During an event-related bout of depression I experienced some years ago, my motivation was extremely low. I didn't leave the house for extended periods. At that point exercise helped me overcome my mental state and made me feel better in most aspects of my life. Indeed, consistent running not only improves mood and self-esteem, but it can also help maintain mental health and treat depression. One year ago, Lauren Robinson lost her second pregnancy and soon fell into a depressed state:

“It was just too much for me and I completely lost my way. On the 9th of February 2019, I decided to put on a pair of running shoes. Today I’m proud to say that I ran myself out of an extremely dark tunnel. I later managed to cross the Cape Town marathon finish line in September. My journey this year has changed my life. I owe it all to running”.

On a nationwide scale, depression affects just over 25% of people in rural and urban settings. I was curious to hear stories on treating depression with running, so I posted the question to South African fitness groups Cape Town Runners Community and SleekGeek Health Revolution. I didn’t expect a big response given the stigma and taboo surrounding mental health talk. To the contrary, the feedback was huge. I was surprised by a long thread of moving stories, and pleased by how openly people spoke about it. Many members gave success stories, several names and organisations were tagged, and more people contacted me privately. While many people vouch for treating depression with running, the method has only gained scientific credibility in the past decade.

Running Therapy

The saying "Sound Mind, Sound Body" rings true. After running, your body releases a cascade of feel-good chemicals called endorphins that give rise to the so called “runner’s high” (and your running post on Instagram). While one run makes you feel better immediately, consistent running can be an antidepressant. Indeed, research shows that repeated aerobic exercise is just as effective at treating mild to moderate depression when compared to drugs and psychotherapy. Aerobic exercise includes running, and any strength training that gets your heart rate up over extended periods of time (e.g., cross fit, cardio, etc.). Interestingly, this form of exercise can improve rehabilitation for those already taking antidepressants. These findings come from two powerful scientific reviews, including a recent meta-analysis and a subsequent meta-analysis on a younger group. 

How Depression Manifests

On the outside, depression is characterised by symptoms including sadness, discouragement, irritability, disturbed sleep and appetite, feeling helpless, low energy, and the tendency to stay indoors and avoid social interactions. On the inside, a depressed person’s brain may show lowered hippocampus volume, and altered levels of serotonin and noradrenaline. While there is some truth that there is a chemical imbalance at play, depression can spring from other sources such as genetic predispositions, and poor mood regulation by the brain. That’s not to say that chemicals aren’t involved in the process, but rather that there are tons of other chemicals (e.g., dopamine, acetylcholine), and environmental factors that make up the dynamic processes that give rise to mood.

How Treatment Works

The most prominent antidepressants act by increasing levels of mood-enhancing compounds such as serotonin and noradrenaline. The constant release of these chemicals over extended periods results in neural growth in the hippocampus – a central brain region involved in emotion regulation. That is why it takes at least a few weeks for people on antidepressants to experience a response. In a similar vein, repeated aerobic exercise may alleviate depression over a sustained period of time. Interestingly, running produces some key effects of antidepressants by boosting serotonin and noradrenaline, which in turn stimulates growth of new neurons in the hippocampus after consistent training sessions.

Get Outside, GET WITH NATURE

Some depressed people suffer from low motivation, and want to to stay indoors. For Dr. David de Klerk, a seasoned cyclist and runner specialising in sports medicine, exercise has been key to managing his anxiety. He notes that "with depression, the tragedy is that the lack of motivation makes exercise difficult but if one could only exercise, one might feel more motivated. This is a great example of how a small step can make a big difference to break the cycle."

When I fell into a depression, my motivation and drive was extremely low. I'd stopped training for some time and then struggled to reintegrate with my exercise routine again. I found the hardest part was getting outside. Once I got out though, on those few occasions, I would complete my sessions (5km, 10km). So I told myself "just get outside and do at least 200m. If you still feel like being indoors after that, then you can turn around and go home". That rule worked for me– most of the time I didn't turn back home. Slowly I began exercising more frequently, and my drive returned after some months. It's a small step that helped me end the cycle, and the method may work for others too. 

Another good way to take a step out the door is to hold yourself accountable by joining exercise groups and training with your friends (and feeding off their habits). Signing up for your local 5km ParkRun is an easy way to get involved with a friendly community that’s open to all levels of walkers and runners. With 222 locations hosting a ParkRun every Saturday, it's accessible to many South Africans. The social aspects of going outside and engaging with other runners in the community is also beneficial to your mental wellbeing and self-esteem. What's more is that recent research shows that being outdoors in green settings boosts serotonin, alleviates depression, and improves other health factors. Thus running outdoors is the ideal candidate for mental equilibrium. 

New to running and don’t know where to start? You can join up with ASICS Run Club every Wednesday @ 17h30 from Canal Walk (CPT) or Mall of Africe (JHB) - all levels welcome.

Prescribing Exercise

Doctors have started prescribing exercise and running to treat depression. According to Stellenbosch based sports physician Dr. Janesh Ganda “The exact formula of exercise prescription is a balance between Aerobic, Resistance, Stretch/flexibility and Neuromotor (pilates etc).” according to the American college of Sports Medicine. He also points out that exercise is also used to treat a host of other mental disorders.

In my opinion, consistent aerobic exercise should be the first step for treating depression before moving onto invasive drugs that come with a host of unwanted side-effects that are often overlooked. Psychiatric authorities from Canada, New-Zealand, and Australia now recommend exercise as a first step to treating sedentary depressed patients. In South Africa, Dr. Janesh Ganda says that while the pharmacotherapy model is still very prominent, the concept of exercise as therapy is still growing.

Conclusion

Stepping outside may prove difficult to depressed people, but there are some ways that can make that step easier. Exercise itself isn’t going to cure all and anti-depressants are not a hoax. Some people may only respond to medication while others don’t. Treating depression is a trial-and-error process for many people, who often jump between medications or take a mixture thereof before regaining their feet. However, given the non-invasive nature of exercise and its accessibility, exercise in green settings ought to be the first step in treating depression and considered as an adjunct to an already existing treatment regimen. Perhaps prescribing ParkRuns is a good place to start.

Looking for an introductory program? Check out RunnersCreed free 1 month program which can be integrated with a weekly ParkRun/ASICS Run Club regime.