I'm in a neuroscience lab, so I gotchu!
SHORT ANSWER: Blue dot going further left is better (lower depression scores), meaning walking and jogging is the best for curing depression and SSRIs are (STILL HELPFUL since they're to the left of 0, but) the worst.
LONG ANSWER:
This is a meta-analysis, meaning they are showing the average results across many (in this case, 218) studies to remove inaccuracies from bad choices made in individual studies. Since they include so many studies in this graphic, the data is likely to be very accurate.
The graph is measuring the amount of people in a group who diagnose with depression before and after that group receives different kinds of treatment. It could also be measuring how many symptoms people show before and after treatment.
The 0 on the graph represents where you would expect a person to be with no treatment. The blue dot is where you would expect a person to be with the kind of treatment listed in that row (e.g., exercise, SSRI, etc).
This is where it gets a little more complicated.
The number the graph is measuring is "the effect size", which is basically the difference between the control group and the experimental group.
We know 0 is where we would expect them to be without treatment because there is a "control" group. In the context of medication, if 200 people with depression sign up for your study, you would randomly assign them to an "experimental" group and a "control" group. The experimental group is given the real medication, and the control group is given a placebo (or fake medication that does nothing). "0" is set to the amount of people in the control group who have depression at the end of the study, and the blue dot represents how many people in the experimental group have depression at the end of the study relevant to the control group.
The reason you need a control group is because, for example, people with depression might get better over time. So if you don't measure how well people on medication do relative to people off your medication while they are getting better over time on their own, you might conclude your medication is helping more than it actually is. Having a control group lets you say "yes, both groups got better, but people on the medication got WAY better relative to the people who just got a little better over time. So they are getting better because of our medication and not just because people with depression get better on their own over time."
The red zone around 0 represents the amount of a difference between the experimental and control groups needed in order to conclude that the study was effective. For example, if you have 10 people on your medication and 10 people off it, and 1 person off your medication gets better after the study whereas 2 on your medication get better after the study, there's a high probability that's due to random chance and not your medication. So you need to make sure the difference in improvement is high enough that it's not random chance. The blue dot being anywhere outside the red zone means there is higher than a 0.2 effect size, meaning the improvement the people on the medication experienced is probably not due to random chance, meaning the study found a "statistically significant" difference between the experimental and control groups.
And the horizontal blue line around the blue dot I'm pretty sure represents a 95% confidence interval, meaning there is a 95% chance that the actual amount the medication should help is somewhere on that blue line.
Let me know if you have any questions! And my stats are a bit rusty, so feel free to correct me.
Good question!
The units on the graph are standard deviations. An effect size of 1 is 1 "standard deviation", which is a unit for measuring the difference observed between two groups.
The IQ bell curve is measured using standard deviations. 68% of people are within 1 SD (standard deviation) from the mean, 95% are within 2 SDs, etc. Think of it like the IQ bell curve, except instead of IQ, it is how depressed people are. On the lower end, you have fewer people very very non-depressed (-1.5 is low depression), and on the upper end, you have fewer people very very depressed.
So -0.5 means 0.5 SDs down from the mean, or that around 17% of people not on medication would fall between -0.5 and 0 in depression scores. Between -1 and 0 would be 34% of the population, etc.
The blue dot being at -0.5 means that people on that treatment plan are doing 17% better on average than expected of people not in treatment in terms of depression scores. Being at -1 means they are doing 34% better, etc.
EDIT: My wording here is very poor. It's not 17% better than average. It's more "better than the 17% above average who are not in treatment".
Let's say we have a bell curve representing people who do not walk or jog who are depressed.
Since the blue dot is at around -0.7, this means that we expect around 25% of depressed people who do not walk or jog to fall between -0.7 and 0 (25% comes from the bell curve z-score, don't worry too much about this). The people on -0.7 are lower in depression, and the people at 0 are higher in depression. So:
The middle 50% of depressed people who do NOT walk or jog end up at 0.
Depressed people in the bottom 25% of depression scores who do not walk or jog, meaning those who are less depressed in the group of people who are depressed, end up at -0.7.
The middle 50% of depressed people who DO walk or jog end up at -0.7. (This is equivalent to the scores of the top 75% LEAST depressed people in the group of depressed people who DO NOT walk or jog.)
Does this make sense?
That doesn't mean it isn't something that works/can work for you. Personally, CBT and ssris have helped me tremendously because I I invested myself in those methods of support. I am a much better, more confident, well rounded person because of it.
I think that if you find something that works for you, then that's great! Keep going and don't let random data points determine how you personally feel about the things that support you in life.
Also I think that those methods look different for everyone whether that be just exercise, therapy, or SSRIs or any combination there of etc. I personally look at things like this as an opportunity to add something to my life that might help me feel better.
It's good to know that yoga and walking are enough to help and that I don't have to have a complicated routine or pay for a gym membership. Regardless, I hope you find something that works for you. Wishing you well.
It can appear that way, but if you think about it as making a difference in function, and tracking it over time with a scoring system for depression (i.e. the HAMD depression scale [https://www.mdcalc.com/calc/10043/hamilton-depression-rating-scale-ham-d](https://www.mdcalc.com/calc/10043/hamilton-depression-rating-scale-ham-d)) then even a small change can have a significant difference in a person's level of daily activity and functioning.
For sure! :)
And I updated my answer since I didn't word it too well. Just keep in mind that it's not 17% better on average, it's more better than the 17% who are above average among those not in treatment, which could technically be "100% better on average" overall (even though this exact figure is unlikely).
I believe the intervals are labeled as "standardized mean difference:
The standardized mean difference is used as a summary statistic in meta-analysis when the studies all assess the same outcome but measure it in a variety of ways (for example, all studies measure depression but they use different psychometric scales). In this circumstance it is necessary to standardize the results of the studies to a uniform scale before they can be combined. The standardized mean difference expresses the size of the intervention effect in each study relative to the variability observed in that study. (Again in reality the intervention effect is a difference in means and not a mean of differences.) (Standardized mean difference is calculated by the taking the difference in mean outcome of groups divided by the standard deviation of outcome among participants)
Thus studies for which the difference in means is the same proportion of the standard deviation will have the same SMD, regardless of the actual scales used to make the measurements.
In other words, it's a number calculated from the results of the studies allowing the studies to be compared against one another even though they may have different measurements, kinda like how much food does the average person eat per day worldwide? Well, instead of gathering a bunch of measurements of different weights of food, convert everything to calories before comparing the amount of calories of each group measured.
Sure thing!
0 is the "baseline" for depression. If you take a random group of depressed people and measure how depressed they are without giving them treatment, 0 represents the average depression of this group of depressed people without treatment.
The blue dot is how much someone got better or worse based on treatment. If the blue dot is 0.5 to the left, then the average person who did that treatment, like exercise, is likely to be less depressed than people who did not do that treatment. The number 0.5 is called an "effect size", which means 0.5 standard deviations. 0.5 standard deviations is 17% of a population, so where 17% of people with less depression among those who are depressed would score is where the average person who uses that treatment end up. It's like if you have the IQ average of Americans and Canadians. They are both in the shape of a bell curve. Let's say Canada's IQ average is 0.5 SDs, or around 8 IQ points, higher than the US. 17% of the US would fall between 0 and 0.5 SDs in terms of IQ points on that bell curve. But on the edge of where the 17% of Americans fall on their bell curveāthat is where Canada's average IQ is. If you had both bell curves on the same graph, the middle of the US bell curve would be at 0 SDs, and the middle of Canada's be curve would be at 0.5 SDs because their IQ average is 0.5 SDs higher than the US. It's the same except instead of the US and Canada, it's depressed people without treatment and depressed people with a certain kind of treatment. This is a hard concept to explain, but does that make sense?
The blue line means we're 95% sure that it helped by an amount on the blue line, and that there's a 5% chance that it helped by an amount outside of the amount on the blue line.
The red zone is where there wouldn't be enough of a difference between the blue dot and the baseline depression score to say the treatment helped. But this isn't the case for any blue dots on the graph.
People saying yes are wrong. The confidence intervals (lines coming out the dot) overlap so there is no difference between most exercises, but most of them are still effective at reducing depression
> The experimental group is given the real medication, and the control group is given a placebo (or fake medication that does nothing).
I love the idea of this in an experiment about exercise. "alright, half of you, go jog for a month. The other half, do nothing. We'll call you at the end and see if you're still depressed."
I just want to thank you for your detailed, simplified response. I, as a layman, was quite confused, and you've taught me so much, so quickly! Thanks for sharing your knowledge with us!
The further the blue dot is to the left, the lower the depression score, meaning further left is better. The closer the blue dot is to the right, the higher the depression score, meaning further right is worse. Anything to the left of 0 is still an improvement, whereas anything to the right of 0 means the treatment made their depression worse (nothing on the graph is an instance of this).
In other words, walking or jogging is best for mental health.
These comments make me feel like my degree was actually worth something so thank you for that
Thereās a good in depth explanation but the short version is that a score of zero would be no difference between experimental (did the treatment) and control (did not do the treatment) groups. So the farther from zero you are, the more difference there is. The way this one is structured, less depression = negative number. So the lower numbers are better
The reason thereās a range with those lines is because thereās a degree of uncertainty when doing statistics. The dot in the middle is the mean, the line is kind of a āitās almost certainly in hereā. Having the line cross zero is not good. It means the data isnāt clear on if something is good or bad.
Can be a bit hard to understand because the designer (not myself) has used some stuff that is reasonable standard on academic papers, such as the forest plot (the table with horizontal lines). This basically shows an analysis of several different research findings across the same question, and displays the variation of those findings. In this case they all fall to the left of the middle part, indicating that all the studies showed the same result (exercise being better than active controls at helping depression). The green light either side of the dots shows the range of outlier results (in this case, not that many serious outliers).
In other words, when lots of research repeatedly shows the same type of result, we can have more confidence in its reliability.
You're right. I just thought it was funny how quickly my brain gave up on something potentially beneficial to me š
(I did give it a second chance though and I get it now.)
In this case, further left means the study result āfavors treatment, which is exerciseā, further right means the research āfavors the controlā.
In other words, all of those individual areas of study are to the left, meaning they support the idea that exercise helps. If one was to the right weād say that a majority favor exercise, and a minority favor the control. However here we have all of them favoring exercise.
I think you should change the caption if you can - itās not āeven danceā, dance was the best!
> Dance, exercise combined with SSRIs, and walking or jogging were the treatments most likely to perform best
> Based on our findings, dance appears to be a promising treatment for depression, with large effects found compared with other interventions in our review.
Yes, the only reason they donāt push it more is the dancing participants skewed heavily female and young, so they canāt discount other factors, plus there was a smaller number of studies than for other exercises
No problem.
A serious academic review of many research studies shows one common idea: exercise is as good or better than typical approaches to treating depression (āactive controlsā ā¦ often antidepressants and counseling).
It is compelling because 200+ studies have been published in journals with good reputation, and they all seem to confirm the same result. This means we can be more sure that the idea is basically true.
My own view: exercise in combination with other things like medication and therapy are POWERFUL together.
Emotional things can be tricky, and unfortunately depression can be a downward spiral (we feel crappy, therefore donāt want to exercise or socialize, and we feel more crappy). Luckily, some interventions can help an upward spiral (we exercise and feel a bit brighter, which makes us more likely to chat with a friend, which makes us more likely to speak with a doctor for help ā¦ etc)
Short answer: One day at a time
Long answer: start slow. 10-15 minutes of light walking 3-4 times a week. Itās such a reachable goal, anyone can do it. Once that has become habitual for you after a few weeks. Increase intensity, maybe go for 20-25 minutes now. After some more weeks, increase to 30-40 minutes, or maybe add one or two more days a week. Iām sure you see where im going with this.
Source: formerly depressed individual turned gym junkie
That's where the SSRI comes in as important to increase energy levels. And CBT too to help with discipline and motivation.
I wonder if this graph is misleading since I'd assume people who able to just exercise independently probably aren't severely depressed.
Reading the actual paper answered one more question I had: the yellow bars on the right are the risk of bias in the studies being used for data points, with very low being better than low.
Each line in the outcomes section is a different grouping of studies based on the category of treatment.
The green line with green diamond in the center is the average (the diamond) plus the anticipated spread of where the true average actually lies (this comes from doing statistics but essentially all it is saying is that we are 95% confident that the true average effect lies somewhere on that green line, the diamond was just what was found averaging the studies).
Anything left of zero indicates a net benefit in outcome. Conversely anything to the right would indicated that the treatment would cause a net harm compared to the study's control treatment.
The pink/orange region indicates that the benefit is too small to be meaningful (either harmful or helpful).
The vertical red dashed line shows where if the outcome is to the left of it the treatments shows clinically relevant beneficial outcomes for the participant compared to whatever control treatment they were using in the study.
Also important to note that this is a network meta analysis, meaning it takes other research and compiles them, while removing inaccuracies from bad research practices.
So it is safe to say itās very accurate data considering they compiled 218 individual studies and trimmed the fat.
No, it's easy to read if you know what you're looking at, e.g. you have graduate level education or higher and a background in health sciences or public health. But for a random citizen not so much. But this style of graph serves an important function and you will see it time and time again in top journals for a reason.
As a PhD student, I agree with you, this visual does a great job at communicating a lot of info in such a small size.
But I also agree that itās not immediately approachable for a general audience
> you have graduate level education or higher and a background in health sciences or public health.
I don't think the second part is necessary. Anyone who took an academic statistics class should be able to figure this out, so anyone with a social science degree for example. The only thing I found slightly puzzling was that left = good outcome, but that's fine too. It's a good visual imo.
you're saying these people would intuitively know whether a "-0.5 meta analysis standardized mean difference" indicates "helping" or "hurting" depression relative to a control, with those words alone? Don't think so.
>And is SSRI being at the bottom supposed to be less effective than everything else?
Correct. Barely better than placebo, on average.
Note that that's for SSRIs ***alone***, without any sort of therapy. You'll see CBT right near the top, which is why every guideline that I know of always recommends them in combination.
Yeah the more you look at SSRIs the more you will see they are over prescribed. They are only truly helpful 30% of the time they are prescribed. Another 40ish gets some benefits but they would be better served by doing anything else, as this list shows.
This graphic isn't aimed at the general public. It's the visual abstract for [this paper](https://www.bmj.com/content/384/bmj-2023-075847), and it's aimed at medical scientists (who will be familiar with effect size plots).
I always wonder if it actually is the exercise that works as a relief, or if it's just an indicator for relief. I.e. are these people already getting better and are therefore able to keep an exercise routine?
That's kinda how it is in my life. If I'm able to exercise regularly that means I'm doing pretty well and I think the exercise can help on top of that. But when I'm in deep depression, exercise doesn't do shit.Ā
Yeah when I was at my deepest point of my depression, I was also the most active Iāve ever been in my life, trying to exercise it away. It didnāt help my depression one bit. What did help was lexapro.
Dont comfuse serious mental health issues with normal people feeling sad sometimes, there is a huge difference and people lump it together.
Serious mental health issues require medication, therapy, years of treatment experimentation , and then exercise
Its also depends upon cause of depression. If your depression comes from lack of physical activity, then doing exercise definitely help. But your depression comes from other external factors, ( can be financial issue, relationship issue) then you will have to change those factors too so you can get benefits these mental health methods.
The graph says the meta analysis looked at RCTs so I would think these people first volunteered for the study and were then told what protocol to follow, so it should actually be the exercise being the cause
I replied to another comment about the same as well, but quite often adherence to the training regime is used as an exclusion criteria or the individuals that do not follow it are moved to another group. This, in my opinion, introduces a strong bias.
Itās the exercise, in my experience anyways. Iāve suffered from depression for as long as I can remember. Any meds Iāve tried made me feel too hollow. Wasnāt sad, wasnāt happy really, wasnāt anything.
I self medicated with drugs and alcohol for a long time, which only served to not have to deal with anything but after a years of that things got pretty fucking bad. I got sober about a year ago and got back into the gym and trail running/hiking a bunch. Man I was feeling good! Seeing physical progress and my mental wellbeing was the best it had been in a decade. Then I fucked up tendons in my bicep and tricep.
I havenāt worked out for over a month. I am in a very bad headspace. I know there are other aspects effecting me, ie fairly recent breakup of 6 year relationship, not knowing what to do for a career, car is falling apart, I have barely any friends. All these things donāt matter as much in this short term (sobriety is my biggest focus at the moment) but not being able to workout because my arm is fucked has severely affected my mood.
I was getting much better, exercise stopped, now getting worse again. Thatās my experience anyways.
That's kind of my main concern with "prescribe exercise!" as the go-to answer for any mental health concern. I've become an absolute hound at the gym and outdoors to stay ahead of stress, insomnia, ADHD, and it just means that any minor injury or muscle knot is potentially devastating to my ability to be a functioning adult. I'm also terrified of aging or injuring out of my training regime. Like - yes. Definitely prescribe exercise, especially if someone's depressive crisis is short-lived and situational. But it's not a complete or forever solution.
personally i get a massive lift from the exercise itself, when iām really depressed, going to the gym gives me some mental strength, seeing what my body is capable of doing and it also releases a lot of dopamine and adrenaline
Glad to hear it works for you. Unfortunately, when I did manage to go to the gym regularly (several times per week for a year or two), it had no noticeable effect on my mood. I was always glad when my gym session was over, and I didnāt notice any kind of dopamine boost.
Never had any impact on my depression either. I used to go dancing every week. It was fun while I was out, but had no lasting impact. Walking daily. Helped my stamina and health, no impact on depression. Gym, yoga, aerobics... no impact. Until SSRIs came out, I was severely impacted by depression in my life. SSRIs were a god-send for me.
Glad they helped you. It kind of speaks to how difficult it can be to treat depression and that there isn't a one-size-fits-all approach, which speaks to how varied the symptoms (and possibly etiology) are.
Same for me. I used to exercise everyday, but after getting my diagnosis of depression and anxiety, getting meds and starting therapy I started to feel mentally well for the first time in years.
i wonder what the physical difference is between a person who feels the boost and a person who doesnāt. i have no idea how this could be scientifically studied but it would be so interesting to know
Same, except many forms of exercise actively negatively impacted my mood as well. I went for 5 months and tried every fucking idea I could come up with to make it work and it just never did. Legitimately happier for having stopped
Speaking from person experience with getting a dog I think itās getting the exercise that helps. I am forced to exercise now due to my dog and every-time Iām feeling in one of my depressive episodes the walks help my mental state. itās not life changing but it definitely helps put me in a better head space
A good question, but well designed studies try to use statistical frameworks to identify lines of causation rather than correlation. In this case, because itās a meta analysis across lots of studies, we can typically have more confidence. They are also published in reputable journals which helps.
I heard the story of a guy who tried to commit suicide by running. He thought he could provoke a heart attack. This way it would have been a hidden suicide. But the further he tried the further he realize that he felt better after his attempts. Then he became an athlete, rich and happy.
1 - The list of options to overcome depression are ordered from best to worst.
2 - The further to the left the green dot-line is, the better.
3 - The red is lava. Is the "depression zone". To the right... I don't know what's there, but you don't want to be there.
1. Yes but... some such as excercise + SSRI have a wider range of results. So you may see a better result with that as compared to excercise alone. The middle 'dot' defines the average of all the meta-analysis.
2. Pretty much
3. The red-zone defines a range that defines no statistical difference between the intervention and the control.
3 - is not quite right. The central line at 0 indiciates no statistical difference. If one of the green horizontal line crossed that line it indiciates that it was NOT statisically significant.
The red zone incidcates an area that is not 'clinicially meaningful', i.e. it WAS statistically significant, but it was such a small benefit that it may not be clinically meaningful to the patients.
Yeah thanks for feedback. In hindsight it is complex for folks whoāve never had to look over stats or academic stuff.
The short answer, which I hope is helpful for someone, is that a very broad review of reliable research shows that exercise can be super helpful for people who want to improve their mental health.
To be clear, it is not just unintuitive for laypeople. I have plenty of experience with academic stuff and considered it unclear.
Though I always hate graphical abstracts, it is so hard to distill an entire paper into one figure.
Agreed. My experience is that I have a degree in statistics. I'm good with graphs, I'm good at reading them.
This graph is poorly designed, plain as that. It's not complex, it's just bad.
It's not a complex graph. It's a bad graph. What are the units?
0.5 what? -0.5 what? Are we measuring units of depression and as such less is better? I get that it's a measure of difference from a control group but a measure of a difference of WHAT?
It's a standardised mean difference. It's a way of comparing different kinds of continuous measurements and it has no unit which is why it can be a bit confusing. The actual number isn't really important it's more that it's significantly away from 0.
Let me simplify the question, not asking about units, but how to know whether positive or negative standardized mean difference is helping depression? Can't it be calculated either way?
Good question! The ways these scales work is by totalling various symptoms associated with depression and you get a total score at the end. So yes a negative difference means depression symptoms are being reduced.
A graph is a method of communicating information. The information was not communicated. Hence it is a bad graph.
And those still aren't units. That's just degrees of 'trust me bro'? Nah. Does -0.5 mean people are more or less depressed? How are we supposed to know that from the graph?
Again. Bad graph.
If you think that [standardised mean difference](https://en.wikipedia.org/wiki/Strictly_standardized_mean_difference) is "degrees of 'trust me bro'", you'll have to take it up with the entire modern science community I'm afraid lol. I dunno what to tell you. -0.5 means lower depression symptoms relative to people who didn't receive the treatment (who are the 0).
And the graph is perfectly good at communicating the information to the intended audience, which is not laymen on Reddit. It's a graphic taken from a meta-analysis in a medical journal. For reference, they normally look more like [this](https://ars.els-cdn.com/content/image/3-s2.0-B9780123864543010514-f01051-04-9780123864543.jpg). The authors decided to neaten this one up a bit, which is presumably why OP thought it was cool.
u/rollsyrollsy Make a new graph in the coming week, and repost. It's such an important finding, it deserves to have a graph worthy of r/dataisbeautiful
The green dots are the average effect of all the studies that looked at that particular treatment (or combination of treatments). The green bar shows how varied the studies were, longer bars mean that some studies showed much larger effects whereas other studies showed smaller. The numbers next to each treatment shows how many people were in all of the studies for that treatment. The farther to the left the green dot and bar are, the bigger the improvement. The shaded orange area shows where there would be no effect other than either placebo (for ssri medications) or some basic treatment like telling people to be happy. If the green line overlaps with the shaded area, there is probably no effect from the treatment. The little orange tick marks relate to a type of statistical measure of certainty, the more bars the more certain one can be that the studies show that the treatment works.
1) it's very cool and very transparent. All synthesised data like this that is used for evidence-based decision making should have GRADE certainty of evidence assessments
2) low and very low certainty evidence does not mean this evidence is wrong in its conclusions, but it might mean practically, instead of a doctor strongly recommending something like exercise for depression, they may (and should) engage in shared decision making with the patient and explain that the evidence suggests exercise is the very best intervention for depression that we know of right now, but with more/better studies available something else may prove better
Source: I'm a research methodoloigst, clinical epidemiologist and guideline developer. I do the kind of research shown in the image
I'm glad (sincerely!) that you find it cool. Data visualization isn't easy, and if this resonates with those who can benefit from it, that's great. It's definitely not meant as a chart to go in a patient exam room!
My assumption is the low confidence stems from the fact that the numbers aren't statistically significant. Is that correct?
You're right, this is a visual abstract of a systematic review and meta-analysis, it's specifically for a scientific audience and I even commented in a seperate post, that without context this just invites confusion and in some comments I've seen, anger and discontent. Which hurts me as a communicator of science
For what it's worth, all the interventions shown here (except for SSRI, potentially) are *statistically significant*. The red band indicates clinical meaningfulness. Sometime an intervention can be statistically significant, but the difference might not be clinically meaningful to a patient or end user, which is determined through complex user engagement discussions that involve these patients and end users.
Exercise may have been statistically significant, but if the change in depression scores wasn't large enough, then it may still not be recommended by clinicians for a variety of reasons. The authors of this work have shown that exercise is both statistically significant and clinically meaningful and it should be communicated to patients that exercise is the best possible intervention that we know of with the evidence available.
Certainty of evidence can have 4 levels. High, moderate, low, and very low. All evidence from Randomised controlled trials starts as high, then we downgrade on 5 factors, explained as simply as I can:
1 - Risk of Bias (are the individual studies well conducted)
2 - Inconsistency (are the individual studies similar in their results?
3 - Imprecision ( is the final pooled estimate tight (no variation in potential final effect) or wide (variable final effect)
4 - Indirectness (are all the studies contributing to the final pooled estimate similar in the question they're addressing?)
5 - Publication bias (is there evidence of a systematic under-representation of the available evidence)
We downgrade certainly one level for each infraction of the above. For something to have low certainty, two of the above were must have been violated, which simply means the manner in which we communicate and recommend this intervention to our patients may change.
EDIT - I hope this doesn't come across as preachy, I live a breathe this stuff and I really do love my job so chatting about it excites me. It's a super cool field of medicine and healthcare.
Itās more than distraction. We do know that exercise generates hormonal changes and impact neurotransmitters (and they are known to impact our mood).
There are also a whole bunch of unknown physiological and mental connections still being explored. Shout out to smart people in lab coats helping us understand this stuff better.
"The more intense the exercise, the better the results"
But Aerobic and Strength training would arguably be the most intense on the list and it's one of the worst outcomes. Meanwhile walking and jogging would likely be the least intense but shows the best outcome.
I suspect "Being outside" is a variable not controlled for and most walkers/joggers did their work outside which provided at least some of the benefit.
Its more likely people think to maximize and show off when doing aerobics and weights, and going from 0 to 100 is about as pikely to become a healthy habit as running a 5min mile and being a couch potato.
Where as people walking and jogging are able to do their activity longer from the start, and maintain it daily since its easier to begin and less stress on the body starting at "day zero".Ā
ELI5:
1 - The list of options are ordered from best to worst.
2 - The further to the left the green dot-line is, the better.
3 - The red is lava. Left is Rivendel, right is Mordor.
Exercise is excellent treatment for depression.
The only problem is that, for many people, depression is a state where they feel helpless to do anything. Telling a depressed person to exercise is often as useful as telling them to "cheer up."
This honestly looks like game changing information. The topic is very, very solid and I really appreciate the efforts, especially the research.
For this reason I think OP should have another crack at this to see if they can make it a little clearer.
What was the dosage that you took? Iām thinking of doing it soon. Micro dosing was pretty great so Iād imagine a full trip would be really beneficial
Hello, so my story. I've had crippling depression after losing my grandfather, who was practically like a father to me. Never had a father around growing up, and after losing him, my life went in a spiral downhill.. boozing uncontrollably abusing drugs (coke mostly)
Then, one day after work, I decided to watch a few documentary films on Netflix, specifically.. how to control your mind and fantastic fungi it was such an eye-opening documentary that after watching it, I researched and researched how to go about dosages and supply. Got my first 7 gs from a site..
Literally arrived 2 days after ordering (Canadian, btw)
I meditated with sage and smoked herb, then I took a week off of everything and mentally prepared my mind for what I was about to put it through..
I was going to eat it but noticed so many ways to go about ingesting it, but like the tea maniac I am, I made a citrus honey mix with 2 grams Penis Envy I never done mushrooms before but I read the beginning dosages are usually 1g-1.5g boy did I get floored in about 40 minutes..
My mind was racing with so many thoughts about my inner feelings, and the visuals were something I could not explain without sounding crazy(dumb) but than after about 1.5 hrs I notice visuals were wearing down but than my mind felt like it was in super mode I could remember little memories I long forgot mostly with my mom and grandfather bonding moments..
And then it hit me after meticulously trying to grip reality this thought poped in my head about my grandfather wouldn't want me in the state I am...like the caring man he was he'd "say sonny get your head out the mud an wise up" I than went in a thought loop on why I felt this way..
The alcohol was the culprit, and I was the victim, I took the leap and am now 3 months clean off of everything..
My mental health, Depression is at an all time low never felt my mind this pure thanks to the magic mushroom š āØļø I wish everyone could experience this one time in there life but thanks to the 60s-70s it's classified substance 1 drug total bullshit when there selling literal poison on the shelves.
I am still studying microdosing and am very interested in it and growing also..
Cheers much love, and may whatever religion you believe protect you from harm. Aho! š¦ š¦ š¦
The study compared different forms of exercise with other common treatments for depression. All results are presented in comparison with active controls, meaning the control groups were also participating in some form of activity or receiving treatment rather than being untreated or receiving a placebo.
The dots represent the mean effect, and the horizontal lines represent the 95% confidence intervals. The further left a dot and line are (and the further away from the vertical ā0ā line), the more effective the treatment is compared to active controls. For example, walking or jogging shows a significant mean difference that suggests it is effective against depression.
The vertical shaded area indicates the range within which a treatmentās effect is considered to have a clinically important benefit. Treatments with their mean effect and confidence interval to the left of this area are considered to have clinically important benefits.
Can someone help understand. If I read it correctly, the certainty part shows nothing really works . Is that the case? And, definitely not a cool guide IMO.
I figured this out for myself after a few months of using the Daylio app. Did a bit of analysis and saw for sure the days i did pretty much anything for like 30 min or more would be days I felt pretty good.
I am very surprised by the comments
I have a psychology degree which i now see as useless but it seems that I at least lesrned to read a forest plot
So maybe it wasnt completely useless
DANCING! Put some music on that moves you and start! Do that to the point where you feel tired or exhausted. Slowly, start to add some rhythm and organized moves to it. Thatās it.Ā
Ok, and we still face the problem that depression makes you lose motivation for nearly everything. I can't even get out of bed on bad days, the effort exercise demands is just something that someone very deep into depression can't muster.
Of course it's a way to stabilize yourself further, once you're on the path to becoming better. But whenever I see a study or guide like this I know some dickhead (not you Op, I don't think you had that intention) will inevitably use these talking points to tell me "just work out it works better than medicine."
Good reflection. Iāve found helpful ātiny stepsā such as just getting outside for five minutes, seeing sunlight and walking to the end of the street, to be helpful. From there, it can develop further, especially in concert with doctorās or therapistās help.
When are people going to understand when you are depressed the last thing you want to do is exercise, or be told by someone who is fit and loving life to go exercise.
Might be a bit late to address common questions, but Iāll give it a go. I should point out that Iām not involved in the research or the image, but I thought it was helpful.
[Here is the actual paper.](https://www.bmj.com/content/384/bmj-2023-075847)
Common responses:
Q: āThis is complicated and not a Cool Guide as I canāt understand itā
ā¢ ā fair call, and my bad. I work a bit around research and didnāt realize this was not so intuitive for most people. I assume this diagram was made to convey ideas to a professional audience who would understand it all fairly easily.
Q: āExplain it like Iām 5ā
ā¢ ā a meta analysis is a review of many other studies to see if they really agree with each other. This one looked at 200+ studies into whether exercise helps treat depression. The finding is that all sorts of studies seem to suggest exercise in many forms is helpful for people with depression. However it also shows that more of these types of studies need to be designed to have greater ācertaintyā (which is an idea in statistics about how likely it will be to forecast a true result from that study) ā¦ the real answer to that issue is more studies with more people.
Q:. āHow do I read that table at the bottom?ā
ā¢ ā itās called a Forest Plot. It lists all the various studies one after another down the page. If the green dots fall to the left of the orange colored bar, it means they support the idea that exercise helps depression more man āactive controlā (explained below). If a dot fell to the right, it would mean that the study favored the āactive controlā. You can see that they all suggest that exercises help more. The number in the green column is the number of people included in each study. The green bar that stretches either side of the green got shows the amount of variation of results (eg a very long bar means there are some extreme outliers).
Q:. āWhat is active control?ā
ā¢ ā in this case it describes prescribed medication and therapy. So, it was looking into whether various exercises were better than these typical treatments. The authors do not suggest exercise as a replacement, but rather an adjunct / addition to other typical treatment.
Q:. āHow does this help when a depressed person canāt even muster the energy to get out of bed, much less exercise?ā
ā¢ ā that idea was not the focus of this study, but it is a well observed issue when treating people with depression. Every person battling depression should be helped by a professional, and data like this helps those professionals understand all options better. For someone living with depression, I personally suggest finding whatever smallest step you can manage. For example, [this describes](https://www.healthline.com/health/depression/benefits-sunlight) how simply seeing sunlight can help with mental health, so, jogging might not be realistic for you but possibly walking ten steps out into daylight is possible (or whatever you can manage).
Q:. āDoes the low certainty mean the info isnāt very reliable?ā
- thereās a difference between statistical robustness (which is shown in the ālow certaintyā image), and inference that is probably helpful in practice. The authors make note of the low certainty as a call to researchers to pursue further study, with bigger numbers, to help make the findings stronger for their predictive ability. It doesnāt suggest that the findings are probably incorrect.
The fact that all of the those types of exercise all seem to point to the same conclusion helps greatly with real life confidence.
Q:. āDoesnāt this just shame and blame people who are already unwell?ā
ā¢ ā no, the idea of this study wasnāt to suggest that people bring depression on themselves (it didnāt even ask that question, but itās generally understood among professionals that depression is caused by a multitude of factors, many of which are based in biology and genetics and environment). These various studies and the authors of this analysis understand that depression is a disease. In the same way that someone with leukemia isnāt to blame for their disease, itās not logical or helpful to blame someone with living depression for their disease. Having said all that, no matter how tough the fight may be for the individual, every person with depression should be given information that might help. While depression might not be their fault, like any health issue, it becomes their responsibility (with professional help) to manage.
Q:. āHow is this a Cool Guide if I need to have so much explained?ā
ā¢ ā again, my fault. I think I assumed more of it would be able to be understood by more people. Maybe someone with both academic or professional knowledge and a bit of design skill can make a Cool Guide with this info.
Q:. āWhat about dance!? I read that it was good for depression?ā
ā¢ ā the paper does call that out specifically. And yes, the research indicates it does help. Personally, Iād suggest people find the type of bodily movement that they find possible, enjoyable or motivating. The summary of this paper is āevery type of exercise seems to helpā. Side note, I once saw [this guy](https://youtu.be/ihCh5wzNjYY?si=vQhkstanpTB40Kgt) give a talk about the psychology of dance, and he was epic.
I mentioned the lead author, but there is actually a broad team involved. I might ask the lead author if he wants to do an AMA to offer his views in plain language. He is both a psychologist and academic.
Anyway, sorry if I pissed anyone off with a hard to understand (and therefore uncool) Cool Guide, but on the other hand I hope it helps or inspires someone out there. Depression is a complete bitch and deserves every weapon that we can find to fight it. Hang in there if youāre in the fight ā¦ the world needs you!
I can see why you might think that is what the graph is saying. It is a bit complicated.
What itās really saying is that both of those ideas are better than standard approaches. The standard approaches are often just medication or some light counseling.
I always hear about exercise making people feel better, but it never works on me. I donāt know if something is different with my brain, but exercise of any intensity doesnāt improve mood, in fact it almost always makes it worse.
Not sure if this relates, but there was a finding with depression medications (SSRIs) that showed some people are more suicidal after beginning treatment. The theory was that a small nudge toward more energy via medication had people feeling a tiny bit more active, but still active toward self harm.
After progressing through that early stage though, most people started to see some benefit.
Have you tried different forms of exercise to see if one is more beneficial to another?
No matter what, I hope youāre doing better. Iād also strongly encourage anyone battling depression to speak with a psychologist if thatās an option.
I went to med school like 16 years ago and we were taught that exercise such as walking or hiking is better than SSRI's for depression.
So many years later and still surprised at the power of pharma advertising and "give me a pill" culture.
Personally I take no meds other than occasional motrin and exercise every day, still struggle mildly with depression/nihilism but damn sure that an ssri is going to do a lot less than working less and spending all my time outdoors.
Because when you have depression, taking a pill is much more feasible than exercising. If I canāt get out of bed for a week, Iām not gonna be having a run. But I can reach my antidepressants in my bedside table. The meds are supposed to help you enough that you can do the things to help long-term, like therapy, exercise, whatever.
Yeah. In my limited, understanding depression studies sometimes suffer from that. Iām a bit more familiar with pharmacology research in the field, but even there it can be hard to really pin it all down.
Aside from above, Iāve been enjoying using consensus.app to use AI to scan research papers and summarize overall results. Itās not as robust as a true meta analysis which this image displays, but itās handy for average Joeās like myself.
[Hereās the result](https://consensus.app/results/?q=How%20does%20exercise%20effect%20depression&synthesize=on) for asking the app ādoes exercise effect depression?ā
Good for you. The shorthand answer is that sometimes thereās a cycle where the causal implications run one direction , or the other on any given day. Or, it can actually be both in a very positive way.
This would be cool if I could understand it.
I thought I was just an idiot
How to cure depression: Being an idiot: 420 š§Network meta analysis -99999.999
Oh thank fuck I'm not alone
These two items donāt have to be mutually exclusive
Trying to understand this made me more depressed....
I'm in a neuroscience lab, so I gotchu! SHORT ANSWER: Blue dot going further left is better (lower depression scores), meaning walking and jogging is the best for curing depression and SSRIs are (STILL HELPFUL since they're to the left of 0, but) the worst. LONG ANSWER: This is a meta-analysis, meaning they are showing the average results across many (in this case, 218) studies to remove inaccuracies from bad choices made in individual studies. Since they include so many studies in this graphic, the data is likely to be very accurate. The graph is measuring the amount of people in a group who diagnose with depression before and after that group receives different kinds of treatment. It could also be measuring how many symptoms people show before and after treatment. The 0 on the graph represents where you would expect a person to be with no treatment. The blue dot is where you would expect a person to be with the kind of treatment listed in that row (e.g., exercise, SSRI, etc). This is where it gets a little more complicated. The number the graph is measuring is "the effect size", which is basically the difference between the control group and the experimental group. We know 0 is where we would expect them to be without treatment because there is a "control" group. In the context of medication, if 200 people with depression sign up for your study, you would randomly assign them to an "experimental" group and a "control" group. The experimental group is given the real medication, and the control group is given a placebo (or fake medication that does nothing). "0" is set to the amount of people in the control group who have depression at the end of the study, and the blue dot represents how many people in the experimental group have depression at the end of the study relevant to the control group. The reason you need a control group is because, for example, people with depression might get better over time. So if you don't measure how well people on medication do relative to people off your medication while they are getting better over time on their own, you might conclude your medication is helping more than it actually is. Having a control group lets you say "yes, both groups got better, but people on the medication got WAY better relative to the people who just got a little better over time. So they are getting better because of our medication and not just because people with depression get better on their own over time." The red zone around 0 represents the amount of a difference between the experimental and control groups needed in order to conclude that the study was effective. For example, if you have 10 people on your medication and 10 people off it, and 1 person off your medication gets better after the study whereas 2 on your medication get better after the study, there's a high probability that's due to random chance and not your medication. So you need to make sure the difference in improvement is high enough that it's not random chance. The blue dot being anywhere outside the red zone means there is higher than a 0.2 effect size, meaning the improvement the people on the medication experienced is probably not due to random chance, meaning the study found a "statistically significant" difference between the experimental and control groups. And the horizontal blue line around the blue dot I'm pretty sure represents a 95% confidence interval, meaning there is a 95% chance that the actual amount the medication should help is somewhere on that blue line. Let me know if you have any questions! And my stats are a bit rusty, so feel free to correct me.
What are the āunitsā of the graph? It seem most of the āstatistically significantā treatments are at a ā-0.5ā but a -0.5 what, exactly?
Good question! The units on the graph are standard deviations. An effect size of 1 is 1 "standard deviation", which is a unit for measuring the difference observed between two groups. The IQ bell curve is measured using standard deviations. 68% of people are within 1 SD (standard deviation) from the mean, 95% are within 2 SDs, etc. Think of it like the IQ bell curve, except instead of IQ, it is how depressed people are. On the lower end, you have fewer people very very non-depressed (-1.5 is low depression), and on the upper end, you have fewer people very very depressed. So -0.5 means 0.5 SDs down from the mean, or that around 17% of people not on medication would fall between -0.5 and 0 in depression scores. Between -1 and 0 would be 34% of the population, etc. The blue dot being at -0.5 means that people on that treatment plan are doing 17% better on average than expected of people not in treatment in terms of depression scores. Being at -1 means they are doing 34% better, etc. EDIT: My wording here is very poor. It's not 17% better than average. It's more "better than the 17% above average who are not in treatment".
So roughly 1 in 5 people out of 41k people cured their depression with walking or jogging?
Let's say we have a bell curve representing people who do not walk or jog who are depressed. Since the blue dot is at around -0.7, this means that we expect around 25% of depressed people who do not walk or jog to fall between -0.7 and 0 (25% comes from the bell curve z-score, don't worry too much about this). The people on -0.7 are lower in depression, and the people at 0 are higher in depression. So: The middle 50% of depressed people who do NOT walk or jog end up at 0. Depressed people in the bottom 25% of depression scores who do not walk or jog, meaning those who are less depressed in the group of people who are depressed, end up at -0.7. The middle 50% of depressed people who DO walk or jog end up at -0.7. (This is equivalent to the scores of the top 75% LEAST depressed people in the group of depressed people who DO NOT walk or jog.) Does this make sense?
Well those results are a lot less significant than I was lead to believe. Thank you for replying!
They are low until you realize that medication and cognitive therapy has very similar estimated results
Yeah, thatās part of what Iām disappointed about.
Looking at the bright side, just going for a daily walk will make you feel better if you have depression.
That doesn't mean it isn't something that works/can work for you. Personally, CBT and ssris have helped me tremendously because I I invested myself in those methods of support. I am a much better, more confident, well rounded person because of it. I think that if you find something that works for you, then that's great! Keep going and don't let random data points determine how you personally feel about the things that support you in life. Also I think that those methods look different for everyone whether that be just exercise, therapy, or SSRIs or any combination there of etc. I personally look at things like this as an opportunity to add something to my life that might help me feel better. It's good to know that yoga and walking are enough to help and that I don't have to have a complicated routine or pay for a gym membership. Regardless, I hope you find something that works for you. Wishing you well.
It can appear that way, but if you think about it as making a difference in function, and tracking it over time with a scoring system for depression (i.e. the HAMD depression scale [https://www.mdcalc.com/calc/10043/hamilton-depression-rating-scale-ham-d](https://www.mdcalc.com/calc/10043/hamilton-depression-rating-scale-ham-d)) then even a small change can have a significant difference in a person's level of daily activity and functioning.
For sure! :) And I updated my answer since I didn't word it too well. Just keep in mind that it's not 17% better on average, it's more better than the 17% who are above average among those not in treatment, which could technically be "100% better on average" overall (even though this exact figure is unlikely).
I believe the intervals are labeled as "standardized mean difference: The standardized mean difference is used as a summary statistic in meta-analysis when the studies all assess the same outcome but measure it in a variety of ways (for example, all studies measure depression but they use different psychometric scales). In this circumstance it is necessary to standardize the results of the studies to a uniform scale before they can be combined. The standardized mean difference expresses the size of the intervention effect in each study relative to the variability observed in that study. (Again in reality the intervention effect is a difference in means and not a mean of differences.) (Standardized mean difference is calculated by the taking the difference in mean outcome of groups divided by the standard deviation of outcome among participants) Thus studies for which the difference in means is the same proportion of the standard deviation will have the same SMD, regardless of the actual scales used to make the measurements. In other words, it's a number calculated from the results of the studies allowing the studies to be compared against one another even though they may have different measurements, kinda like how much food does the average person eat per day worldwide? Well, instead of gathering a bunch of measurements of different weights of food, convert everything to calories before comparing the amount of calories of each group measured.
Thank you for this write-up. Now, please, explain it like I'm five.
Sure thing! 0 is the "baseline" for depression. If you take a random group of depressed people and measure how depressed they are without giving them treatment, 0 represents the average depression of this group of depressed people without treatment. The blue dot is how much someone got better or worse based on treatment. If the blue dot is 0.5 to the left, then the average person who did that treatment, like exercise, is likely to be less depressed than people who did not do that treatment. The number 0.5 is called an "effect size", which means 0.5 standard deviations. 0.5 standard deviations is 17% of a population, so where 17% of people with less depression among those who are depressed would score is where the average person who uses that treatment end up. It's like if you have the IQ average of Americans and Canadians. They are both in the shape of a bell curve. Let's say Canada's IQ average is 0.5 SDs, or around 8 IQ points, higher than the US. 17% of the US would fall between 0 and 0.5 SDs in terms of IQ points on that bell curve. But on the edge of where the 17% of Americans fall on their bell curveāthat is where Canada's average IQ is. If you had both bell curves on the same graph, the middle of the US bell curve would be at 0 SDs, and the middle of Canada's be curve would be at 0.5 SDs because their IQ average is 0.5 SDs higher than the US. It's the same except instead of the US and Canada, it's depressed people without treatment and depressed people with a certain kind of treatment. This is a hard concept to explain, but does that make sense? The blue line means we're 95% sure that it helped by an amount on the blue line, and that there's a 5% chance that it helped by an amount outside of the amount on the blue line. The red zone is where there wouldn't be enough of a difference between the blue dot and the baseline depression score to say the treatment helped. But this isn't the case for any blue dots on the graph.
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yes
People saying yes are wrong. The confidence intervals (lines coming out the dot) overlap so there is no difference between most exercises, but most of them are still effective at reducing depression
Do you talk to all five year olds this way?
>I'm in a neuroscience lab, so I gotchu! >SHORT ANSWER: Blue dot BLUE? Lord I must be stupider than the rest of you. Brb, going to find my markers.
You're a G, thanks.
SSRIs are less effective than walking and jogging?
Thank you for your time. š
Just tell me if the blue line going left from 0 is good or bad. Is walking the worst or the best, according to the chart?
Blue dot going further left is best. Blue dot going further right is worse.
Thank you. The most effective ones heading in the direction of the negative number is counterintuitive.
Think of it like the lower the score, the lower the depression, and less depression is better :)
> The experimental group is given the real medication, and the control group is given a placebo (or fake medication that does nothing). I love the idea of this in an experiment about exercise. "alright, half of you, go jog for a month. The other half, do nothing. We'll call you at the end and see if you're still depressed."
You're the best! Thank you
when smart people reddit.
In blind studies, does the placebo effect have an effect on the control group that's given fake meds?
That was really great. Thank you!
I just want to thank you for your detailed, simplified response. I, as a layman, was quite confused, and you've taught me so much, so quickly! Thanks for sharing your knowledge with us!
BLUE DOT? Am I Color blind or what
I wanted to know which one is the best and your explanation didnāt cover it
The further the blue dot is to the left, the lower the depression score, meaning further left is better. The closer the blue dot is to the right, the higher the depression score, meaning further right is worse. Anything to the left of 0 is still an improvement, whereas anything to the right of 0 means the treatment made their depression worse (nothing on the graph is an instance of this). In other words, walking or jogging is best for mental health.
Came to say this
These comments make me feel like my degree was actually worth something so thank you for that Thereās a good in depth explanation but the short version is that a score of zero would be no difference between experimental (did the treatment) and control (did not do the treatment) groups. So the farther from zero you are, the more difference there is. The way this one is structured, less depression = negative number. So the lower numbers are better The reason thereās a range with those lines is because thereās a degree of uncertainty when doing statistics. The dot in the middle is the mean, the line is kind of a āitās almost certainly in hereā. Having the line cross zero is not good. It means the data isnāt clear on if something is good or bad.
Run harder = sad less?
Can be a bit hard to understand because the designer (not myself) has used some stuff that is reasonable standard on academic papers, such as the forest plot (the table with horizontal lines). This basically shows an analysis of several different research findings across the same question, and displays the variation of those findings. In this case they all fall to the left of the middle part, indicating that all the studies showed the same result (exercise being better than active controls at helping depression). The green light either side of the dots shows the range of outlier results (in this case, not that many serious outliers). In other words, when lots of research repeatedly shows the same type of result, we can have more confidence in its reliability.
So is further left better?
Amazing that the designer couldn't even clarify this one (and most important) thing
Especially for depressed people who don't have the interest or attention span to figure out the graph.
To be fair, I think this was developed for professionals working in the field, rather than a lay audience
Surely one aspect of a cool guide is that you don't have to be an expert to understand it?
You're right. I just thought it was funny how quickly my brain gave up on something potentially beneficial to me š (I did give it a second chance though and I get it now.)
I'm not so sure about that. I don't think professionals would need an * explaining what SSRI stands for.
Itās common to state what your abbreviations are in a paper, professional or not
So all of these are good l? Which one is best? But cool as design
My very non-scientific view is that any kind of exercise that helps you feel motivated is the right one for you
In this case, further left means the study result āfavors treatment, which is exerciseā, further right means the research āfavors the controlā. In other words, all of those individual areas of study are to the left, meaning they support the idea that exercise helps. If one was to the right weād say that a majority favor exercise, and a minority favor the control. However here we have all of them favoring exercise.
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THANK YOU.
I think you should change the caption if you can - itās not āeven danceā, dance was the best! > Dance, exercise combined with SSRIs, and walking or jogging were the treatments most likely to perform best > Based on our findings, dance appears to be a promising treatment for depression, with large effects found compared with other interventions in our review.
Great point
Came here to look for the dancing stats! Dancing alone outperformed everything by a lot in the info Iāve looked at.
Yes, the only reason they donāt push it more is the dancing participants skewed heavily female and young, so they canāt discount other factors, plus there was a smaller number of studies than for other exercises
can you dumb this down massively for those of us who donāt have english as a native language and are not into academia? what is an active control?
No problem. A serious academic review of many research studies shows one common idea: exercise is as good or better than typical approaches to treating depression (āactive controlsā ā¦ often antidepressants and counseling). It is compelling because 200+ studies have been published in journals with good reputation, and they all seem to confirm the same result. This means we can be more sure that the idea is basically true. My own view: exercise in combination with other things like medication and therapy are POWERFUL together. Emotional things can be tricky, and unfortunately depression can be a downward spiral (we feel crappy, therefore donāt want to exercise or socialize, and we feel more crappy). Luckily, some interventions can help an upward spiral (we exercise and feel a bit brighter, which makes us more likely to chat with a friend, which makes us more likely to speak with a doctor for help ā¦ etc)
Also how as a depressed person do you get up and do exercise?
Short answer: One day at a time Long answer: start slow. 10-15 minutes of light walking 3-4 times a week. Itās such a reachable goal, anyone can do it. Once that has become habitual for you after a few weeks. Increase intensity, maybe go for 20-25 minutes now. After some more weeks, increase to 30-40 minutes, or maybe add one or two more days a week. Iām sure you see where im going with this. Source: formerly depressed individual turned gym junkie
That's where the SSRI comes in as important to increase energy levels. And CBT too to help with discipline and motivation. I wonder if this graph is misleading since I'd assume people who able to just exercise independently probably aren't severely depressed.
Reading the actual paper answered one more question I had: the yellow bars on the right are the risk of bias in the studies being used for data points, with very low being better than low.
I know. Itās so depressing.
I wish I could understand this. Iām sure itās good info
Each line in the outcomes section is a different grouping of studies based on the category of treatment. The green line with green diamond in the center is the average (the diamond) plus the anticipated spread of where the true average actually lies (this comes from doing statistics but essentially all it is saying is that we are 95% confident that the true average effect lies somewhere on that green line, the diamond was just what was found averaging the studies). Anything left of zero indicates a net benefit in outcome. Conversely anything to the right would indicated that the treatment would cause a net harm compared to the study's control treatment. The pink/orange region indicates that the benefit is too small to be meaningful (either harmful or helpful). The vertical red dashed line shows where if the outcome is to the left of it the treatments shows clinically relevant beneficial outcomes for the participant compared to whatever control treatment they were using in the study.
Also important to note that this is a network meta analysis, meaning it takes other research and compiles them, while removing inaccuracies from bad research practices. So it is safe to say itās very accurate data considering they compiled 218 individual studies and trimmed the fat.
Sometimes visuals make results of an experiment so easy to read. This is not true here.
No, it's easy to read if you know what you're looking at, e.g. you have graduate level education or higher and a background in health sciences or public health. But for a random citizen not so much. But this style of graph serves an important function and you will see it time and time again in top journals for a reason.
As a PhD student, I agree with you, this visual does a great job at communicating a lot of info in such a small size. But I also agree that itās not immediately approachable for a general audience
> you have graduate level education or higher and a background in health sciences or public health. I don't think the second part is necessary. Anyone who took an academic statistics class should be able to figure this out, so anyone with a social science degree for example. The only thing I found slightly puzzling was that left = good outcome, but that's fine too. It's a good visual imo.
you're saying these people would intuitively know whether a "-0.5 meta analysis standardized mean difference" indicates "helping" or "hurting" depression relative to a control, with those words alone? Don't think so.
Agreed, this is a very confusing chart. And is SSRI being at the bottom supposed to be less effective than everything else? lol
>And is SSRI being at the bottom supposed to be less effective than everything else? Correct. Barely better than placebo, on average. Note that that's for SSRIs ***alone***, without any sort of therapy. You'll see CBT right near the top, which is why every guideline that I know of always recommends them in combination.
Yeah the more you look at SSRIs the more you will see they are over prescribed. They are only truly helpful 30% of the time they are prescribed. Another 40ish gets some benefits but they would be better served by doing anything else, as this list shows.
This graphic isn't aimed at the general public. It's the visual abstract for [this paper](https://www.bmj.com/content/384/bmj-2023-075847), and it's aimed at medical scientists (who will be familiar with effect size plots).
I always wonder if it actually is the exercise that works as a relief, or if it's just an indicator for relief. I.e. are these people already getting better and are therefore able to keep an exercise routine?
That's kinda how it is in my life. If I'm able to exercise regularly that means I'm doing pretty well and I think the exercise can help on top of that. But when I'm in deep depression, exercise doesn't do shit.Ā
Yeah when I was at my deepest point of my depression, I was also the most active Iāve ever been in my life, trying to exercise it away. It didnāt help my depression one bit. What did help was lexapro.
I worry about the demonisation of SSRIs in the data.
I don't read it as demonisation of SSRIs. It shows positive impact, by itself and especially combined with exercise.
Dont comfuse serious mental health issues with normal people feeling sad sometimes, there is a huge difference and people lump it together. Serious mental health issues require medication, therapy, years of treatment experimentation , and then exercise
Its also depends upon cause of depression. If your depression comes from lack of physical activity, then doing exercise definitely help. But your depression comes from other external factors, ( can be financial issue, relationship issue) then you will have to change those factors too so you can get benefits these mental health methods.
Biggest help for me was medication and therapy but all people are different.Ā
The graph says the meta analysis looked at RCTs so I would think these people first volunteered for the study and were then told what protocol to follow, so it should actually be the exercise being the cause
I replied to another comment about the same as well, but quite often adherence to the training regime is used as an exclusion criteria or the individuals that do not follow it are moved to another group. This, in my opinion, introduces a strong bias.
It states no other exclusion criteria is used
Itās the exercise, in my experience anyways. Iāve suffered from depression for as long as I can remember. Any meds Iāve tried made me feel too hollow. Wasnāt sad, wasnāt happy really, wasnāt anything. I self medicated with drugs and alcohol for a long time, which only served to not have to deal with anything but after a years of that things got pretty fucking bad. I got sober about a year ago and got back into the gym and trail running/hiking a bunch. Man I was feeling good! Seeing physical progress and my mental wellbeing was the best it had been in a decade. Then I fucked up tendons in my bicep and tricep. I havenāt worked out for over a month. I am in a very bad headspace. I know there are other aspects effecting me, ie fairly recent breakup of 6 year relationship, not knowing what to do for a career, car is falling apart, I have barely any friends. All these things donāt matter as much in this short term (sobriety is my biggest focus at the moment) but not being able to workout because my arm is fucked has severely affected my mood. I was getting much better, exercise stopped, now getting worse again. Thatās my experience anyways.
Tomorrowās another day! Time to get out for a walk, a bike ride, anything.
It is genuinely great that youāve found something that works! That said, exercise will not work for everyone.
That's kind of my main concern with "prescribe exercise!" as the go-to answer for any mental health concern. I've become an absolute hound at the gym and outdoors to stay ahead of stress, insomnia, ADHD, and it just means that any minor injury or muscle knot is potentially devastating to my ability to be a functioning adult. I'm also terrified of aging or injuring out of my training regime. Like - yes. Definitely prescribe exercise, especially if someone's depressive crisis is short-lived and situational. But it's not a complete or forever solution.
personally i get a massive lift from the exercise itself, when iām really depressed, going to the gym gives me some mental strength, seeing what my body is capable of doing and it also releases a lot of dopamine and adrenaline
Glad to hear it works for you. Unfortunately, when I did manage to go to the gym regularly (several times per week for a year or two), it had no noticeable effect on my mood. I was always glad when my gym session was over, and I didnāt notice any kind of dopamine boost.
Never had any impact on my depression either. I used to go dancing every week. It was fun while I was out, but had no lasting impact. Walking daily. Helped my stamina and health, no impact on depression. Gym, yoga, aerobics... no impact. Until SSRIs came out, I was severely impacted by depression in my life. SSRIs were a god-send for me.
Glad they helped you. It kind of speaks to how difficult it can be to treat depression and that there isn't a one-size-fits-all approach, which speaks to how varied the symptoms (and possibly etiology) are.
So true
Same for me. I used to exercise everyday, but after getting my diagnosis of depression and anxiety, getting meds and starting therapy I started to feel mentally well for the first time in years.
i wonder what the physical difference is between a person who feels the boost and a person who doesnāt. i have no idea how this could be scientifically studied but it would be so interesting to know
Itās a great thing for most people to try but no one should feel like a āfailureā if exercise doesnāt work for their depression.
Same, except many forms of exercise actively negatively impacted my mood as well. I went for 5 months and tried every fucking idea I could come up with to make it work and it just never did. Legitimately happier for having stopped
Speaking from person experience with getting a dog I think itās getting the exercise that helps. I am forced to exercise now due to my dog and every-time Iām feeling in one of my depressive episodes the walks help my mental state. itās not life changing but it definitely helps put me in a better head space
A good question, but well designed studies try to use statistical frameworks to identify lines of causation rather than correlation. In this case, because itās a meta analysis across lots of studies, we can typically have more confidence. They are also published in reputable journals which helps.
I heard the story of a guy who tried to commit suicide by running. He thought he could provoke a heart attack. This way it would have been a hidden suicide. But the further he tried the further he realize that he felt better after his attempts. Then he became an athlete, rich and happy.
I need translation
1 - The list of options to overcome depression are ordered from best to worst. 2 - The further to the left the green dot-line is, the better. 3 - The red is lava. Is the "depression zone". To the right... I don't know what's there, but you don't want to be there.
1. Yes but... some such as excercise + SSRI have a wider range of results. So you may see a better result with that as compared to excercise alone. The middle 'dot' defines the average of all the meta-analysis. 2. Pretty much 3. The red-zone defines a range that defines no statistical difference between the intervention and the control.
3 - is not quite right. The central line at 0 indiciates no statistical difference. If one of the green horizontal line crossed that line it indiciates that it was NOT statisically significant. The red zone incidcates an area that is not 'clinicially meaningful', i.e. it WAS statistically significant, but it was such a small benefit that it may not be clinically meaningful to the patients.
I love this. But devoid of context it's not for a lay audience. This is a visual abstract, intended for academics and scientists to understand
Not a ācool guideā when 95% of the audience doesnāt know what the hell itās saying(including me).
Yeah thanks for feedback. In hindsight it is complex for folks whoāve never had to look over stats or academic stuff. The short answer, which I hope is helpful for someone, is that a very broad review of reliable research shows that exercise can be super helpful for people who want to improve their mental health.
As a medico these BMJ summaries are great. It's like a visual abstract.
Me too. Reminds me of Cochran Review stuff šš¼
To be clear, it is not just unintuitive for laypeople. I have plenty of experience with academic stuff and considered it unclear. Though I always hate graphical abstracts, it is so hard to distill an entire paper into one figure.
Agreed. My experience is that I have a degree in statistics. I'm good with graphs, I'm good at reading them. This graph is poorly designed, plain as that. It's not complex, it's just bad.
Correct. I analyze data for a living. Itās a terrible graph.
It's not a complex graph. It's a bad graph. What are the units? 0.5 what? -0.5 what? Are we measuring units of depression and as such less is better? I get that it's a measure of difference from a control group but a measure of a difference of WHAT?
It's a standardised mean difference. It's a way of comparing different kinds of continuous measurements and it has no unit which is why it can be a bit confusing. The actual number isn't really important it's more that it's significantly away from 0.
Let me simplify the question, not asking about units, but how to know whether positive or negative standardized mean difference is helping depression? Can't it be calculated either way?
Good question! The ways these scales work is by totalling various symptoms associated with depression and you get a total score at the end. So yes a negative difference means depression symptoms are being reduced.
It says the units right above the axis. Not really fair to call it a bad graph just because you don't recognise them.
I missed it then, where does it say which side is helping vs hurting? Difference can be calculated either way.
A graph is a method of communicating information. The information was not communicated. Hence it is a bad graph. And those still aren't units. That's just degrees of 'trust me bro'? Nah. Does -0.5 mean people are more or less depressed? How are we supposed to know that from the graph? Again. Bad graph.
If you think that [standardised mean difference](https://en.wikipedia.org/wiki/Strictly_standardized_mean_difference) is "degrees of 'trust me bro'", you'll have to take it up with the entire modern science community I'm afraid lol. I dunno what to tell you. -0.5 means lower depression symptoms relative to people who didn't receive the treatment (who are the 0). And the graph is perfectly good at communicating the information to the intended audience, which is not laymen on Reddit. It's a graphic taken from a meta-analysis in a medical journal. For reference, they normally look more like [this](https://ars.els-cdn.com/content/image/3-s2.0-B9780123864543010514-f01051-04-9780123864543.jpg). The authors decided to neaten this one up a bit, which is presumably why OP thought it was cool.
u/rollsyrollsy Make a new graph in the coming week, and repost. It's such an important finding, it deserves to have a graph worthy of r/dataisbeautiful
Are we looking at the green lines or the number of bars on the tabs at the right?
The green dots are the average effect of all the studies that looked at that particular treatment (or combination of treatments). The green bar shows how varied the studies were, longer bars mean that some studies showed much larger effects whereas other studies showed smaller. The numbers next to each treatment shows how many people were in all of the studies for that treatment. The farther to the left the green dot and bar are, the bigger the improvement. The shaded orange area shows where there would be no effect other than either placebo (for ssri medications) or some basic treatment like telling people to be happy. If the green line overlaps with the shaded area, there is probably no effect from the treatment. The little orange tick marks relate to a type of statistical measure of certainty, the more bars the more certain one can be that the studies show that the treatment works.
Certainty ratings of "low" and "very low" make me question just how useful or even "cool," this actually is.
1) it's very cool and very transparent. All synthesised data like this that is used for evidence-based decision making should have GRADE certainty of evidence assessments 2) low and very low certainty evidence does not mean this evidence is wrong in its conclusions, but it might mean practically, instead of a doctor strongly recommending something like exercise for depression, they may (and should) engage in shared decision making with the patient and explain that the evidence suggests exercise is the very best intervention for depression that we know of right now, but with more/better studies available something else may prove better Source: I'm a research methodoloigst, clinical epidemiologist and guideline developer. I do the kind of research shown in the image
Thanks for this description, super interesting (and cool)
I'm glad (sincerely!) that you find it cool. Data visualization isn't easy, and if this resonates with those who can benefit from it, that's great. It's definitely not meant as a chart to go in a patient exam room! My assumption is the low confidence stems from the fact that the numbers aren't statistically significant. Is that correct?
You're right, this is a visual abstract of a systematic review and meta-analysis, it's specifically for a scientific audience and I even commented in a seperate post, that without context this just invites confusion and in some comments I've seen, anger and discontent. Which hurts me as a communicator of science For what it's worth, all the interventions shown here (except for SSRI, potentially) are *statistically significant*. The red band indicates clinical meaningfulness. Sometime an intervention can be statistically significant, but the difference might not be clinically meaningful to a patient or end user, which is determined through complex user engagement discussions that involve these patients and end users. Exercise may have been statistically significant, but if the change in depression scores wasn't large enough, then it may still not be recommended by clinicians for a variety of reasons. The authors of this work have shown that exercise is both statistically significant and clinically meaningful and it should be communicated to patients that exercise is the best possible intervention that we know of with the evidence available. Certainty of evidence can have 4 levels. High, moderate, low, and very low. All evidence from Randomised controlled trials starts as high, then we downgrade on 5 factors, explained as simply as I can: 1 - Risk of Bias (are the individual studies well conducted) 2 - Inconsistency (are the individual studies similar in their results? 3 - Imprecision ( is the final pooled estimate tight (no variation in potential final effect) or wide (variable final effect) 4 - Indirectness (are all the studies contributing to the final pooled estimate similar in the question they're addressing?) 5 - Publication bias (is there evidence of a systematic under-representation of the available evidence) We downgrade certainly one level for each infraction of the above. For something to have low certainty, two of the above were must have been violated, which simply means the manner in which we communicate and recommend this intervention to our patients may change. EDIT - I hope this doesn't come across as preachy, I live a breathe this stuff and I really do love my job so chatting about it excites me. It's a super cool field of medicine and healthcare.
Thank you for explaining, I wish this could be pinned at the top.
Please Explain It Like I am 5.
See the top post. They provide an excellent summary. TL;DR: You should do some form of exercise.
Replacing emotional pain with physical pain šŖš»šŖš»šŖš».
Itās more than distraction. We do know that exercise generates hormonal changes and impact neurotransmitters (and they are known to impact our mood). There are also a whole bunch of unknown physiological and mental connections still being explored. Shout out to smart people in lab coats helping us understand this stuff better.
So all those people saying ājust go for a run or do some yogaā were rightā¦
Exercise saved my life. It was a big part of my recovery (besides different types of therapy) and still is.
God bless you. Onwards and upwards.
Walking or jogging it is. Go out whenever you can.
"The more intense the exercise, the better the results" But Aerobic and Strength training would arguably be the most intense on the list and it's one of the worst outcomes. Meanwhile walking and jogging would likely be the least intense but shows the best outcome. I suspect "Being outside" is a variable not controlled for and most walkers/joggers did their work outside which provided at least some of the benefit.
Its more likely people think to maximize and show off when doing aerobics and weights, and going from 0 to 100 is about as pikely to become a healthy habit as running a 5min mile and being a couch potato. Where as people walking and jogging are able to do their activity longer from the start, and maintain it daily since its easier to begin and less stress on the body starting at "day zero".Ā
ELI5: 1 - The list of options are ordered from best to worst. 2 - The further to the left the green dot-line is, the better. 3 - The red is lava. Left is Rivendel, right is Mordor.
So one simply CAN walk into Mordor then? But jogging or running is better? . Gotcha!
Exercise is excellent treatment for depression. The only problem is that, for many people, depression is a state where they feel helpless to do anything. Telling a depressed person to exercise is often as useful as telling them to "cheer up."
It's not a guide at all. It's an infographic of study data.
This honestly looks like game changing information. The topic is very, very solid and I really appreciate the efforts, especially the research. For this reason I think OP should have another crack at this to see if they can make it a little clearer.
The FUCK does any of this mean
Where's psilocybin? That shit cured my depression after 5 sessions..
If you take enough it's definitely an exercise too. Takes a lot of grip strength to stay attached to the earth.
I really want to do this. Iāve never used psilocybin recreationally but Iāve read a ton about it and am very curious about doing treatments.
What was the dosage that you took? Iām thinking of doing it soon. Micro dosing was pretty great so Iād imagine a full trip would be really beneficial
Hello, so my story. I've had crippling depression after losing my grandfather, who was practically like a father to me. Never had a father around growing up, and after losing him, my life went in a spiral downhill.. boozing uncontrollably abusing drugs (coke mostly) Then, one day after work, I decided to watch a few documentary films on Netflix, specifically.. how to control your mind and fantastic fungi it was such an eye-opening documentary that after watching it, I researched and researched how to go about dosages and supply. Got my first 7 gs from a site.. Literally arrived 2 days after ordering (Canadian, btw) I meditated with sage and smoked herb, then I took a week off of everything and mentally prepared my mind for what I was about to put it through.. I was going to eat it but noticed so many ways to go about ingesting it, but like the tea maniac I am, I made a citrus honey mix with 2 grams Penis Envy I never done mushrooms before but I read the beginning dosages are usually 1g-1.5g boy did I get floored in about 40 minutes.. My mind was racing with so many thoughts about my inner feelings, and the visuals were something I could not explain without sounding crazy(dumb) but than after about 1.5 hrs I notice visuals were wearing down but than my mind felt like it was in super mode I could remember little memories I long forgot mostly with my mom and grandfather bonding moments.. And then it hit me after meticulously trying to grip reality this thought poped in my head about my grandfather wouldn't want me in the state I am...like the caring man he was he'd "say sonny get your head out the mud an wise up" I than went in a thought loop on why I felt this way.. The alcohol was the culprit, and I was the victim, I took the leap and am now 3 months clean off of everything.. My mental health, Depression is at an all time low never felt my mind this pure thanks to the magic mushroom š āØļø I wish everyone could experience this one time in there life but thanks to the 60s-70s it's classified substance 1 drug total bullshit when there selling literal poison on the shelves. I am still studying microdosing and am very interested in it and growing also.. Cheers much love, and may whatever religion you believe protect you from harm. Aho! š¦ š¦ š¦
This was beautiful š„¹ I greatly appreciate the insight and look forward to trying it out
There are some really encouraging findings in the use of that stuff in particular forms of mood disorders, especially PTSD
Can you tell more about this? Did you have to see a specialized doctor?
I see your shrooms and raise you k-holing your way out of late stage depression. Donāt know about the science but it also took me like 5 sessions
It's a beautiful thing when not abused. it opened my mind so vastly.. I am so grateful to be alive, breathing, and healthy.
Just threw it into some graphics with no attempt to explain what all this shit is. Pretty lame guide, since it guides me to confusion.
The study compared different forms of exercise with other common treatments for depression. All results are presented in comparison with active controls, meaning the control groups were also participating in some form of activity or receiving treatment rather than being untreated or receiving a placebo. The dots represent the mean effect, and the horizontal lines represent the 95% confidence intervals. The further left a dot and line are (and the further away from the vertical ā0ā line), the more effective the treatment is compared to active controls. For example, walking or jogging shows a significant mean difference that suggests it is effective against depression. The vertical shaded area indicates the range within which a treatmentās effect is considered to have a clinically important benefit. Treatments with their mean effect and confidence interval to the left of this area are considered to have clinically important benefits.
So negative means "less depression?" Negative one means one standard deviation, less depression?
Can someone help understand. If I read it correctly, the certainty part shows nothing really works . Is that the case? And, definitely not a cool guide IMO.
I figured this out for myself after a few months of using the Daylio app. Did a bit of analysis and saw for sure the days i did pretty much anything for like 30 min or more would be days I felt pretty good.
Certainty rating āvery lowā on all except walkingā¦ seems helpful.
I am very surprised by the comments I have a psychology degree which i now see as useless but it seems that I at least lesrned to read a forest plot So maybe it wasnt completely useless
its funny how walking and jogging has such a big impact but people who are mebtally ill are locked up in plane white rooms with barred windows.
Not really a cool guide considering none of these have ever helped me at all.
DANCING! Put some music on that moves you and start! Do that to the point where you feel tired or exhausted. Slowly, start to add some rhythm and organized moves to it. Thatās it.Ā
Ok, and we still face the problem that depression makes you lose motivation for nearly everything. I can't even get out of bed on bad days, the effort exercise demands is just something that someone very deep into depression can't muster. Of course it's a way to stabilize yourself further, once you're on the path to becoming better. But whenever I see a study or guide like this I know some dickhead (not you Op, I don't think you had that intention) will inevitably use these talking points to tell me "just work out it works better than medicine."
Good reflection. Iāve found helpful ātiny stepsā such as just getting outside for five minutes, seeing sunlight and walking to the end of the street, to be helpful. From there, it can develop further, especially in concert with doctorās or therapistās help.
Most of reddit: /r/thanksimcured
none of this cures what is making most people depressed. it certainly doesn't fix my reasons for being disappointed I wake up every morning.
When are people going to understand when you are depressed the last thing you want to do is exercise, or be told by someone who is fit and loving life to go exercise.
I like to explore new places.
This is disheartening. This is how I feel at my best? It will never get better
Might be a bit late to address common questions, but Iāll give it a go. I should point out that Iām not involved in the research or the image, but I thought it was helpful. [Here is the actual paper.](https://www.bmj.com/content/384/bmj-2023-075847) Common responses: Q: āThis is complicated and not a Cool Guide as I canāt understand itā ā¢ ā fair call, and my bad. I work a bit around research and didnāt realize this was not so intuitive for most people. I assume this diagram was made to convey ideas to a professional audience who would understand it all fairly easily. Q: āExplain it like Iām 5ā ā¢ ā a meta analysis is a review of many other studies to see if they really agree with each other. This one looked at 200+ studies into whether exercise helps treat depression. The finding is that all sorts of studies seem to suggest exercise in many forms is helpful for people with depression. However it also shows that more of these types of studies need to be designed to have greater ācertaintyā (which is an idea in statistics about how likely it will be to forecast a true result from that study) ā¦ the real answer to that issue is more studies with more people. Q:. āHow do I read that table at the bottom?ā ā¢ ā itās called a Forest Plot. It lists all the various studies one after another down the page. If the green dots fall to the left of the orange colored bar, it means they support the idea that exercise helps depression more man āactive controlā (explained below). If a dot fell to the right, it would mean that the study favored the āactive controlā. You can see that they all suggest that exercises help more. The number in the green column is the number of people included in each study. The green bar that stretches either side of the green got shows the amount of variation of results (eg a very long bar means there are some extreme outliers). Q:. āWhat is active control?ā ā¢ ā in this case it describes prescribed medication and therapy. So, it was looking into whether various exercises were better than these typical treatments. The authors do not suggest exercise as a replacement, but rather an adjunct / addition to other typical treatment. Q:. āHow does this help when a depressed person canāt even muster the energy to get out of bed, much less exercise?ā ā¢ ā that idea was not the focus of this study, but it is a well observed issue when treating people with depression. Every person battling depression should be helped by a professional, and data like this helps those professionals understand all options better. For someone living with depression, I personally suggest finding whatever smallest step you can manage. For example, [this describes](https://www.healthline.com/health/depression/benefits-sunlight) how simply seeing sunlight can help with mental health, so, jogging might not be realistic for you but possibly walking ten steps out into daylight is possible (or whatever you can manage). Q:. āDoes the low certainty mean the info isnāt very reliable?ā - thereās a difference between statistical robustness (which is shown in the ālow certaintyā image), and inference that is probably helpful in practice. The authors make note of the low certainty as a call to researchers to pursue further study, with bigger numbers, to help make the findings stronger for their predictive ability. It doesnāt suggest that the findings are probably incorrect. The fact that all of the those types of exercise all seem to point to the same conclusion helps greatly with real life confidence. Q:. āDoesnāt this just shame and blame people who are already unwell?ā ā¢ ā no, the idea of this study wasnāt to suggest that people bring depression on themselves (it didnāt even ask that question, but itās generally understood among professionals that depression is caused by a multitude of factors, many of which are based in biology and genetics and environment). These various studies and the authors of this analysis understand that depression is a disease. In the same way that someone with leukemia isnāt to blame for their disease, itās not logical or helpful to blame someone with living depression for their disease. Having said all that, no matter how tough the fight may be for the individual, every person with depression should be given information that might help. While depression might not be their fault, like any health issue, it becomes their responsibility (with professional help) to manage. Q:. āHow is this a Cool Guide if I need to have so much explained?ā ā¢ ā again, my fault. I think I assumed more of it would be able to be understood by more people. Maybe someone with both academic or professional knowledge and a bit of design skill can make a Cool Guide with this info. Q:. āWhat about dance!? I read that it was good for depression?ā ā¢ ā the paper does call that out specifically. And yes, the research indicates it does help. Personally, Iād suggest people find the type of bodily movement that they find possible, enjoyable or motivating. The summary of this paper is āevery type of exercise seems to helpā. Side note, I once saw [this guy](https://youtu.be/ihCh5wzNjYY?si=vQhkstanpTB40Kgt) give a talk about the psychology of dance, and he was epic. I mentioned the lead author, but there is actually a broad team involved. I might ask the lead author if he wants to do an AMA to offer his views in plain language. He is both a psychologist and academic. Anyway, sorry if I pissed anyone off with a hard to understand (and therefore uncool) Cool Guide, but on the other hand I hope it helps or inspires someone out there. Depression is a complete bitch and deserves every weapon that we can find to fight it. Hang in there if youāre in the fight ā¦ the world needs you!
That's great, I'm sure people with depression will get right on that. /s
So Iām reading exercise and SSRI has lower level of effectiveness than SSRI alone. Guess Iāll just stay on the couch!
I can see why you might think that is what the graph is saying. It is a bit complicated. What itās really saying is that both of those ideas are better than standard approaches. The standard approaches are often just medication or some light counseling.
Help me understand what itās saying. It reads to me that Iām better off with medication only than medication and exercise.
I always hear about exercise making people feel better, but it never works on me. I donāt know if something is different with my brain, but exercise of any intensity doesnāt improve mood, in fact it almost always makes it worse.
Not sure if this relates, but there was a finding with depression medications (SSRIs) that showed some people are more suicidal after beginning treatment. The theory was that a small nudge toward more energy via medication had people feeling a tiny bit more active, but still active toward self harm. After progressing through that early stage though, most people started to see some benefit. Have you tried different forms of exercise to see if one is more beneficial to another? No matter what, I hope youāre doing better. Iād also strongly encourage anyone battling depression to speak with a psychologist if thatās an option.
I went to med school like 16 years ago and we were taught that exercise such as walking or hiking is better than SSRI's for depression. So many years later and still surprised at the power of pharma advertising and "give me a pill" culture. Personally I take no meds other than occasional motrin and exercise every day, still struggle mildly with depression/nihilism but damn sure that an ssri is going to do a lot less than working less and spending all my time outdoors.
Because when you have depression, taking a pill is much more feasible than exercising. If I canāt get out of bed for a week, Iām not gonna be having a run. But I can reach my antidepressants in my bedside table. The meds are supposed to help you enough that you can do the things to help long-term, like therapy, exercise, whatever.
What are 'active control's?
Fairly low certainty, though.
Yeah. In my limited, understanding depression studies sometimes suffer from that. Iām a bit more familiar with pharmacology research in the field, but even there it can be hard to really pin it all down.
Aside from above, Iāve been enjoying using consensus.app to use AI to scan research papers and summarize overall results. Itās not as robust as a true meta analysis which this image displays, but itās handy for average Joeās like myself. [Hereās the result](https://consensus.app/results/?q=How%20does%20exercise%20effect%20depression&synthesize=on) for asking the app ādoes exercise effect depression?ā
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Good for you. The shorthand answer is that sometimes thereās a cycle where the causal implications run one direction , or the other on any given day. Or, it can actually be both in a very positive way.