When Drugs and Therapy Didn't Cure Depression, Woman Finds That Running Did
Tuesday, September 15, 2009
I did it, I thought in disbelief, and I even sprinted at the end. Did anyone notice, I wondered. I somehow managed to find it in me to sprint across the finish line. Then I tried not to collapse right there on the road.
My body ached, and after hours of sweating, I was quickly becoming chilled in the 50-degree wind. Desperately trying to keep moving, I suddenly found myself in a crowd of post-marathoners shuffling slowly, cattlelike, along a barricaded corridor, as volunteers handed out water and enshrouded us with thin mylar blankets and then others handed us medals, all alike, to commemorate our run.
This should have been my greatest hour. After all, I had secured the grail of marathons, the holy Boston, something I had been dreaming about for years. Yet it seemed strangely pointless, so after-the-fact, so anticlimactic. And then it dawned on me. Finishing the Boston Marathon was nothing in comparison to the real hurdle I'd been able to surmount and the one that had turned me into a runner in the first place: major lifelong depression.
Long before Boston, in fact, running had saved my life.
* * *
I can't even say for certain when dark thoughts started to take control of my life. But I remember, when I was just 6 years old, crying every day. I didn't sleep at night. When I did, I had nightmares. I stopped eating. When I did eat, I often couldn't keep the food down. I felt that something terrible was going to happen, to my parents or to me. I was soon plagued by bad headaches. The condition became severe, and I began to develop paranoid thoughts and panic attacks, though at the time no one, including me, would recognize that's what was going on.
I told them my head hurt, which is the best way a 6-year-old could describe it, so my parents took me to a doctor. They said the headaches were caused by tension. They gave me Tylenol with codeine. This stopped the headaches, but the nightmares, the crying . . . everything else continued.
I remember once that year, in first grade, I had had a good day. I hadn't cried, and I was able to keep my lunch down. My teacher was so impressed by my "good behavior" that she gave me gold stars and colorful stickers. I can vividly remember smiling, yet now I cannot think about this without shaking, at the realization of how bad I always felt and how little they understood that stickers really weren't going to help me.
I believe they wanted to help me: my parents, my teachers, the doctors. But it was the mid-1970s, and much of the medical community still didn't think it possible for young children to suffer severe depression. It was, in a lot of ways, a decade of living in denial, and the doctors seemed to think painkillers fixed everything. I don't believe they had the slightest idea of the hell I was experiencing.
Over those early years the darkness came and went. When I hit my teens, though, it hit hard. On the worst days, of which there were too many to count, I would stay in my room or I would disappear into the woods near my house in rural Pennsylvania. I wouldn't speak to anyone for days. For a while, I lived in a state of overwhelming dread. I would look at a perfectly normal object, or a scene out a window, and feel like I was staring at something horrific. When I could bear it no longer, I started planning my death.
* * *
At this point, my mother interceded. My silence and withdrawal were enough to grab her attention, and when she asked, I told her how I was feeling. This began a long series of treatments. Like many depression sufferers, at first I was prescribed cognitive, or talk, therapy. When that didn't work, often-mammoth cocktails of medications were added: a tricyclic antidepressant, SSRI and SNRI medications. I was told I had a severe and resilient case of major depressive disorder. But talk therapy proved emotionally draining and often left me feeling worse, so it was hard to get any sense of progress. And the medications were either ineffective or mildly effective, or they lost their effectiveness over time, and they often had terrible side effects that, even if they had relieved the darkness, made normal life impossible.
And then I discovered running. Or running and long walking, to be exact.
One day, particularly agitated, I fled my house and began walking toward a nearby mountain. I walked for a long while that first day, discovering some old dirt tram roads that seemed to snake all over the mountain. When I got home I was excited about my discovery -- and happy. My mother was curious about how far I'd walked, so we got in the car and tracked it. I had walked about 27 miles, and it did more for my emotional state than all the therapy and pills.
From then on I walked, hours and hours, nearly every day. I filled nearly all my free time with it, walking all weekend when school was in session, from sunup to sundown or later, sometimes covering as much as 35 to 40 miles at a time. During the summer I went even longer. I walked through the seasons, through summer thunderstorms and winter snow, all day when possible, often into the dark. I got lost on more than one occasion and even once had to hitchhike home. Then I started taking a backpack and staying overnight.
At first my new hobby worried my mother, especially since I insisted on going alone. But the dramatic improvement in my mood and the enthusiasm with which I would describe the details of my treks proved enough to keep her from stopping me or insisting I take a friend. I led a pretty isolated existence at the time, and I knew no one who would have joined me for those mammoth distances anyway.
* * *
At some point I began adding running to my long-distance walks. At first it was just through fields and up the mountain with my dogs, but as I got fitter, school friends on the track team noticed I could easily keep up with them, sometimes beat them, in running during gym class. They persuaded me to join the team, which I did because I had begun to realize that I really loved to run. I decided I wanted to be a distance runner and started doing the long training runs with the track team. But as the track season approached, I became anxious about competing, and I finally quit before the meets started. When I created the excuse that I had too many after-school conflicts, my coach told me that I had already put in the hard work and time and that I owed it to myself to continue. The truth of her words in the face of my lie stung, and though I still quit, I never forgot them. I silently decided I would somehow make it up to myself, and I imagined that someday I'd run the Boston Marathon.
I didn't fully realize the huge impact all the running and walking were having on my moods until I graduated from high school and started college not far from home. I no longer had time to walk or run that many hours. By my second year, my mood swings began to spiral out of control. I could feel the darkness descend over me. I had been an A student but soon I was in and out of class, then in and out of jobs. Finally, I dropped out of school completely, lost touch with my family and fell into abusive relationships interspersed with periods of isolation, into bouts of illicit drug use and homelessness.
Much of what came next is a blur. Mostly, I don't dare think about it. The reckless behavior -- little things such as balancing in high places, playing chicken with trains and cars, and careless use of drugs -- grew more serious, more intentionally destructive and was accompanied by physical abuse, self-inflicted and from others. There were many close calls. There were ambulance rides and quiet talks from well-meaning police officers. There was family support, and more therapy, and medication off and on.
But what started me back on the path to health, what I remember the most vividly, were long, quiet walks, then runs, often in the woods. I found it helped clear my thoughts and made me feel more in control. I still hadn't put together how dramatically it was affecting my brain chemistry.
Slowly, I began the climb back. I re-enrolled in school and got a degree. I got married. I weaned myself off all the depression medication, a slow and often painful process. I sought to create a support system. People were there for me, but sporadically, much as they had been throughout my life. And their support didn't always help despite their good intentions. Depression is an isolating disease. But I found that when I ran, I could be my own support system. * * *
There's a lot of medical research that confirms my experience of mental health through running. Although studies show the benefits vary from person to person, most reveal exercise to be as useful as medications and psychotherapy in reversing mild to moderate depression. It's not totally clear why that is. Many believe exercise has neurochemical effects on the brain that closely mimic the effects of antidepressant medication. But while antidepressants tend to boost a few select mood-enhancing neurotransmitters, studies show exercise boosts the supply of several of them, including serotonin, dopamine, endorphin, epinephrine and norepinephrine, which play key roles in depression. Exercise may also reduce the level of the stress hormone cortisol.
A March 2006 article in the Journal of Psychiatry & Neuroscience found evidence that major depressive disorder is linked to a decrease in neurogenesis, the process of synthesizing new neurons in the brain, and that exercise, which is known to promote the growth of new neurons in the brain, may be effective for this reason.
In a study comparing the therapeutic effects of walking to stretching and relaxation, researchers found even mild exercise to provide fast and effective relief from depression. Researchers had college students facing a major depressive episode begin exercise walking. After 10 days, the results were compared with a similar group whose members had been told to do stretching and relaxation exercises. The proportion of walkers reporting a significant decline in depression was 65 percent, compared with 22 percent for the relaxation group. Their conclusion: Endurance exercise may help to achieve substantial improvement in the mood of selected patients with major depression in a short time.
There is also evidence that the therapeutic benefits of exercise increase with intensity.
"With just 20 to 30 minutes of vigorous exercise, you get five or six hours of lasting effects -- reducing anxiety, anger, fatigue, and other negative emotions," Keith Johnsgard said in a 2007 Runner's World article. Johnsgard is a clinical psychologist who has studied exercise's effects on depression for decades.
However it works, it works for me.
I began to run more and more regularly and to rely on it to get me through tough times. Eventually, I learned that it was something -- sometimes the only thing -- I could really depend on to get me through, and that it could get me through just about anything. A year or two after I had finally weaned myself from all depression medication, my mother succumbed to cancer. I suddenly stopped running. And soon I crashed. Not knowing exactly what else to do, I decided to go back on medication.
* * *
I had once been warned that the type and severity of my depression made it very likely I'd relapse after going off medication, that it was just a matter of time. So I had somewhat expected the crash. But going back on medication didn't help. And finally I recognized what I should have seen all along, that running had saved me, and so I hit the streets again. At first it was three to five miles at a time, three days a week My mood improved quickly. But it wasn't until I started running long distances -- 30, then up to 50 miles a week, regularly -- that I began to really experience its full benefits for health and happiness.
Now, if I am feeling down, I go for a run. I usually start feeling better almost as I head out the door -- in part, I believe, because I am taking charge and doing something. But by mile four, I can actually feel my thinking beginning to change, from negative to positive, as if four miles, or about 30 minutes, is some kind of threshold. On longer runs, by about mile 13 or 14, I start to feel a mild euphoria. If I run faster, I'll notice it earlier. If I'm doing an easier, slower run, it takes a bit longer.
On really long runs, of 18 to 20 miles or more, the nature of my thoughts go beyond just positive to creative. I start having brainstorms, one after the other, and I begin to feel "one with things," for lack of a better way to describe it. It's like deep meditation in which your personal boundaries open up and you no longer notice where you end and everything else begins.
I have figured out that if I run at least four miles, I feel relaxed, positive and clearheaded, feelings that can last from hours to days. And if I do so consistently, I won't fall into a really dark state.
Every once in a while, though, I'll have a day when it's as if no time has passed since I've gotten better. It's hard to describe, but it's more than just feeling down. There's an awful familiarity to it. But it never lasts very long. This, I believe, is due to my keeping around me a safety net of mood lifters -- talking to positive people, listening to uplifting music, etc., but especially running.
You can overdo it, though, and this is something to be very careful about if you suffer from depression. Keith Johnsgard addresses the effects of overtraining, citing evidence that the "stresses of unremitting increased physical demands, like any other chronic stress," can actually bring on a depressive episode.
I have experienced overtraining and know what that feels like: It's as if the running doesn't work anymore. So I've learned to back off and rest for a few days, and then I am fine.
Now, in addition to other forms of exercise, I run five or six days a week, and miss it when I don't. Sometimes it functions as a therapy for me, as it did recently on a routine run to work through a summer rain. The day happened to be my 39th birthday, and so I had been caught up in thinking back on my life. I remembered again that frightened 6-year-old I once was, lost in that cold, dark place. I imagined visiting her at school, picking her up and holding her. I dried her tears and told her everything would be all right, that there was joy in her future. One day she would discover she is an endurance runner; that this would help her endure any challenge life throws her way -- even the Boston Marathon -- and that that would lift her out of the darkness, hopefully for good.