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Raleigh, NC 27612
Telephone: (919) 782-4597

Walking and Talking

Dr. Lucy Chartier, one of the Triangle’s most innovative and creative psychiatric nurse practitioners, is not only educating her patients about the importance of physical movement for the improvement and maintenance of mental health, she is getting out and doing it with them.

Dr. Chartier

“Exercise is a fundamental element of good mental health and management of mood,” Dr. Chartier says.  “Over the last 30 years, the research has demonstrated  over and over again that mood disorders, particularly mild to moderate depression, respond very well to exercise.”

In fact, studies have shown that in many cases, the benefits of exercise for mood disorders generally and depression specifically, is more helpful than anti-depressants alone, or anti-depressants combined with talk therapy—the traditional standard recommendation.

So, in an effort to motivate clients to get out and move, Dr. Chartier is doing it with them.  “I am fortunate to be located close to Umstead Park,” Dr. Chartier explains. “So on designated clinic days, I meet patients outside and we do walking therapy.  For some this may be once a month, and for others once a week if they need something more intensive.  Whatever the individual patient need is, we strap on our shoes and we walk together. We’re walking and talking and conducting a therapy session in Umstead Park.”

Exercise and Depression

While this may seem a bit unconventional, Dr. Chartier explains that something outside the box is often just what is needed for her patient population.  “When someone is deeply depressed, it can be a huge challenge to get to the gym, or even get outside for a walk.  These patients need someone to help them get started.  Then, in addition to walking therapy, my first recommendations are simple: start by taking the stairs instead of the elevator; park your car at the far end of the parking lot when walking into a store; commit to walking outside in your neighborhood or in the mall for 10 minutes a day—wherever you are most comfortable.  Then, you can start to increase your goals as you start to feel better.

“One of the really interesting aspects of the research on movement and mood,” Dr. Chartier continues, “ is that the best outcomes are found in those who participate in group exercise.  Possibly there is some social component contributing to the benefit, or that in the presence of another or others we work harder, push ourselves more. For these and other reasons I started doing walking therapy sessions with my patients.  This isn’t to say that benefit isn’t still gained when exercising alone; I want to be clear: it is.  But for those who can tolerate a class at the gym or the YMCA, or can arrange to go walking with a friend, studies indicate this is what will produce maximal outcomes.”

The Physiological Rational

It turns out that the association between improvement of mood and physical movement is credited to a whole lot more than just an increase in blood flow, and therefore oxygen, to the brain.  Dr. Chartier explains that when you engage in exercise, you are actually changing your neurochemistry.

“We think that, in part, depression is related to a depletion of certain neurotransmitters, such as serotonin, which causes certain areas of the brain to atrophy (physically shrink).  So when we treat depression with anti-depressants, we are attempting to correct this depletion with pharmaceuticals.   However, both human and animal studies have now demonstrated that a critical component in the production of these important neurochemicals, something called neurotrophic factor, actually increases following exercise.  This means,” Dr. Chartier continues, “that areas of the brain that had stopped producing the appropriate neurochemistry are capable of regenerating and making those chemicals again following regular exercise.  From a neurochemical standpoint, exercise for some is literally like taking a natural anti-depressant medication.”

Interestingly, and further demonstrating the point, anti-depressant medication is only effective in about 47 percent of the population who take them.  In the studies to which Dr. Chartier referred, 45 percent of depressed patients who engaged in group exercise classes saw a remission in depressive symptoms, compared with 40 percent who engaged in solo exercise routines. “As you can see,” Dr. Chartier points out, “exercise is about on par with anti-depressant medication in terms of the statistics.”

So is exercise an anti-depressant replacement?  Should the chronically depressed abandon their meds in favor of a good run? Dr. Chartier clarifies that she is not advocating complete abandonment of pharmaceuticals for all.  “Major depressive disorder and suicidal depression are more severe diagnoses than the mild to moderate depression that was the topic of the studies.  Severely depressed patients will likely need more than simple lifestyle changes, although the addition of exercise to the treatment of deeply depressed persons can only help.

“My goal is to help patients accomplish what they want to accomplish,” she says matter-of-factly.  “If someone wants to stay on medicine, if s/he is afraid to come off or feel attached to what has been working for him/her, it is not my place to take that away.

“However, if someone isn’t doing as well as she’d like despite being on an anti-depressant, or would prefer to avoid medication if possible, the kind of movement therapy I am talking about can be an incredibly beneficial treatment or adjunct to the current treatment.”

One more benefit specifically related to outdoor exercise, Dr. Chartier points out, is the absorption of vitamin D. “There is  a strong association between vitamin D levels and mood,” she says. “Unfortunately, most of us don’t have the luxury of spending enough time outdoors in the sun to get the amount of vitamin D from sunlight that we need. Additionally, as we age, our ability to convert sunlight into vitamin D decreases. So I often prescribe to my patients higher doses of vitamin D, particularly if they struggle with depression or are already on an anti-depressant.”

A co-owner of Life Quality Resources in Raleigh, Dr. Chartier has been employing cutting edge therapeutic techniques in her practice, such as biofeedback, neurofeedback, and Nexalin Technology throughout her 30-year career.  She is an exercise enthusiast, and has a particular passion for long-distance cycling.