’s a “can’t hurt†thing as long as one doesn’t put a guilt trip on the person with anxiety or depression to cure themselves. I think way too many people tend to do that. And often they’re people who have no direct experience.

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I’ve exercised regularly for the past thirty years (pretty much my entire adult life). I’ve also had a few episodes of anxiety that required medication. When I “push back†on the notion that exercise is helpful I do so based on my own personal experience. I never found it one bit of use in making me feel better when I was in the midst of an anxiety episode. Now maybe it kept me from feeling even worse. That would be difficult/impossible to judge. But from personal experience I sure couldn’t recommend it as being helpful at all. Although of course it’s a “can’t hurt†thing as long as one doesn’t put a guilt trip on the person with anxiety or depression to cure themselves. I think way too many people tend to do that. And often they’re people who have no direct experience.

I would be surprised that anyone with any experience with anxiety in themselves or close family/friends would suggest exercise in the midst of an attack. However someone close to me does struggle greatly with anxiety and regular exercise does cut down greatly on the frequency AND severity of the attacks. It is marked enough that daily exercise is simply not an option to skip.

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I’ve exercised regularly for the past thirty years (pretty much my entire adult life). I’ve also had a few episodes of anxiety that required medication. When I “push back†on the notion that exercise is helpful I do so based on my own personal experience. I never found it one bit of use in making me feel better when I was in the midst of an anxiety episode. Now maybe it kept me from feeling even worse. That would be difficult/impossible to judge. But from personal experience I sure couldn’t recommend it as being helpful at all. Although of course it’s a “can’t hurt†thing as long as one doesn’t put a guilt trip on the person with anxiety or depression to cure themselves. I think way too many people tend to do that. And often they’re people who have no direct experience.

Exercise is a huge piece of my anxiety-management protocol, but it’s something I use to reduce chronic anxiety. I’ve never used it to treat an acute attack. For those, I have meds and really awesome friends who let me leave long voicemail messages to talk myself down (back when the panic attaches were more intense and unmanagable, I did not leave long voicemails...I was lucky if I remembered that I HAD meds).

Anyway, my point is: exercise helps me reduce my baseline level of anxiety. If I slack on exercise for a few weeks, my anxiety gets worse.

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I watched an online talk with him last night. he emphasized that he is not against antidepressants at all but we need something more. We cannot ignore the social aspects of people's lives and that rises in depression in society are caused by loneliness and disconnectedness so the way to make people less depressed has to happen at a society level, not just an individual level. He told a nice story of a community that came together and how it made the people happier. I found nothing to disagree with in what he said. He also said that he was not really saying anything new or anything that was not intuitive to us all.

Thanks. That is what it looked like it would be about.

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And I find it odd that we accept that a healthy lifestyle can be preventative in other medical areas, but it seems to be a bit of a taboo to talk about depression that way, even though we are saying it too is of the body.

 

So generally I am in favour of books that get people talking about these things.

 

I think I'm going to get the book. Since moving here (this is our fourth winter), I've suffered from seasonal depression. The first year I didn't even know what was going on - I just thought I was really homesick. The third year was the absolute worst and I ended up on anti-depressants and those made it much, much worse. It was so bad that dh was suggesting I go live on the other side of the country (where we have family) from January to April. 

 

I spent pretty much all of the summer and fall trying to figure out how I was going to avoid seasonal depression this year. I think exercise is a big part of it, even though I have been exercising regularly since I moved here. The first year I was in a TRX class at the gym three times a week, the second year I'd added running three times a week. This year, I'm working out with a private trainer twice a week doing heavy lifting and I run with a training group three times a week. I am enjoying the social part of it as well - I don't make friends easily, so having an excuse to sit and have coffee with the group after our weekend long runs is really nice.

 

Besides exercise, I've basically thrown everything I can at seasonal depression - saw a naturopath and am taking supplements, have regular acupuncture, am working towards personal goals, make a point of doing some sort of fun out of the house thing each week with someone else, journalling. So far, I've been really happy - I feel like my normal self. I'm still terrified that I could slip down into it again - I find it so baffling that I can logically be grateful for my life and also find living it unbearable all at the same time. 

 

So I'm not sure if it's the combination of what I'm doing or if there's one particular thing that is making the biggest difference, but I know that the pills I took last year sure didn't do me any favours. I'd be interested in reading anything that helps me figure out what I can do to try and avoid seasonal depression.

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I would be surprised that anyone with any experience with anxiety in themselves or close family/friends would suggest exercise in the midst of an attack. However someone close to me does struggle greatly with anxiety and regular exercise does cut down greatly on the frequency AND severity of the attacks. It is marked enough that daily exercise is simply not an option to skip.

 

 

Exercise is a huge piece of my anxiety-management protocol, but it’s something I use to reduce chronic anxiety. I’ve never used it to treat an acute attack. For those, I have meds and really awesome friends who let me leave long voicemail messages to talk myself down (back when the panic attaches were more intense and unmanagable, I did not leave long voicemails...I was lucky if I remembered that I HAD meds).

Anyway, my point is: exercise helps me reduce my baseline level of anxiety. If I slack on exercise for a few weeks, my anxiety gets worse.

 

 

To clarify -- I wasn't referring to a panic attack. That's why I said "episode" and not "attack." I don't believe I've ever had an anxiety attack, so I wouldn't attempt to posit what might or might not help with that. My anxiety is chronic--always there, a seemingly integral part of me, but it behaves itself at a tolerable (to me) level unless/until a stressful life event exacerbates it. Those are the times I've needed to go on medication (which has been wonderfully, miraculously helpful). I was exercising regularly before, during and after each episode. From what I could tell exercise did nothing to head it off or minimize it.

 

My "beef" here is that the premise some posters seem to be pushing or at least subtly implying is that medication doesn't help everyone, but exercise does (or should). I don't buy that. 

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Probably because there are many factors impacting an individual's ability to exercise, from access to cost to pre-existing conditions.

 

No, I don't think that's it.  

 

I think they feel that if you put certain things, even potentially, within the control of the individual, you are essentially blaming people for their mental illness.  They feel that b making it something completely objective, that will reduce stigma against mental illness.

 

Of course in reality it is far more nuanced than that, especially since the illness itself often works against self-care.  But I think it's crazy to go to the extent of essentially denying that the kinds of things an be really important are helpful, and on the other hand over-estimating the extent to which meds can help.

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I think I'm going to get the book. Since moving here (this is our fourth winter), I've suffered from seasonal depression. The first year I didn't even know what was going on - I just thought I was really homesick. The third year was the absolute worst and I ended up on anti-depressants and those made it much, much worse. It was so bad that dh was suggesting I go live on the other side of the country (where we have family) from January to April. 

 

I spent pretty much all of the summer and fall trying to figure out how I was going to avoid seasonal depression this year. I think exercise is a big part of it, even though I have been exercising regularly since I moved here. The first year I was in a TRX class at the gym three times a week, the second year I'd added running three times a week. This year, I'm working out with a private trainer twice a week doing heavy lifting and I run with a training group three times a week. I am enjoying the social part of it as well - I don't make friends easily, so having an excuse to sit and have coffee with the group after our weekend long runs is really nice.

 

Besides exercise, I've basically thrown everything I can at seasonal depression - saw a naturopath and am taking supplements, have regular acupuncture, am working towards personal goals, make a point of doing some sort of fun out of the house thing each week with someone else, journalling. So far, I've been really happy - I feel like my normal self. I'm still terrified that I could slip down into it again - I find it so baffling that I can logically be grateful for my life and also find living it unbearable all at the same time. 

 

So I'm not sure if it's the combination of what I'm doing or if there's one particular thing that is making the biggest difference, but I know that the pills I took last year sure didn't do me any favours. I'd be interested in reading anything that helps me figure out what I can do to try and avoid seasonal depression.

 

Have you tried light therapy?  It seems to help some people quite a lot.

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I'll second this idea. I'm in the PNW and I find light therapy very helpful. I'm sitting in front of my light right now. :)

 

Thirding this, and also mentioning that you need to get a strong light. My psychiatrist said at least 10,000 LUX. 

 

Speaking of whom... I think he's definitely the type of doctor the author of this book is talking about regarding meds. I've been seeing him for around 7 years, and have tried every drug under the sun, with varying degrees of effectiveness and ridiculous side effects. And never once did he suggest therapy to me. He suggested the light box for my suspected SAD, and sort of off-handedly mentioned exercised a few times, but that was it. He's all about the meds, and when we ran out of options, he pushed MAOIs (which would eliminate 90% of my diet, and have no guarantee), but had no other suggestions. That's when I sought out therapy on my own, and it's been helpful, and we're working on those "other things"- diet, exercise, social engagement. 

 

I was diagnosed with depression and anxiety in college. I went to a therapist for about three months, and she right away sent me to a psychiatrist who put me on meds. The meds helped immensely, and eventually I was coming into therapy going, "I have nothing to talk about really, I'm feeling good." So my therapist said that's wonderful, and sent me on my way. No talk about scaling down the meds and continuing work with her, or other life changes I should make. It was more like, "the meds are the solution, so we're done here." 

 

The therapist I'm seeing now is the first person I've seen about my mental health who seems interested in pursuing options or solutions other than meds. So reading the article the author wrote that was making the rounds recently, really resonated with me. I totally saw where he was coming from, and it was helpful/hopeful for me to read. 

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I haven't come across this. Must be regional. Doctors here bend over backwards to insist that meds are not the answer and lifestyle changes need to happen in addition.

 

Probably.  Though I am not thinking about doctors so much as some advocates.  I've not seen it among doctors.  I have seen them be basically chemistry tinkerers, but I think that is a different kind of attitude.

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I recently bought Hari's new book, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions. Is anyone else reading it? I'm finding the book absolutely fascinating, but it is really challenging my inner "story" about depression/anxiety. I can read a few pages and then I get frustrated, have to spend some times with the footnotes, have to process, and then can go onto the next few pages. I haven't finished the book (I'm about a third of the way through), but I'm interested to hear others' thoughts?

Did you finish the book? Ive finally finished.

 

It was a difficult read. The last third of the book (for those who havent read it) is about societal changes that need to be made to improve mental health states. There is some personal change but mainly it came across as an argument for cooperative work environments and universal income. It looked more like he was trying to convince someone of his political stance than cure depression. Because of that, I became more leery of his research.

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In his book Spark, John Ratey speaks of the effects of exercise on depression. One point he makes is that it is more successful for someone who initially engages in exercise in a group setting.

 

This has me wondering - do many psychiatrists (or other antidepressant-prescribing practitioners) have exercise equipment on site? So, like physical therapy, a patient could start with supervised exercise therapy in a gym like setting, but with scheduled appointment times for accountability? I realize a doctor will likely suggest joining a gym or something, but seriously, like you say, getting started can be the hardest part for someone struggling with depression. I wonder if exercise-as-medicine would be more successful if there were a high level of (affordable!!! or insurance-covered!!!) support in the initial phases to help build an effective habit of activity.

 

I've seen this concept touched on in the fitness certification world.  I think it would have great potential if insurance companies would get in on it.  Many of them do already offer gym membership incentives/discounts, but the accountability factor could have amazing potential.

 

That said, I would want trainers in that situation to have some sort of psych training, or the psych/therapist to have some sort of fitness certification.  The fitness industry already borders on anything goes. I've met plenty of trainers who could make things a heck of a lot worse instead of better.

 

I say that as someone whose mental health IS greatly improved by regular, intense exercise.  Nowhere close to 100%, though.

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Someone said something on another thread about there being blood tests for which meds to prescribe. Why isn't that more widely available! Again, you'd think it would be cheaper to do that.

Yes, could someone give a link with more information about the type of test or how to request one? I really need this for one of my kids.

 

 

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In his book Spark, John Ratey speaks of the effects of exercise on depression. One point he makes is that it is more successful for someone who initially engages in exercise in a group setting.

 

I wonder if this has something to do with linking to the community? I know that one of the reasons I go to yoga class (even though it's inconvenient) is because I feel I get so much more out of the class (emotionally/mentally) than I do doing yoga at home with a video. 

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