If studies showed that African women who walk miles and miles collecting water somehow are less depressed than women with local water, I'll be more sold that exercise does something special..

Going back to the subject: Have you ever been clinically depressed or dealt with people in that predicament? Getting up from the bed is already a huge win for that day, let alone exercising and doing it consistently and regularly. Even taking medication regularly can be a hit or miss.

So, yeah the prescription is easy to write and thank god it's real and effective, but that's only ~5% of the work.

My exercise volume varies throughout the year because of physical health concerns (sickness, injury, combination of the two), and I notice it and will become mopey, but it's far from the crippling anxiety and depression that sets in if I miss my SSRIs for a few days.

But this is just anecdata, treat accordingly.

All that to say, I think IMO exercise can help improve general daily mood, but it did not really do anything for my overall depression.

https://www.youtube.com/watch?v=yKf40CLF9MU

I joked to her that puppies beat SSRIs any day of the week, that she should write prescriptions to take to the animal shelter. And it's probably true! Unfortunately, I don't live the kind of life that's compatible with a pet.

Personally, I'm grateful that doctors mostly stay in their lane, although I would hope a good therapist might recommend physical activity to someone who needs it.

And as to what kind of exercise to recommend -- the advice I've heard is that the best kind of exercise to do is what you enjoy and will therefore stick to. Brisk walking three times a week for 20-30 minutes might work great for some people. But if someone finds that a tedious chore, they're probably not going to stick to it.

I heard the practice referred to recently as "Outrunning the darkness", which is glib but kinda describes why I am typically either at work, caring for my kids, or out on a bike.

That said, I very much sympathise be all the accounts by people for whom days are made palatable, and exercise is made possible, by taking prescription medication.

If only doctors could prescribe it and have people adhere to the prescription.

If only American culture weren't so car-centric and our daily lives involved some natural amount of exercising. We've built a society where only the privileged few can walk or bike to work. It's just too easy these days to barely move in our normal life. Drive to work, drive to the store, drive the kids places... you literally have to specifically schedule exercise (and ironically, many people will drive to the gym to walk on a treadmill).

Also, when fat people eat less they lose weight.

As with any intervention, the devil is in the details. The author doesn't really provide any.

If the fix was easy we wouldn't need doctors to provide it.

Every checkup for me has started with "what is you diet and exercise like?"

I get where he's coming from, but at the same time, if we can achieve even roughly the same result with exercise as with medication, that's a ridiculously huge win. Side effects of antidepressants are usually uncountably many, whereas for exercise it's (just) injuries and it's pretty well understood how to prevent them. Granted depression is a thousand different diseases in a trench coat, but even if we can ameliorate some forms with exercise, that would still make it considerably more available and approachable.

Exercise doesn't need to be complex or intimidating. Starting out with going for a short walk counts as exercise. You could even do it while you have the patient with you on an appointment, go walk out and about with them. Depression is a complex beast and the more tricks we have up our sleeves to fight it, the better.

If you're depressed, trying to make exercise happen can be the hardest thing in the world for some. But for those that it isn't, it could help a lot.

Maybe we could use flock cameras to enforce prescriptions for walking on the sidewalks.

In any case, I'm not exactly up to date on the state of the art in terms of standard of care, but as far as I understood the role of a psychiatrist, it is specifically to write prescriptions. Exercise is not a controlled substance. You don't need a prescription to do it. Any doctor or even just a clinical therapist, counselor, anyone with a license to listen to you and make recommendations, can recommend exercise. And I'm sure they do. If you make it to a psychiatrist, it's because the less controlled options didn't do the trick.

Clinical depression is a serious mental illness, it causes great suffering, broken relationships, and far too frequently, death by suicide.

A person suffering to such an extent frequently will seek treatment (if they don't, well we don't generally pursue people with medical conditions) from a trained, licensed professional for evaluation, and the extent to which the patient gets out of the house and interacts with people is part of the assessment. Exercise will be among the suggestions that will be encouraged.

However, you don't need a prescription to exercise, so it's not treated like medicine, but it is recommended. If you are prescribed medication or exercise, if you don't take it or do it, there generally isn't a compliance system that kicks in (unless the courts have become involved)