Five years ago, after ending a long-term relationship, Anita became seriously depressed. It benched the once-physically active writer, who asked that her last name be withheld to protect her privacy.
She stopped running and began gaining weight and falling out of shape. It was not the first time she had been depressed, and traditional therapy had not helped her as much as she had hoped. This time, she sought out someone different. She found Jane Baxter, PhD, a therapist who was able to get her moving again, mentally and physically.
Baxter, who is based in Washington, D.C., has a unique background and practice. She is a psychologist and a certified personal trainer. When Anita showed up for her first appointment, Baxter eschewed the couch in favor of a treadmill.
"She’s a mental health trainer and a physical trainer," says Anita, 46.
"Every day, there is more and more evidence," says Harvard Medical School psychiatrist John J. Ratey, MD, the author of Spark: The Revolutionary New Science of Exercise and the Brain. "There are very good placebo control studies comparing antidepressants and exercise, and the effect on mood is the same."
In one 2005 study conducted by researchers at the University of Texas Southwestern Medical Center, 30 minutes of moderately intense exercise five days a week reduced symptoms of depression by nearly half after 12 weeks.
"I’m not opposed to medication," he says. "And when someone is very depressed, you want everything going [to treat that person]."
Up and Running
Anita, who takes the antidepressant Wellbutrin in addition to the talk therapy/workouts she does with Baxter, had always been accustomed to doing intense workouts. But, she says, "when the depression hit, I had no energy."
Baxter’s program helped her regain it. Anita says her workouts with Baxter were gentle and subtle, but, crucially, they were what got her moving again. She found herself wanting to work out on her own, and she began running again; she also started lifting weights. She has lost 30 pounds in the past year.
"My work with Jane helped me get accustomed to going out and being physically active again," Anita says.
Baxter says that is a common response to her program. In fact, many of her patients join a gym and even hire a second personal trainer.
Though she also does traditional talk therapy, about half of her patients opt for the program she calls PsychFit.
“When I was in graduate school, learning about different types of therapy, exercise was never mentioned,” Baxter says of the early inspiration for her practice. “That blew my mind.”
As the idea for PsychFit began to form, about eight years ago, Baxter began sharing her plans with other therapists, as well as doctors and personal trainers.
“They loved it,” she recalls, especially the personal trainers.
“They would tell me about women who would start crying on the treadmill,” she says. “They didn’t know what to do with them.”
Many of her patients come to her after trying more traditional approaches.
“Therapists often will just sit and talk and tell you to exercise,” says Baxter. “But if you are depressed, you are not going to do it.”
A typical session with Baxter includes 7-8 minutes of warming up on the treadmill, followed by balance ball exercises to work the abs and the upper and lower core muscles, and then some weight work before cooling down on the treadmill. All the while, patients talk to her about their problems.
It’s an empowering process, she says. “They feel strong while talking about their weaknesses.”
Your Brain on Exercise
According to Ratey, depression shuts down the brain’s ability to adapt to new situations by limiting the ability of brain chemicals called neurotransmitters (such as dopamine, serotonin and norepinephrine) to foster communication throughout the brain.
“Not only is the [depressed] brain locked into a negative loop of self-hate,” he writes, “but it also loses the flexibility to work its way out of the hole.”
Exercise, Ratey says, counters that by boosting the production of BDNF (brain-developed neurotrophic factor), a protein that helps neurotransmitters perform their function, and which may help depressed people emerge from their rut. Ratey describes BDNF as “Miracle-Gro for the brain."
To reduce depression, Ratey advises patients to follow general public health guidelines, which recommend at least 30 minutes of moderately intense exercise five days a week as well as two days of strength training each week.
However, not everyone will experience the antidepressant effects of exercise, Ratey cautions. He estimates that less than 50% will see a significant reduction in symptoms.
“That’s comparable to response rates for medications,” he says.
In Baxter’s practice, she finds that her patients respond better - they get a bigger mood boost - if they do exercises that require them to use their brain rather than let it run on auto pilot.
For example, a multistage exercise that requires you to lift a ball above your head then move into a forward lunge will get your brain working better than rote exercises like rowing or pedaling a stationary bike.
Ratey agrees. “We know that a harder-working brain is a smarter brain -- probably a more hopeful and motivated brain, as well,” he says.
And a more hopeful and motivated brain is just what Anita needed in order for her to begin making her way out of her depression.
“I think the workout/therapy sessions helped me move through times of being stuck or anxious more quickly,” Anita says. “I took up running on my own, and I credit the gentle but consistent talk/workout sessions with helping me reach this goal of health and fitness.”