“It’s been said that exercise is the most potent and the most underutilized antidepressant,” says Dr. Lucy Chartier, of Life Quality Resources in Raleigh. “I would have to agree! The importance of exercise is true to my heart, and central to the focus of my practice when dealing with patients who present with depression and anxiety. I consider it one of the basic pillars of mental health.”

Dr. Lucy Chartier is a psychiatric nurse practitioner, doctorally prepared in clinical psychology whose practice at Life Quality Resources in Raleigh is focused on medication management and therapy for patients dealing with depression, anxiety, and adult ADHD (Attention Deficit/Hyperactivity Disorder).

In a conversation with Health&Healing, Dr. Chartier discusses the important role movement plays in our overall physical and mental health, and explains how she uses that understanding in her therapeutic work.

Health&Healing: What’s the connection between exercise and mental health?

DR. CHARTIER: My interest in the connection goes back to the 1980s, when my first research project as a graduate student was a study exploring the impact of aerobic fitness on mood. My study confirmed the benefit of exercise and underscored my interest in the connections between physical and mental health. That first project led me to approach my work holistically.

I was certainly not the first person to consider the relationship between exercise and mental health, but at that time it was not mainstream. However, there is plenty of research today supporting the value of exercise in the treatment of depression. While the links between depression, anxiety, and exercise aren’t entirely clear, it is well established that exercise can decrease symptoms of depression, and that the benefits increase when patients engage in exercise regularly and frequently. In other words, building exercise into one’s lifestyle is of great benefit for mental health.

I should add that exercise is just one of what I consider the pillars of mental health and wellbeing. Research also underscores the importance of sleep, nutrition, and meditation in dealing with depression and anxiety, and with the challenges of attention deficit disorders (ADHD). For these reasons, the focus of my practice is holistic. This means going beyond medication management and therapy to consider the lifestyle choices that are the critically important foundation of mental health and wellbeing: good sleep, nutrition, exercise, and meditation.

H&H: How do you use exercise in working with your patients?

DR. CHARTIER: First, exercise is important—and it’s just one critically important factor. Depression is impacted by life experiences, genes, diet, and other health issues. So, any therapeutic relationship begins with my understanding of the multiple factors affecting my patients.

One the psychiatrists I trained with expressed it best when she said, “When patients come in for an assessment, before I decide if they’re Prozac deficient, we need to figure out what other areas of deficiency they might have.” In other words, before we decide to use a medication we nee to understand other factors that could be contributing—depression, anxiety, insomnia, etc.—and address those first.

So I want to know about diet, about sleep issues and habits, and I want to know about exercise. Because we know that exercise can benefit mood and relieve stress—especially when we’re talking mild to moderate depression. And persistent stress can lead to clinical anxiety and depression. So, if we can manage our stress better, then maybe we won’t develop that clinical syndrome that requires medication.

H&H: How does that happen? Why does exercise help?

DR. CHARTIER: We know that exercise increases the production of serotonin and dopamine in the brain. Those are the neurotransmitters that we target when we’re using antidepressants. So, exercise is doing much the same thing that those medicines are doing.

One major study that stands out concluded that sedentary people are much more likely to be depressed. By “sedentary people,” we mean those who aren’t actively up and about and moving. And that’s not even talking about exercise—that’s just saying: they don’t move, they sit. Those people are more likely to be depressed.

Another study found that people with mild to moderate depression got almost identical results in terms of treatment response from exercise as those who took medicine. Close to 50 percent of people who take antidepressants have a positive treatment response; and about 45 percent of people who engage in regular exercise have a similar response. That underscores the assumption that the increase in serotonin and dopamine from exercise plays a key role.

H&H: You note that exercise is one component of your holistic approach to treating depression. How does it connect to other components?

DR. CHARTIER: As I said, addressing other lifestyle factors—especially sleep and diet—is important. But, while these can be enormously helpful in addressing depression, it’s also true that medication and therapy play critical roles as well. And the connections between these is important. For example, there is a significant synergistic effect when you use antidepressants and exercise—often resulting in better outcomes than doing either one alone.

The healing process is a combination of three things. I can offer medication, counseling, and guidance about things that the patient can control—diet, exercise, meditation, whatever. Those are aspects of any holistic program. And, for many people, there’s a role for medication as well.

How to address symptoms depends on several factors: how long the symptoms have been present, the severity of the symptoms, medication use history, and lifestyle (current stressors, diet, exercise, sleep quality and quantity). If this is a first episode of depression and the symptoms are mild, making adjustments to lifestyle and engaging in psychotherapy might be adequate to promote symptom remission. If symptoms are more severe and/or have persisted over time, introduction of an antidepressant might be a necessary first step accompanied by supportive therapy and followed by lifestyle changes

H&H: Depression is debilitating; it slows you down. How do you get depressed patients to start moving?

DR. CHARTIER: That is a challenge. Depression doesn’t just slow you down, it often stops you in your tracks. Starting to move is hard, but once you start it is incredibly powerful.

One case—a client I’ll call Donna—stands out as a perfect example. She was in her late forties, a high-functioning professional, with a good life and stable family, and no prior history of depression. But, in the wake of a significant breach in her relationship with one of her adolescent children, she developed a severe depression.

She couldn’t understand it. She wasn’t suicidal, but said “All I do is sit around thinking about dying and wondering what it’s going to be like? I just feel like my body’s caving in on me. I’ve lost my motivation, energy, and my joy.”

Donna had been a person who was really fit, and had an exercise routine and a great diet. But as time passed, she got to the point where she quit exercising because she couldn’t muster the energy. She demonstrated the signs of clinical depression. She had no motivation. She didn’t care about her work. She was going through the motions, but just came home, went directly to the couch, then to bed. She withdrew from social engagements.

Donna understood she was on a self-destructive path, but she didn’t want to start an antidepressant, and she just couldn’t get back to her exercise routine.

I warned her that if these symptoms continued much longer, the recovery process would become more complicated and could result in the need for a cocktail of medications. And I kept saying to her: “You really must get back into your exercise routine. The one thing you can control is how much you move your body.”

That was the key—and her turning point. Donna came in one day and looked entirely different. She had started exercising two to three weeks before. When I asked her what had gotten her off the couch and out of bed. She told me: “I knew I had to, because I knew that I was dying. I didn’t know if that was physical death or psychological death. But I knew I was dying and had to do something. And even though I didn’t have the energy, with sheer force of will I put my shoes on, and I walked outside, and walked around the block.” And I say this to patients every day. What Donna did—taking that first step—is the hardest thing. But if you take that first step you can then take the next one. Don’t wait until you’re motivated. Don’t wait until you want to do it; just do it. Pick a day, put your shoes on, and walk out the door.