Running to Ward Off Depression

Running is my therapy. If you talk to enough runners, you're bound to hear it again and again.

“Running is my 'me' time, where I can plug my headphones in and sort through whatever thoughts I can't untangle on the ride home from work," says Jessica Skarzynski, 35, who says she has dealt with anxiety and depression since grade school. The South Amboy, New Jersey-based runner didn't discover running as a mental health tool until college, the day she learned her mother was diagnosed with breast cancer. In an impromptu moment, she went to her local park and ran until she was out of breath. “It planted that seed that running could help me control my emotions when they spiraled."

Since then, she's turned to running to help her through periodic bouts with intense anxiety and depression, in conjunction with medical help. “Each time, I have managed to fight my way through with running and regular exercise," says Skarzynski, who blogs about her journey at Jess Runs Happy.

In the U.S., an estimated 31 percent of adults experience an anxiety disorder at some point in their lives, and more than 20 percent will encounter major depression. That's not counting bipolar disorder, postpartum depression, seasonal affective disorder, atypical depression and other depressive diagnosis that are now part of our vernacular.

While running might not work for everyone, it can be a powerful tool in the battle against stress, anxiety, depression and other conditions, even during winter months when mental health issues can spike. Exercise can positively effect mood, self-esteem and restructure brain function to better handle stress.

“Exercise as a treatment for depression, either alone or in addition to an antidepressant, is very effective," says Dr. Madhukar H. Trivedi, director of the Center for Depression Research and Clinical Care at UT Southwestern Medical Center in Dallas. He has spent his career studying the relationship between the two as a leading researcher and psychiatrist. Trivedi advocates for exercise as a routine treatment option in American medicine. It's not yet. But in Australia, Canada, the Netherlands, New Zealand and the U.K, exercise is already the standard of care as a topline depression treatment.

Data suggests exercise not only treats depression, but might actually prevent it, both for people who've never been depressed and for those who are in remission.

“People who exercise on an ongoing basis seem to have lower rates of depression," Trivedi says. “For people who have had depression, longer term exercise seems to prevent new episodes from coming back. The same thing happens with medication and with therapy. If you find a treatment that works, continuing that treatment prevents you from having another episode."

Research shows that exercise has a similar effect on anxiety. While specific mood disorders in the anxiety and depression spectrum, like SAD and obsessive-compulsive disorder haven't been studied as much, Trivedi says indicators suggest exercise might be effective there as well.

How? Running and other vigorous forms of exercise actually alter brain function. No matter what's on your mind, the mechanism is similar even if the eventual effects differ from condition to condition or person to person, Trivedi says.

We've all heard of the runner's high, the well-known rush of endocannabinoids we get with exercise, along with a flow of endorphins that reduce our perception of pain. But scientists now understand that exercise can actually restructure the brain in the long term, too. “The immediate effect is not itself an antidepressant," Trivedi says. “The real antidepressant effect takes several weeks to work."

That's because exercise changes neurotransmitter function—chemicals passing messages from one cell to another in the nervous system—including the mood-regulating serotonin and stress hormone norepinephrine. Exercises like running also promote neuroplasticity—the brain's ability to adapt over time. When we talk about rewiring or retraining your brain, neuroplasticity is at play. Exercise may even have an anti-inflammatory effect, essentially acting as an antidepressant in the 20 to 25 percent of patients with depression-linked inflammation markers, Trivedi says. Put together, research shows continued exercise can actually be as effective as drugs that aim to do much of the same things.

Those immediate mood boosts might indicate whether running could be successful for you. Trivedi's research suggests that exercise is more likely to help people in the long term if they experienced positive feelings immediately afterward.

“Know that it won't be easy, and it won't be like magic," Skarzynski says. “Just because you start running doesn't mean the clouds will immediately clear and you'll be whistling your way through life once more. But it's a cumulative thing. If consistency is key in training, it's doubly so when dealing with your mental health."

There are other ways running can help, too. Depression is one of the most common side effects of chronic illnesses like obesity and heart disease. “Running can help ward off some of those long term conditions," says Dr. Erin Stair, founder of Blooming Wellness. Stair also has a master's degree in public health.

Stair, who runs almost every day after struggling with depression as a medical student, says the sensory stimulus of running—seeing new people in changing surroundings—can help curtail depressive ruminations.

“Staying committed to my running schedule has helped me with that tremendously," she says.

Then there's the added benefit of self-agency—feeling like you're doing something for yourself. “When exercise is effective the person feels a sense of self efficacy," Trivedi says, noting research supports this idea too. That sense of self can be empowering and raise self-esteem, says University of Nevada Las Vegas psychologist Brad Donohue.

After all, in order to change mood and cognition, you have to change behavior, says Julia M. Kim, who has a doctorate in clinical psychology and works at Hospital for Special Surgery in New York City. Exercise is one way to do that. “When patients are depressed, making behavioral changes is important to help facilitate mood changes," Kim says. “The goal is doable behavioral changes that lead to success. Change behaviors first, feelings will follow. Kind of like 'if you build it, they will come.'"

Running also creates social opportunities that help people focus on positive relationships, Donohue says, like regular jogs with a running buddy. This can be especially helpful around holidays, when social isolation weighs on people who live far from family and friends, according to Bethany D. Lavins-Merillat, who has a master's degree in clinical psychology, and is an avid runner. “It is also a time when people tend to reflect on those they have lost, which can cause sadness," she says.

For others, unachieved New Year's goals can be a source of stress, Lavins-Merillat adds. Winter brings the most anxiety for Skarzynski, thanks to overindulgence during the holidays and coming down from a celebratory high.

“I've learned in recent years that the New Year is the worst for me," she says, "after I come face to face with seemingly endless cold weather and nothing to celebrate until spring."

Skarzynski says running “almost entirely" saved her from an especially dark period one winter.

“There were days where I couldn't even get off the floor of the bedroom," she says. “Running was the last thing on my mind." Her husband drove her to their local park and forced her to get some fresh air. “I kept putting those sneakers on every other day, and eventually came out of it to enjoy one of the most successful years of my running career."

Even if you don't struggle with depression, running can be an effective aid no matter the time of year. “Exercise is beneficial year-round, and needed year-round," Kim says. “We need to be mindful of how external factors, i.e. weather, seasons and holidays, etc. can affect us."

Of course, exercise does not work for everyone as a sole therapy, Trivedi and Kim caution. “It works for some people, and some people may need medications, some people may need therapy," Trivedi says, in addition to, or instead of, workouts. The key is trial and error, with the guidance of a health care professional, to figure out which combination of treatments is right for you.

Kim says she might prescribe exercise if it's something a patient has enjoyed in the past, and if they're able to maintain a balanced perspective toward working out. “I don't think I can emphasize enough the need to have fun while you exercise, no matter what you do," Kim says. “Feeling the 'must run' drive can create more pressure and anxiety."

And like any prescription, the amount you run matters, too. “You have to have the appropriate dose," Trivedi says. He uses a calculation based on body weight that roughly translates to burning 1,200 to 1,400 calories per week or 45 to 50 minutes of intense exercise four to five times a week. How intense? “You should not be able to hold a reasonable conversation," he notes.

Of course, if you're using exercise to treat depression, seek the guidance of a health care provider. How do you know when it's time to reach out? “If you are wondering if you should get treated, you probably have depression," Trivedi says. He encourages people to ask their primary care physician or gynecologist at an annual exam to screen them for the condition every year.

“Everyone has difficult days," Kim says. “But if it's at the point that you need to run daily, then I believe therapy would be beneficial to help reduce the source of stress and to develop more adequate coping skills. While exercise is a great stress reliever, having only exercise as a stress reliever can be detrimental. We need to have a variety of ways to relieve stress. Not all strategies work for all issues."

Seeking professional help can give you a full arsenal of tools—medication, therapy and more—that can help support your running routine. Skarzynski says she went to multiple therapists and tried a few medications before she found the combo that worked for her.

“It's important to remember that you don't have to do it alone," she says. “I don't want people to think they shouldn't consider medicine because they run, or run instead of seeking help from a professional."

For her, therapy and medication was a kick-start to retraining her brain. “I discovered that working out and running helped me do that too," she says about breaking "worry loops" that plagued her. “Soon, I didn't need the medicine because I had managed to retrain myself how to handle those thoughts."

Whether you struggle with periodic stress or more regular depression, running and other intense exercise just might help.

“Just know that the idea is to keep putting one foot in front of the other," Skarzynski says. “In running and in life."