Mental Illness, Exercise, and Me

I sat down to write some sort of post commemorating the arrival of 2016, but I wasn’t feeling particularly inspired on that front.  I love seeing other people make resolutions and reflect on the past year, but I’ve never been that good at it.  I’m self-important enough that I don’t need another excuse to talk about myself, thankyouverymuch.  As this post will show, I’m plenty good at that without a specific prompt.  New Year’s is all about new beginnings, changes, and hope, which makes this particular topic a bit ironic.  Basically, I want to talk how I’m crazy and how exercise interacts with my particular neuroses.  This is a difficult topic to write about without sounding like I’m asking for sympathy or condolences.  So I’ll attempt to be just matter-of-fact about it and just hope I don’t come off as completely whiny.

First, a little bit of my own history in regards to mental health.  I can’t remember a time when I didn’t struggle with anxiety and/or depression.  It’s been a thread in the fabric of my life since I was a child, not always visible, but always a presence.  It’s sometimes hard for me to pick out specific instances when I struggled with depression and anxiety while very young because those experiences don’t stand out.  They were just a part of my life.  In kindergarten, I got so nervous about a coloring contest that my older sister had won three years ago that I never even completed it (and then felt guilty for weeks).  I tried so hard to enjoy summer camp and sleepovers.  And I mostly did, but I spent most of my nights away crying because being away from home made me so anxious.  This continued into high school.  During my last couple of years of high school, I started having panic attacks while playing basketball.  I had no idea what was happening the first time.  I was just frozen out there on the court, completely confused and completely unable to do anything but shuffle between the three-point lines as the possessions changed.

By the time I got to college and went through my first major tragedy, I was able to survive a debilitating couple of years of depression because I had spent years developing coping mechanisms (some more healthy than others, by the way).  I was going through an emotionally-trying falling out with my family, and more than during any other period in my life, I felt like I was a worthless sack of flesh, incapable of living in the world with other people.  (Hopefully, my frequent posts about my visiting my family convinces you all that we have gotten past that particular issue.)  I never got a diagnosis, though, because it wasn’t until I was going through my divorce that I managed to find a therapist that was a good fit for me and attend on a regular basis for a while.  But while I was seeing that therapist, I decided to get a screening for several mental illnesses.  My ex-husband had spent considerable effort trying to convince me that I had bipolar disorder and borderline personality disorder.  I am a very sensitive person, enough that it’s sometimes hard for other people to understand.  I am easily moved to both laughter and tears.  So, knowing this and knowing how serious those mental illness are, I wanted to know if I really did have them.  So I had my therapist screen me.

Extreme reaction to real or imagined abandonment? “I don’t know.  The divorce has been really hard.” How about smaller things like someone being late to lunch or forgetting to call you back? “What?  No.”

Unstable relationships? “Not in general.  I’ve had a few fallings out with people, though.”

Impulsive behaviors like excessive spending or unsafe sex? “No.” Oh my gosh, those are literally my stress dreams.

Unstable self-image or quickly changing goals and ideas? “No.” Change is pretty much my least favorite thing in the world.

And so on and so forth.  While I met the criteria for a depressive episode of bipolar disorder (to no one’s surprise), I didn’t have experiences that lined up at all with a manic or hypomanic episode.*

Not surprisingly for most people who know me, she ruled out borderline personality disorder and bipolar disorder.  She agreed with my belief that I had generalized anxiety disorder and also offered up the possibility that I had dysthymia, which is a low-grade, long-term form of depression.  After reading more about it later, I agreed with her.

So where does exercise fit into all of this?

For me (and I realize this varies widely among individuals), exercise has been the most consistent and most effective tool in managing my anxiety and depression.   As someone who always stayed active in sports in high school and college, I never had the opportunity to see the correlation between exercise and mood until I quit track in college.  There was one full semester in college where I didn’t work out at all.  I had a light class load as well, and I was looking forward to the break.  But that semester I just could not keep my crap together.  I struggled with certain symptoms of anxiety and depression—procrastination, hiding myself away, disorganization—more than during any other time in my life, even though my life was actually less stressful and I wasn’t quite as hopeless as I had been for a year or so prior.  And when I started exercising again the next semester, those particular symptoms disappeared, even though my class schedule was more consuming and nothing had changed to lessen my depression.

I noticed this, and I never stopped exercising again.  From that point on, even for the years when I wasn’t training for anything, I worked out 3-6 times a week.  Sometimes. it was only running.  Sometimes, it was running and swimming.  Sometimes, I’d even dabble in lifting.  People I knew would periodically ask me how I stayed motivated to work out.  I never knew how to answer them because I didn’t feel like I needed motivation to work out any more than I needed motivation to get to bed early at night.  Because if I didn’t, I wouldn’t be able to function.  I had some very dark years in my early twenties, and those years are the reason I joked with Rob a few months ago that crying a few times a week is no big deal.  It’s when I start crying a few times a day that I need to start worrying.  I believe that during this period of my life, I was suffering from a major depressive disorder on top of my normal-to-me dysthymia, which creates an effect known as double depression.  I remember one particularly dim day (my days were either like knives cutting me open or so dull that I couldn’t feel anything—I don’t know what was worse), I didn’t look before crossing a street and a car zoomed by right in front of me.  I usually startle easily, but I had absolutely no startle response, no elevated heart rate or adrenaline surge, to this close call.  I just remember feeling a vague disappointment that I hadn’t made it to the intersection a few seconds earlier.  During this time, exercise (and, to be fair, general self-care like getting enough sleep) was the only thing I was doing to manage my anxiety and depression.  That is by no means a recommendation, and since then, I have spent some time both on medication and in therapy, but at the time, exercise was all I really had.

I actually specifically remember being so distraught this day that I could barely put on the happy-face I needed to have on a family vacation.  It actually kind of makes me sad to look at this picture.  I’m pretty sure that people often thought I was being a snot when really I was giving 100% just to function.

I knew exercise was good for me, but I hadn’t seen the new research that looked at exercise as a treatment for mental illness.  In grad school, a close friend of mine who had earned his BA in psychology told me about some research that showed that exercise was almost or just as effective as an antidepressant in treating depression.  I was a little skeptical, but it turns out, he was right.  Though, one should note that while exercise has been found to help anxiety as well, it doesn’t approach the effectiveness of anti-anxiety medication.  Additionally, it doesn’t appear that it’s a specific type of exercise that helps.  One study found that both aerobic and anaerobic exercise produced similar results in reducing depression.  And since I’m posting links to scientific studies, I should offer a caveat: I am not a scientist, and this is not something I’ve studied intensively.  So everything I write here should be taken as how what I’ve read interacts with what I’ve experienced, and absolutely nothing more.  And it’s important to remember that the results of scientific studies can be skewed by poor methodology, small sample sizes, etc. which has apparently been a problem in research on this specific topic.  As I was reading through these abstracts, I found a description of one particular problem with the sample size.  All the people in the study had strictly adhered to their assigned routine, whether it was an exercise routine or a medication routine.  The study authors noted that this showed a level of motivation that potentially indicated that the subjects were less depressed than many depressed patients would be.  And, if I didn’t already have exercise as part of my daily routine, during my worst times I would not have been able to add it in.  That’s the main reason I never stopped—fear of not being able to pick up the habit again after losing it.

There were a million choices when I Googled “exercise depression meme,” but this is the one I chose.

However,  the general conclusion that exercise helps alleviate depression has proven to be true in my own life.  In fact, exercise has become one of the central tenets in managing my depression.  While I’ve sought therapy and taken medication during particularly difficult times and suspect I will have to do so again in the future at some point, neither one is particularly appealing to me as a long-term solution (respectively, for financial reasons and because I, perhaps ironically, have some anxiety around the use of medication).  With exercise, along with good sleeping habits and some mindfulness/self-acceptance techniques I learned in therapy, I’m doing okay right now.  The dysthymia is still there, and my anxiety waxes and wanes as life glides along smoothly or throws unexpected problems into my path.  That won’t always be the case.  Just a few months ago, a long spell of really dull, kind of deadening days that weren’t so bad it hurt to get up started to wear on me, and I had a little bit of a break down.  I could get up each day and go about my business without too much angst, but the thought of doing that every day for another fifty years was just too much to bear.  But generally, the stability I get from exercising regularly, sleeping is enough to work with my mental illness and live a reasonably productive life.

I’m not going to say that exercise has “healed” me or that it’s the end-all, be-all—a magic pill that will save you if you too just give it a shot.  Because it’s not.  It’s a tool, and it doesn’t always do the trick (as evidenced by my continued struggles and occasional need to seek additional help).  Like any other tool, it has positives and negatives.  Though the positives far outweigh the negatives, I need to be careful not to let the need to work out or follow my training plan trump my peace of mind or the relationships in my life.  I need to make sure I sleep and eat enough to keep up with my exercise.  I need to make sure I’m using it responsibly.  For me, though, it’s a necessary tool.  The routine, the endorphins, the time outside—they all combine to create an experience that is hugely beneficial to my mental health.  That experience has helped me maintain at least a semblance of stability and sanity through the months when I cried multiple times every day and the months when my anxiety was almost too much to bear.  It’s easy to write this post right now because I have been going through a good time emotionally.  Exercise is exciting because I’m doing well and improving and working towards goals.  But I know that even when my mood falls and I start struggling again, my exercise routine will be one of the techniques I use to help get me through it.