By Jeff Corbin, MD MPH
“When I was depressed I couldn’t motivate myself to do the things that make me feel good. When I was feeling better, I didn’t think about restarting them. I guess I need to change how I think about my depression: there’s depressed; there’s not depressed; then there’s working to keep myself healthy.”
The difference between fitness and treatment of an illness:
Healthy living is something most of us strive for. To keep people motivated to stay in shape, the fitness industry is forever coming up with new gadgets, developing new dietand exercise programs. Keeping in shape, however, is not the same as treating an illness. You don’t tell someone who is having an exercise-induced asthma attack to keep on pedaling. And you don’t tell someone who is depressed to be happy or socialize more. You would be ignoring the fact that this person is suffering right now and needs to treat the asthma so they can breathe, in order to be able to exercise. Just as the depression needs to be treated for the person to be able to “be happier” and socialize more.
I had been working with Laura, a woman in her 30’s, for about a year and a half when she was diagnosed with lymphoma. She was married and had two children in grade school when she was diagnosed. Laura would describe herself as a strong person that can handle almost anything that is thrown at her.
Starting at a young age, when she was in grade school, she would escape the chaos and neglect at home by going on day-long bike rides. “Sometimes I would see a parent playing with their daughter in the playground and I would go over and ask to play. I would point in the general direction of a building nearby and tell them that I lived right over there, so my mom can watch me from the window.”
The first time she remembers being treated for depression was when she was in college, just after her father died. “I was so down all I wanted to do was sleep. I stopped going to classes and spent most of my time getting high. I didn’t know what to do so I went to the student counseling center for therapy. The next time I got depressed was shortly after getting married. My husband pushed me to see someone for medication. That’s when my friend gave me your name. I have always been the kind of person who does everything I can to take good care of myself but lately it’s been a struggle to do anything. I feel like I am not trying hard enough to feel better which makes me feel worse. I never wanted to become one of those people who ‘needs’ medication to be happy. The only reason I’m willing to take medication now is because it is hard for me to even enjoy my kids, I just want them to leave me alone, and I hate feeling like that.”
We slowly started her on a medication and, as her symptoms improved, she was able to restart all the activities she engaged in before the depression took hold.
After she had been doing well for about a year she wanted to try coming off the medication. We slowly tapered the medication. She had no problem coming off of it and we made a plan that she would follow up with me if she needed to. That’s when she got a diagnosis on lymphoma.
A few months later I received a call from her to schedule a follow up. “I had my yearly physical and some lab work done and there were some abnormalities. Anyway, to, make a long story short, I was diagnosed with Lymphoma. This sucks. I was feeling so good until this happened. Now I can feel some of those familiar symptoms of depression and think I should go back on the medication before it gets worse. My family is already having to deal with the cancer, I don’t want my kids to see me depressed too.”
She went through a year of aggressive treatment for the Lymphoma with some difficult side effects—loss of appetite, loss of taste, weight loss, hair loss, and numbness in her feet. Her mood remained as good as could be expected and at the end of the year she was declared cancer free.
She continued to work with her psychotherapist and remained on her antidepressant. Over the next six months the side effects from the chemo went away—her hair grew back, her taste came back, she gained weight, and the numbness improved. About six months after, during a follow up session, I asked how she is feeling about remaining on the medication.
“I was going to ask you if you think I should increase it?”
“You seem like you’re doing well, but if you are asking me that I am guessing that you notice something is not right.”
“I just don’t feel like I used to. I don’t feel as energetic. My sleep is not as good, I wake up and can’t go back to sleep for an hour or so. I get more irritable, especially in the morning. It’s harder to get out of bed, I used to get up and go to the gym in the morning, now forget it.”
So far, as we spoke, it seemed as if most of the symptoms she experiences when depressed were not present. For many years she had felt very reluctant to go on medication and I didn’t want to increase the medication, risking side effects, without knowing more about what she was experiencing. I wanted to find out more about what she felt was missing.
During the year of treatment for her cancer her family would order-in or pick-up food instead of cooking. When I initially met Laura she was running, working out, and doing yoga. Now, even though she was back at the gym, she was hardly going.
I discovered too that she and her husband decided that they were going to stop putting off doing some of the things that they always talked about, one of those things was joining a wine club. They joined a wine club and received a mixed case of wine each month. They were now drinking several bottle of wine a week.
“It doesn’t seem like your depressed so how about if we have you focus on some behavioral strategies and see if that helps, before increasing the medication. Start exercising more. Eat healthier. Stop drinking so much. Don’t go crazy, just try and get back to how you did these things before the cancer diagnosis.”
That turned out to be the answer. The next time I met with Laura was a few months after she reincorporated all the activities she engaged in the past. Fortunately many of the activities we engage in for physical fitness also help improve mental fitness. For Laura, that meant yoga, eating well by cooking healthy meals at home, cutting back on her alcohol consumption, getting back into running, and more time at the gym.
Although there are many types of physical fitness available to us, cycling classes, boot camps, gyms, as well as many diets to follow, there’s less awareness about developing a mental fitness regimen.
Here are 8 factors to consider when developing your own mental fitness regimen:
- Eat a healthy diet
- Exercise regularly
- Manage your weight
- Get yearly physical exams
- Reduce stress
- Get outside
- Practice good sleep hygiene
- Minimize use of alcohol and marijuana: they may be legal but they do interfere with mood, anxiety, concentration, focus, sleep, and energy.
Keeping ourselves ‘mentally fit’ is as important as keeping ourselves ‘physically fit’. Together they supply a feeling of wellness that medication doesn’t supply on it’s own.
Jeff Corbin, MD MPH, is a board-certified psychiatrist in New York City and the Hudson Valley who has worked in clinical and community mental health for more than 20 years.
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