Comment by asynchronous13 | Hacker News Reader

Comment by asynchronous13 | Hacker News Reader

Parent Full thread

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.

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.

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

Reply on news.ycombinator.com