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Honestly I feel like you're splitting hairs here. You say that exercise is not a treatment, but at the same time say that exercise may help. Isn't a treatment something that may help? I get it, don't pretend that exercise is the magic pill that will work for everyone, especially for those at the more severe end of the depression spectrum. But, even the NICE guidance that you linked to suggests "taking regular physical exercise" (1.4.1.2) in mild to moderate depression.

People commonly use the term "depression" in a way that does not exactly match the true medical definition. People say "i'm depressed" when they should really say "i'm feeling sad today". People say exercise is a treatment, when they should say it makes them feel better. I fear your pursuit for the exact terms might prevent some people from trying a thing that would help them.

For clarity: I don't think exercise helps treat depression, unless we're also happy to say that homeopathy treats depression.

The reason is that different points on the "spectrum of depression" may be entirely different diseases.

For a hypothetical example, it would be entirely possible that people who are sub-clinically depressed turn out to be more-often-than-not lacking in dopamine (due to e.g. Seasonal Affective Disorder), where their depression is secondary to things like fatigue and lack of focus brought about by this. These people would do better with exercise or vitamin D or light therapy or a dose of Wellbutrin... but SSRIs or meditation or behavioral-activation therapy or other "things that help people who are clinically depressed" wouldn't help at all.

"Clinical depression" isn't a disease (= a particular mechanism that causes symptoms.) It is, instead, a syndrome—a name for a cluster of symptoms that get studied because we have no good tests to isolate a particular etiology (cause) in each case. Different etiologies have different best treatments.

Since we can't isolate the etiologies well enough to name them, we can at least refer to "sub-clinical depression", "clinical depression", "treatment-resistant depression", etc. as separate syndromes, such that—hopefully!—each one more closely corresponds with a particular etiology, and thus we can develop a line of treatment best suited to each.

> People in this thread are repeating the myth that exercise is a treatment for depression, when all the evidence we have shows that it probably isn't.

Thank you for clearly stating this.

Depression is not "Gee, I've been feeling tired and blue for a couple of days," but it is commonly confused with "short term, mild melancholy".

Depression is a serious illness and needs to be understood and treated as such.

Lifting saved my life.

Yea, I think people are confusing the effects of exercise in different cases. IMO there are really at least two groups here:

A) >= moderately athletic people with above average health and can sustain strenuous cardiovascular activity. For these people going out and exercising is a form of self actualization which IME is a pretty hard counter to depression. It's an "easy" way of being very good at something and that gives people some level of self worth. People on the upper end of this group are also competitive and tend to participate in teams or events that give them lots of social contact with like minded people which helps further.

B) The average non-athletic person sitting at home struggling with depression. They can try exercising and it might help but most of the time it's going to cause them to feel self conscious at the gym and worthless when they don't see any progress because they have no training or experience with how to work out (and most of the services claiming to provide such are garbage cash grabs). For these people it'll always be an uphill battle but from the point of view of people in A) they just look like they're not trying. In the end they go home feeling worse off than before because they didn't achieve anything and probably feel that it's yet another thing they can't do well or yet another failed attempt at self help. Even those that get some traction are a long way off from reaching that self actualization stage.

tl;dr exercise seems to be about maintaining a lack of depression rather than bootstrapping your way out of it.

It's about increasing pxygen / body flow and increasing the body's detoxification process.

Detoxification process? What would that be and how does that relate to the topic we're discussing?

> Detoxification process? What would that be

Pumping the lymphatic channels, mostly. Because humans don't have https://en.wikipedia.org/wiki/Lymph_hearts, so we don't just naturally do that; we actually need to move around in order for our lymphatic system to maintain the pressure required for flow.

> how does that relate to the topic we're discussing

https://www.ncbi.nlm.nih.gov/pubmed/28342944

"Toxins" (metabolic waste and immune-system antibodies, mostly) cause tissue inflammation. Your body responds to systemic increases in inflammation by becoming depressed. Cleaning the wastes out of your body, in a way that decreases inflammation, will act to decrease depression.

Interesting—and true and well-studied—corollary: things that just suppress the inflammatory response to bodily toxins, are also antidepressant. NSAIDs (e.g. ibuprofen) are anti-depressant.

I keep wondering as I read more and experience more things if the cause of some depression is as simple as nothing to look forward to. Joining a club, taking up a hobby, visiting a church, learning a new skill, etc. all seem to help people with their condition. We're wired to connect and to hope and dream. For some people exercise does that but it just makes me tired and want to crash (even when I was in shape and playing football in school). It is a difficult issue and I worry with our technology induced isolation that it will worsen.

You routinely express obnoxiously bad psychiatric opinions on this website. What exactly is a "national expert adviser to the Mental Health Safety Improvement Programme"? Do you have a medical license? I'm betting my HN account you don't.

Hey, still waiting on a reply here!

By the way, check out this thread: https://news.ycombinator.com/item?id=19551463