Can Depression that Started in Sweden be Treated with Exercise?

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man runningImprovement to mood is one of the most obvious effects of exercise. But can exercise actually be used as a treatment for depression?

An article recently featured in the Stockholm daily newspaper Dagens Nyheter says it can.  Jill Taube, a Swedish psychiatrist, has written a book about how exercise can help to cure mental illness. She points to studies that show the effects of exercise not only last longer than those of antidepressant medication, but physical activity appears to prevent the recurrence of depression better than antidepressants.

Exercise: A Prescription for Depression

Taube’s exercise ‘prescription’ echoes what the health and fitness experts have been saying for at least 20 years: a combination of cardio and strength activities for 30-45 minutes, at least 3 times a week. Obviously those who have not been exercising need to take it easy to begin with and build up to this. But the idea that there is something people can do themselves about depressed mood is great news for those who want to recover from depression and need more hope in their lives (although it might depress the drug companies!).

Antidepressent Use in Sweden, an Increasing Trend

What makes this research so remarkable is that Sweden has one of the highest rates of antidepressant prescription. According to OECD statistics, Sweden has the 3rd highest consumption rate of antidepressants in Europe (after Iceland and Denmark). And antidepressant prescription is on the rise in Sweden. The National Board of Health and Welfare (Socialstyrelsen) has issued guidelines to try to cut the rise of prescribed depression medication and encourage the use of talk therapy. But these changes will take time because the culture around prescribing antidepressants needs to change. A survey of GP attitudes from 2004 indicated that most doctors considered drug treatment with antidepressants alone was effective and sufficient in most cases of depression. Less than half the doctors thought that psychotherapy was required as a complement. This is despite reliable evidence of the effectiveness of talk therapy against moderate depression and the combination of counselling with medication being considered best practice. There is also evidence that effectiveness of antidepressant use really depends on the therapeutic relationship between doctor and patient.

Relief for Anxiety and Depression through Exercising

As a doctor, Taube is concerned with biochemical explanations of how exercise actually works and the article in Dagens Nyheter explains some of this. For the layperson it’s enough to know that it does work. Therapists are familiar with the way depression often goes hand in hand with anxiety (I often describe them as hanging around together, like schoolyard bullies) so it’s no surprise that exercise appears to help relieve anxiety as well.

Taube, who has herself experienced depression, is a dancing enthusiast but explains that other exercise like taking a walk or spin class can give the mind a break from Anxious Thoughts. We know that mental health difficulties can generally lead to poor physical health not only because problems like anxiety and depression stop us from getting out and enjoying life, but because the drugs that are prescribed for them have a slowing down effect on those who take such drugs. So people who are taking medication because they are affected by anxiety, depression and other mental health problems often gain weight and suffer cardiovascular difficulties or musculoskeletal problems because they don’t move themselves as much. Of course it is important to still seek the help of health professionals, particularly if you are experiencing a severe depression or having thoughts of wanting to end your life. Talking together regularly with a doctor, counsellor, therapist or psychologist is a better alternative to just taking drugs on your own.

In 2012 I will be continuing Walking-Talk Therapy  for those who want to have therapeutic and coaching conversations ‘on the go’. Going for a walk together through Rålambshovsparken, along Norr Mälarstrand or around Riddarfjärden is a great physical alternative to sitting down. Of course, if you prefer to talk inside, we can still meet over a tea or coffee in my private consulting room at Fridhemsplan. And for those who are outside of Stockholm or prefer more privacy, online counselling is always available over the internet.

Send me an email or call me on 08-559 22 636 and leave a message if you would like to make an appointment.

Jill Taube’s book “Själ och Kropp” is widely available from book retailers and online, but unfortunately only in Swedish at this stage.

Mental Health in Sweden: Normal Behaviour Becoming Harder to Achieve

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bar graph imageIs psychological disability in Sweden really stopping so many from working?

(Update from June 2013: This post is actually about the pathologising of human experience: how more and more people are being labelled as ‘disordered’ or ‘deficient’ by the psychiatric profession in Sweden and the expectation that individuals fit with certain norms of behaviour. Some bloggers have attempted to use my words as evidence that Sweden is suffering from collective mental breakdown due to a breakdown of gender expectations and norms. I am certainly NOT suggesting that. If anything, taking a more gender neutral approach in education and other social functions has contributed to greater personal freedom for Swedes. However there is an increasing requirement for individuals to be diagnosed with an illness or disability in order to access support. Read on for more…)

The Swedish newspaper Dagens Nyheter has run a story about the sharp increase in numbers of young people leaving work and put onto disability pensions (known as ‘activity support’ for those under 30 and ‘sickness benefits’ for those 30-64).

Fewer young people are returning to employment after being pensioned off work, a phenomenon that has been referred to as a ‘ticking time bomb’ in view of the fact that many may be destitute by the time they are 30.

Sweden is not alone here. There were increases in young people starting on disability support in other Scandinavian OECD countries between 1995 and 2007. In Finland the increase was 5 percent, in Denmark 10 percent but Sweden had a massive 80 percent increase! That’s almost 30,000 people under 30 in Sweden who are on a disability pension.

Psychiatric Disorders Becoming More Common in Sweden

So why the huge increase? Well 73% of those young people have been given medical psychiatric diagnoses such as autism, ADHD and Aspergers. Could it really be that Sweden had such a rise in psychiatric disorders and mental disabilities compared to our Nordic neighbours? Is it something in the water?

As a counsellor, therapist and coach, I am often asked about such diagnoses and the increases. I think people expect me to say something about teenage computer gaming culture or genetics or to applaud the ‘science’ responsible for discovering such a vast previously undiagnosed population.

But what I see happening in Sweden is that so-called ‘normal’ behaviour is becoming more defined. The goal posts for what is considered normal are being brought closer together. The tolerance for non-conformity and extremes of mood and behaviour is reducing. It is becoming harder to be ‘lagom’!

In Sweden, psychiatric health has been constructed as a medical problem. Both anxiety and depression are treated primarily with medication. But drugs are also heavily prescribed for those whose attention, communication techniques or social skills fall outside what is measured to be the norm. And unfortunately, those norms are progressively less accommodating.

There’s no doubt that the pathologising of human experience is increasing in many countries. More people are being diagnosed as depressed, anxious, having a mental disability or disordered in some way. And this corresponds to increasing expectations that we fit prescribed ways of being and relating to each other. In workplaces and schools across Australia, the United Kingdom and America, more standards of performance are being established and procedures for selection are becoming more sophisticated.

Fortunately, not all mental health, psychotherapy or counselling practitioners favour responding to diversity with drugs or exclusion and many take a more norm-critical approach. Narrative therapy, Open Dialogue and other collaborative therapeutic practices are approaches which honour what people have to say about their own experience, rather than categorise us using medical terminology.

My hope is that eventually the doctors, psychiatrists, psychologists, therapists and others responsible for measuring, diagnosing and categorising people will see the limitation of these practices. I look forward to a new era when Swedish society ceases to be obsessed with locating its deficits and deficiencies but instead acknowledges the unique skills, competencies and abilities of all individuals. A time when the expertise we bring to life’s challenges is respected and valued by the health professionals we consult and diversity is appreciated rather than shunned. Perhaps then we will see more young people participating in the workforce in Sweden.