Stop telling your depressed friend to go for a run

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Gratuitous selfie at the top of Chapman’s Peak. This was a good day, and I DID feel pretty high.

“Go for a run, you’ll feel better.”

If you’ve ever been sad, you’ll have heard this. If you’ve been depressed, you’ll have heard it ad nauseum.

What depressed person has the energy, let alone the motivation, to go for a run? Realise that “going for a run” is a multiplex of tasks. First, you must get out of bed. Then, you must get dressed. You must put on shoes. You must (preferably) eat something. You must unlock the door. You must step into the sun. You may have to greet the neighbour. You must put one foot in front of the other. Then you must do it faster, and remember to breathe.

Some days the only thing a depressed person can do is get out of bed. Some days, that will be there achievement.

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Image via Odyssey

I’m a runner (sort of). I’ve had the elusive runner’s high. But I’ve always known that running does not and cannot cure my depression. Until recently, I could never substantiate it.

Earlier the year, I attended an Essential Pain Management course, by Professor Romy Parker of UCT*. A large part of the course looks at chronic pain, and naturally there were a lot of parallels with major depression – one such parallel being the endogenous opioid system.

Endogenous opioids are those little chemicals that make you feel good. Endorphins – the ones you get from chocolate and (good) sex? Those are endogenous opioids. The runner’s high involves endogenous opioids (it’s probably a bit more complicated than just that).

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As any student of biology will know, for any enzyme/peptide to have an effect on the human body, it must have a receptor. Serotonin has receptors, and that is why we have SSRIs. So do norepinephrine and dopamine. And so do endogenous opioids. If the receptors become damaged, or desensitised, or up- or down-regulated, the effect of that peptide changes. And that is when we get pathology, like depression.

Many people know the monoamine theory of major depression (and much of mental illness, actually). Serotonin, norepinephrine, and dopamine are all monoamines; and the idea is that changes in the levels of these peptides, be it by production or absorption, will bring about changes in mood.

What is less well-known is that many other compounds are involved in the regulation of mood. We know it, but we don’t know it. We talk about endorphins, but we don’t recognise that we are essentially referring to endogenous opioids, and that these therefore play a role.

Much recent research illustrates that opioid receptors in the brains of those with major depression are somehow dysfunctional, compared to the brains of neurotypical individuals. In other words: people with depression (and chronic pain, and some other illnesses) do not get the same effect from endogenous opioids as do healthy people.

So, when you drag your depressed friend out of the door and make them run, you are not helping. They won’t feel better. They started the day off depressed, and after their run they will be out of breath, sweaty, in pain, and still depressed.

There are other ways to help, but this is not one of them.

For more information:

  1. Dysregulation of endogenous opioid emotion regulation circuitry in major depression in women; Kennedy, Koepe, Young et al.
  2. Major Depressive Disorder: Looking Beyond Monoamines (pdf); Gus Alva
  3. Endogenous opioids: The downsides of opposing stress; Valentino, Van Bockstaele

* I highly recommend attending this course if you find one near you. Check out the EPM SA website.

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Anatomy: my big mistake

I had a little giggle to myself while charting the notes of a patient with shoulder pain the other day. Specifically, I was thinking of this post of yore, and my belief that I could get by just knowing what anatomy looked like, and not necessarily its various descriptions and qualifiers.

Boy, was I wrong. (And young. And obstinate.)

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Image via dentalbuzz.shop

Continue reading “Anatomy: my big mistake”

Finally had my “magical paeds moment”

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Not the same child, photo with permission.

The little girl had come in hurt and bleeding. No too bad, a small gash that was easily approximated and taped (gosh, I love steri strips).

Next: the Tet tox.

She doesn’t know about it yet. For a moment I consider not telling her at all, but she is old enough to feel betrayed. So she sits on her dad’s lap, and we tell her about the special injection that will prevent her from getting sick. We may have used some imagination and invoked superheroes, too.

I braced myself for the struggle the moment the needle pierced her skin.

Nothing. Nada. She sat chewing her candy while I taped the injection site.

You know all those cute videos of doctors giving kids their shots without them noticing? I finally got mine, and that felt kind of special. Sometimes, you need just one small success to give you a bounce in your step.

Read This Book: An Unquiet Mind

11552857I love that more healthcare workers are talking about depression these days. It’s something I did not see while I was studying, and that meant that I felt very alone. You might even have seen (or participated in) #crazysocks4docs, which was meant to highlight the high rates of depression in the medical profession. (Some took exception to the term “crazy” – but I’m not going to discuss that right now.)

Anyway, more and more HCWs are doing their part to delegitimise stigma by sharing stories of their own depression. But some mental illnesses are still “off limits” – bipolar mood disorder and schizophrenia, for example; and it’s not hard to know why. For a doctor to get sad and burnt out? Most people can wrap their heads around that. But few are comfortable with the idea of an “unstable” doctor. Society hasn’t become comfortable talking about those disorders that may lead to losing touch with reality. Continue reading “Read This Book: An Unquiet Mind”

The Best GP Advice I’ve Received: Part 1

 

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(c) Simon Prades

The night before my first shift in general practice, I frantically messaged one of my doctor-heroes on Twitter (@sindivanzyl). I think I was hoping for a cheat sheet, something about hypertension and diabetes, but the one thing she emphasised was, “Please, please, always examine your patients.”

For medical students that would probably sound absurd. Duh, how can one not examine the patient? 

But I learned quickly that, in an environment where there are always more patients to see, it is sometimes easier to make a quick observation from across the desk than to do as we have been taught. Continue reading “The Best GP Advice I’ve Received: Part 1”

Doctor. Counsellor. Freedom Fighter.

She was a healthy young woman who came to see me for a “complete check-up” before a holiday overseas. Although I tend to think “complete” check-ups are somewhat overkill, they do present a good opportunity for health promotion and disease prevention. As one does, I asked about sexual history and family planning. She hesitated just a split second before answering, “Well, my only partner is a woman, so I don’t have to worry about pregnancy scares.” And then, we moved on.  Continue reading “Doctor. Counsellor. Freedom Fighter.”

General Practice is not exciting, but it is fulfilling

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By Lauren Squires, with permission. Click image for her Instagram.

As I enter into my third month of General Practitioner work, I find myself reflecting. I started with private GP locums to fill the gap til I got the job I wanted. But now I’m signing a contract and I’m here to stay – for at least another five months.

One evening, my housemate asked, “So, did anything interesting happen at work today?” When I responded in the negative, we laughed about how my work had become almost mundane compared to working in hospital and coming home with fascinating stories of grotesque injuries and life-saving surgeries practically every day. Continue reading “General Practice is not exciting, but it is fulfilling”

GP Work is Hard

One week of some GP locums and I am exhausted.

7b609ee5184afeee3a442d25e5549028I can spend 10 minutes per consultation if people have straight-forward tonsillitis or gastroenteritis.

But what about the parents who are hesitant about vaccinating? I need more than ten minutes to make an impact.

What about the woman whose pregnancy test was unexpectedly positive, and needs to discuss options? She might not have anyone else to discuss options with.

What about the myriad people with psychiatric illness? I need more than ten minutes to figure out if it’s depression, or if there is a history of hypomanic spells. Is it substance induced? Is there another general medical condition? Who can start someone on antidepressants after a ten minute consult? Continue reading “GP Work is Hard”

Tips for New Interns: First Week at Work

Last night I worked my last shift for Community Service. 1 January 2018 will mark three years since I walked into my first day of work. And on that day, more than 1,000 new interns will enter our workforce.

I remember the nerves the night before: being unable to sleep. Feeling like a fraud, like I had been allowed to graduate by accident. Worried that I would be labelled Worst Intern Ever; worried that I’d have awful colleagues. But I survived the first week, and eventually the first year, too.

And so will our new interns. I have some tips for those who need ’em.

64062aa6fd8336df8d9536c250fadde7 Continue reading “Tips for New Interns: First Week at Work”