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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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”

Can I Be A Depressed Doctor?

Ever since I wrote about how going for therapy was my biggest gift to myself*, I’ve met with a few medical students to talk about the topic of mental health. Many of them were worried about their ability to make it through med school with their illness. Many were worried about the viability of a career in medicine with depression.

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When I was a student, there was a rumour that students with mental illness would be excluded from the course. We were informed by our senior students, and they by theirs, and thus the rumour was propagated. Continue reading “Can I Be A Depressed Doctor?”

Mental Health Begins With Medical Students

Every few months, the mental health of doctors/medical students makes it to popular media. It seems like these spikes in attention occur, and everyone shouts YOU SHOULD CARE FOR YOUR DOCTORS! and then we write blogs and we tweet and we make youtube videos and eventually we go back to work, and nothing has changed.

I think we are the missing link. And by “we”, I mean qualified doctors. And also, you, the older doctors. Continue reading “Mental Health Begins With Medical Students”

A Lighter Take on Mental Health | Finding Audrey by Sophie Kinsella

If you’re a regular here, you know how much I care about mental health, not just in the medical sense (although I do LOVE psychiatry!) but also in terms of the way it is presented in popular culture. Including books. Books count as popular culture, right?!

I must admit that before Finding Audrey I had never read a book featuring any of the anxiety spectrum disorders (I think…). Weird I guess. But I’ve had a good number of patients with Generalised Anxiety Disorder and Social Anxiety Disorder (with and without agoraphobia) so at least I’m not entirely unschooled.

Sophie Kinsella is kind of a big deal, and this is her first foray into YA. To be honest, I’ve heard of her but I’ve never read her before.  But it could have been anyone who wrote it really, I was still going to request it on NetGalley (thanks, Penguin Random House Children’s UK!). Continue reading “A Lighter Take on Mental Health | Finding Audrey by Sophie Kinsella”

Dear Doctor, From A Med Student

Dear Doctor

I’m writing to ask you please to not do that thing.

You know what I’m talking about.

It’s a Saturday morning, or the middle of the night on an overnight call, or whatever: it is a time of day that nobody wants to be working. And we are working. Maybe we are working on the same service, maybe I don’t know you from a bar of soap.

I am sitting in the doctors’ room writing notes for the latest patient that arrived in our care. You come in and sit next to me, looking for results on the computer or making notes for your own patient or maybe just drinking a coffee.

You see the design of my name badge so you know that if everything goes well, I will graduate by the end of the year and be one of your colleagues.

Then: you let out a long sigh and say loudly, “You know, it’s not too late to walk away and change your career.”

Crick-crick…

Continue reading “Dear Doctor, From A Med Student”

A Tale of Two Sisters (and Grief and Mental Health)

Two little sisters had an extended stay in the small rural hospital. They were the stars of the Paeds ward. The little one was absolutely shining and brightened up the whole ward. I spent ward rounds with her in my arms, on my hips, and eventually falling asleep on my back. She was loved. The older one was a regular little mother-figure. No nurse was allowed to clean or feed her sister: SHE did it.

They were no longer ill, but had lost their parents in quick succession, followed by neglect and abuse by the relatives who took over their care. So, as they lived in a region with a single over-worked social worker, they were staying at hospital until placement could be arranged.

a tale of two sisters 2 Continue reading “A Tale of Two Sisters (and Grief and Mental Health)”

Book Review: Unravel

Edit: I’ve been informed that the psychiatry portrayed in this book actually is a good representation of the way it is practiced in North America… which leaves me a little stumped… But means that some of my criticism below is ungrounded.

Six months ago, I was happy. I was simply Naomi Carradine. One month ago, I was admitted into a psych ward. Yesterday, Lachlan visited me. Kissed me. And told me that I’m starting to lose my mind. Hours later, Max haunted my thoughts, reminding me I’m not crazy and that he needs my help. A few minutes ago, I drifted further from reality, trying to unravel the past. And now . . . everyone thinks I’m insane. But I know he’s real, and I know he needs me. Do you believe me?

I read this book for Mental Health Awareness Month, and I knew that it was going to be a challenge to read it not just as a reader, but also as someone who has a little bit of experience with the practical and theoretical side of psychiatry. Continue reading “Book Review: Unravel”