Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal
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Ask the expert

Is exercise beneficial for depressed people?

Exercice is really good. There are a number of studies that show that exercise is good for the mood. I exercise quite a bit. At the end of the day, I sometimes find myself mentally exhausted. Or, if I haven’t slept, I’m mentally tired, but I’m never physically tired. I could probably dance all night if I had to. What happens is that you have more energy. In fact, as simple as it might sound, if a person isn’t straining to walk up a flight of stairs, everything is easier. If you are in bad shape, normal tasks become a burden. So you can certainly lessen the burden by exercising regularly. Plus, of course, it has all kinds of chemical changes, such as the release of endorphins.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

A 73 year-old recently depressed male wishes to completely divest himself of all responsibilities. Is it better to keep him engaged in life by giving him small manageable tasks?

I think it obviously depends on his ability to function. Is this someone who was depressed all his life or just recently started getting depressed? Generally, the more functional you are, the better it is. If someone cooks for you every day, then, at some point, you’re not going to be able to feed yourself. If someone pays your bills for you, you’re not going to be able to pay your bills, etc. So, ideally, you want to function at the highest level possible. Having said that, when a person is really depressed sometimes they can’t function and they need assistance. So you’re always trying to walk that fine line between doing it for someone and encouraging them to do it themselves. You don’t want to overprotect them, but, at the same time, you don’t want to overburden them. But, sometimes, it becomes just an easy excuse because a person might just not feel confident and they’re looking to relieve themselves of responsibility. But, in so doing, they might actually just keep further chipping away at their self-confidence. I would encourage them to be independent as much as possible if I could.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

Could someone who is depressed heal over time on their own?

Absolutely. You can apply the principles behind cognitive therapy to help yourself. The first thing to understand is that there are different kinds of depression. Some are chronic and some, like seasonal affective disorder, are episodic. Many recent therapies for all types of depressive disorders involve “assisted self help”. This can involve reading books, using the Internet, and having a coach to answer your questions. The effectiveness of this approach may depend on the severity of the depression. When depression is severe, medication may become more necessary.

- Camillo Zacchia, Mini-Psych School 2007

The effectiveness of self-treatment depends on the severity of the depression. Some over-the-counter products are available, such as St. John’s Wort, although there aren’t many studies on this substance. St. John’s Wort may also cause some people to become hypomanic. Omega-3 supplements and a healthy diet along with light therapy may also be good for mild forms and for people with a seasonal disorder, but again, there is not a lot of research in this area.
-Johanne Renaud, MD, Mini-Psych School 2012

Who is the ideal person to consult when accompanying someone with periodic bouts of depression?

The general recommendation when a person is depressed, if they are mildly to moderately depressed, is to get some sort of cognitive therapy, which is a therapy that looks at the way we perceive things and the cause we attribute to them. It helps us to understand our biases, how we see ourselves, and our successes and failures. A depressed person has a tendency to always blame themselves when something goes wrong, regardless of the circumstances. They will distort the facts to fit their belief that they are not very good. They will have a tendency to blame or to attribute to the outside world any successes that they have. So the general recommendation for mild to moderate depression is that kind of treatment.

If a person doesn’t respond, you really need to consider adding an antidepressant or some other pharmacological intervention. For moderate to severe depression, the usual recommendation is a combination of both. What is considered mild to moderate? What about moderate to severe? Again it depends on the person. If you’re not able to work, are not able to function, and are suffering a lot, you need to consider a combination treatment.

So, who is the best person to consult really depends on how bad it is. I think, first and foremost you need to find someone you can trust and you have to be prepared to maybe walk away from that person if they’re not helping you and try someone else. For the most part, there are very effective treatments both psychologically and medically, and a person can do one or either or both. But, sometimes people’s attitudes interfere with the help they can get. They might be against medication, they might be against therapy, or might be so pessimistic that they don’t think it’s going to help.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

Does post-depression psychotherapy eliminate the risk of a relapse?

I think that young people in particular believe they always have to succeed. But this is impossible. In life, everyone goes through difficult situations and experiences failure at a certain point. I think you need to experience small failures and not succeed all the time. You need to have a plan B. In fact, this is what we ask patients in our clinic: "What are you going to do if things don't work out? Do you have other strategies?" We try to get them to adapt or find other ways to deal with problems. Then, if the result is still failure, they can use these strategies to get through the ordeal and come out even stronger.
- Johanne Renaud, MD, Mini-Psych School 2010

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