Atlantic Promotes Exercise Instead of Anti-Depressants, But Why Not Both?

The Atlantic posted an article by Olga Khazan about treatments for depression. The subheading sums up the argument: “Aerobic activity has shown to be an effective treatment for many forms of depression. So why are so many people still on antidepressants?” Or as Khazan asks a few paragraphs down, “After 15 years of research on the depression-relieving effects of exercise, why are there still so many people on pills?”

Khazan is absolutely right about “the depression-relieving effects of exercise”. Any good program for combatting depression must include lifestyle habits: exercising regularly, eating healthy, cutting back or eliminating alcohol, improving sleep patterns.

Exercise is especially effective because it reinforces other good habits. Regular exercise makes you more likely to achieve deep, uninterrupted sleep at night and less likely to feel lethargic and sleepy during the day.

My major disagreement is the “either/or” frame Khazan sets up. Depression sufferers should treat their condition with either exercise or anti-depressant drugs. Why? Why not both?

The best approach to depression includes three prongs: anti-depressant drugs, cognitive therapy and lifestyle habits. These are not mutually exclusive, rather they’re complementary. There’s absolutely no reason not to combine all three, now and for the long haul.

Why exactly should not taking medicine be considered such a positive? Khazan is not alone in this underlying bias. Many popular writers on depression presume that taking anti-depressant drugs is a moral failing, that trying to beat depression without medication is more noble, that taking medication is a crutch only lazy or weak people would use. This presumption makes me furious. It’s a moral judgment masquerading as science, and it’s completely wrong-headed.

Depression is one of many afflictions rooted in a combination of genetic predisposition and modern lifestyle factors. Diabetes and heart disease are other examples. In each case, medicine and lifestyle changes can both have positive effects. But the rhetoric surrounding those other conditions rarely involves a strict either/or debate. You rarely hear complaints that diabetes sufferers should try to treat their condition through lifestyle changes alone, that taking insulin is a moral failing. So why is this view so common in discussions of depression?

People suffering from depression are especially prone to irrational feelings of guilt, shame and inadequacy. Telling them they should feel ashamed of taking medication to alleviate their suffering is cruel and irresponsible.

If you’re taking an anti-depressant drug but not cultivating healthy lifestyle habits, then by all means, start making some changes. Cut back on junk food, get more fruit and veggies into your diet. Start exercising, find something you enjoy enough to stick with (yoga, weightlifting, cardio machines, jogging, swimming, whatever works for you). Take steps to improve your sleep patterns. But …

… there’s no reason to think of these changes as instead of taking anti-depressants. Cultivating healthy habits will ease depression and improve your quality of life in addition to other forms of treatment. Maybe someday you’ll feel capable of quitting anti-depressants. Or maybe you’ll need to take anti-depressants for the rest of your life. But whatever works for you, there’s nothing inherently wrong about taking medication and you shouldn’t feel ashamed of it.

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