Exercise & Mood Part I — Tears and Smiles

“I can’t remember the last time I felt..” I looked up from my notes as she paused over the word as if expecting a mirage to fade into the desert, “You felt?” I said. “..happy,” she said, “.. it feels weird to say that word you know?” I took in the gravity of what she was telling me for a moment and returned her gaze quietly. Then I smiled and for the first time since I had met Alicia about nine months ago she smiled back. Not the half-smile that came with a greeting, fading away no sooner than having appeared, but a full, sustained, toothy smile. A smile that humbled me.

I had first met Alicia last March when she had been referred by her family doctor. She described a life-long struggle with episodes of deep and disabling sadness and sorrow with no clear relation to any ‘triggering’ events in her life such as a break-up or financial troubles. Over the years the recurrence and length of these depressive spells had become faster and longer; so that now she had been living with a two year long depression that was unbroken by more than a few hours of normalcy. She had become overweight and despite perceiving herself as attractive in the past she now saw herself as unappealing and ugly. As a consequence of her depression she had socially isolated herself and lost touch with many of her friends. In short she was feeling miserable and hopeless.

“Well,” I said to her at that time, “You have come to the right place!” You see I was feeling emboldened and self-righteous because I had picked up on a clue in her history that previous health-care providers had missed. When Alicia was younger and she felt ‘better’ in between storms of depression she was in fact doing ‘too better’. She had what we call hypomania — mini episodes of over-the-top happiness bordering on irritability accompanied by faster pace of thoughts and speech and by impulsive pleasure-seeking behavior. Alicia had not improved in the past when doctors gave her anti-depressants because she did NOT have depression! She had Bipolar Disorder (previously known as Manic-Depression). And so armed with this new knowledge I put together a plan with her to start treatment with ‘mood-stabilizing’ rather than anti-depressant medications. Little did I know that I had already missed part of her treatment.

Over the next 3 months Alicia gradually began to improve. Her crying spells subsided, she started eating more regularly and her sleeping improved, and she felt she could concentrate better on her tasks. Overall she described a 60–70% improvement. But the remaining percentage was a big deal because Alicia still did not feel ‘happy’ and she wondered aloud if the best she could get to was to feel ‘not sad’. I kept trying different strategies over the next few months with medications and talk-therapy but we could not break across that elusive happiness barrier.

At this point it occurred to me that in my zeal for helping her get better I had taken on all the work myself and she had become a passive player in her recovery. In fact, that was just the tip of the iceberg because as an extension I had relied solely on the miracles of modern medicine and had not helped her enable her own body’s natural healing potential. I was ashamed I had let pride get to my head but better late then never I thought.

The next time Alicia came in to see me I shared with her this line of thinking. She was a little confused, “..I’m not a psychiatrist.. How can I treat myself?” I then explained how certain “doses” of physical exercise can change the brain (more on this in next blog entry) and lead to healing. She had her doubts, but we put together a plan, she would take up an exercise routine for 30 minutes 5 days a week and I would follow up with her every on her progress. We didn’t change her medications and stayed with the ones that had gotten her 2/3 of the way to full recovery.

It was hard to get started those first few weeks, but once she had exercised for 5 days in a row she was hooked. She reported little incremental changes — her energy improving, her sleep cycle becoming more regular, her concentration better than it had been for years. And after about 4 months of this, in a small office on the 9th floor of Toronto Western Hospital with miserable freezing rain outside, she smiled and her eyes welled with tears. Happy ones.

— More on the biological effects of exercise on the brain and using the right ‘dose’ of exercise in an upcoming post.

*Alicia is a pseudonym and a character drawn from a compound of multiple patients that have allowed me to serve them.

Dr. Mohammad Alsuwaidan is a specialist psychiatrist at Mubarak Al-Kabeer Hospital in Kuwait and an Assisstant Professor of Psychiatry at both Kuwait University and the University of Toronto. He has trained at the University of Toronto, Stanford University and Johns Hopkins University. He is a Fellow of the Royal College of Physicians of Canada and a Diplomate of the American Board of Psychiatry and Neurology. More information at www.AlsuwaidanClinic.com