When I went for a checkup with my general practitioner in November, I was mostly worried about a phantom pain in my boob. As any good doctor would, before we started the physical exam, he started off our appointment by asking questions about my life. How was I feeling on a daily basis? Was I under a lot of stress? Was I getting enough sleep?
I told him I was having a hard time focusing at work and was pouring myself a Big Gulp’s worth of pinot noir every night when I got home. I wasn’t sleeping more than five hours a night, and was so tired all the time that I was having a hard time motivating to do anything beyond lying on my couch and watching reruns of The Office. Even getting through the smallest daily tasks, like doing my laundry or paying my bills, felt impossible. I constantly felt like my entire life was hanging by a thread and I was constantly trying to keep up, and that any moment it was all going to come crashing down.
“Have you ever struggled with anxiety?” He asked.
“Yes,” I replied. I was diagnosed with anxiety and depression when I was 15, and spent eight years on a steady flow of SSRIs (or “selective serotonin reuptake inhibitors,” which are commonly prescribed to treat these disorders). I went off of my meds in 2014, when I felt like I was in a stable enough mental place to manage my symptoms holistically. “But I exercise every single day to help me deal with it.”
“Fitness doesn’t cure anxiety, though,” he told me of the relationship between exercise and anxiety. “It may be time to go back on your medication.”
The anxious brain
The anxious brain is complicated, and the medical community is still learning a lot about what makes it tick. According to Gregory Scott Brown, MD, the founder of the Center for Green Psychiatry, generalized anxiety disorder can come from a genetic pre-disposition (which he estimates cause between 30 and 50 percent of cases) as well as environmental factors like a history of trauma or early childhood stress. Some theories suggest that anxiety is caused by a connectivity issue between the amygdala and the prefrontal cortex, while others point to an imbalance of certain neurotransmitters in our brains, like serotonin, norepinephrine, and dopamine. These chemicals are associated with our bodies’ “fight or flight” response—aka how we respond to stress—and when you’ve got an anxiety disorder, they tend to kick up into high gear.
“Fitness doesn’t cure anxiety, though,” he told me. “It may be time to go back on your medication.”
“Exercise can play an important role in the treatment of anxiety,” says Dr. Brown, confirming what I’ve known for a long time to be true. As a fitness editor at a wellness website, I pride myself on being well-versed in the relationship between anxiety and fitness. In the last few years, we’ve learned that there are a number of benefits that exercise can have on mental health. A well-cited study of 30,000 adults found the regular exercise can help stave off depression, aerobic exercise has been shown to increase blood flow to areas of the brain that help control stress, and some research suggests that exercise can also increase a protein in the brain called brain derived neurotrophic factor, which reduces the symptoms of depression and anxiety.
When I went off of my anxiety medication a few years ago, this data informed my entire life. It was what got me out of bed every morning to hit a pre-work fitness class, and ensured that I moved (at least a little bit) every single day. I knew how I felt when I exercised versus when I didn’t, and could confidently say from experience that my anxiety was a lot higher on the few occasions that I skipped a workout in favor of a few extra hours of sleep. For awhile, that method was enough keep me calm. But thanks to certain stress triggers in my life, eventually it stopped working, and I found myself with a shiny new Zoloft prescription for the first time since 2013.
Fitness and medication aren’t mutually exclusive
There are a number of different theories about how, exactly, anxiety and fitness relate to one another. According to research by Harvard Health, getting your heart rate up changes your brain chemistry to increase the availability of anti-anxiety neurochemcials, like serotonin, gamma aminobutyric acid (GABA), brain-derived neurotrophic factor (BDNF), and endocannabinoids. And according to Dr. Brown, because exercise imitates many of the physical symptoms of anxiety, like a high heart rate and increased sweat, it can help our bodies build tolerance to those symptoms in high-anxiety situations.
While physical activity certainly can help alleviate the symptoms of anxiety, in certain situations (like mine) it has its limits. “You may find limitations in treating anxiety with exercise when the anxiety starts to cause functional impairment,” says Dr. Brown. “If you are already incorporating exercise, but your anxiety is so severe that [you are] having difficulty getting through the day, going to work, or noticing issues with [your] relationships, it may be time to try something else.”
For me, using fitness as the sole treatment for my anxiety worked… until it didn’t. If fitness has stopped offering the same anxiety-reducing properties it once did, like what happened in my case, it may be because you’ve gotten used to your routine. “You’ve probably done whatever your go-to exercise enough that you don’t have to think about it, and you can put it on autopilot, which can allow anxious thinking to creep in,” says licensed clinical psychologist Kevin Gilliland, Psy.D. The best way to combat this, he says, is to try something new that might challenge your brain and body in a different way. Outdoor running and yoga—which all require compound muscle movements and a certain level of concentration that helps keep you distracted from worry—are great ways to supplement your tried-and-true workouts.
But if that doesn’t work, it may be time to seek out a mental health professional who can help you figure out if you should be supplementing your routine with something else to help balance those chemicals in your brain. “Medication is going to be able to settle our neurochemistry better than exercise in general,” says Dr. Gilliand. “One of the worst symptoms of anxiety is that it talks us out of stuff that we know is good, like taking a break and going to exercise. And once anxiety gets to a certain point, it might be necessary to take medication to help you more easily step into these activities.”
The most commonly prescribed anti-anxiety medications, like SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), balance out your brain chemistry similarly to exercise, but in a more targeted way. “With anxiety, people respond to different things in different ways, and that includes different exercises and different medications,” says Dr. Gilliland.
“I would never recommend that someone just take a medication and then forget about incorporating these other mind-body techniques like exercise, therapy, and meditation,” says Dr. Brown. “If you have anxiety and you tackle it from as many angles as possible, you’re giving yourself the best possible chance for sustainable recovery.”
While taking anxiety medication may not be the right choice for everyone, I’m grateful every day to have found the missing piece to my mental health treatment puzzle. After spending years putting together a toolbox of anxiety-reducing practices, my medication now works in tandem with my go-to holistic treatments. Now, I come home from those 7 a.m. workout classes and pop a Zoloft, and I’ve never felt better. (P.S. my boob was fine).
If your anxiety is higher than ever thanks to social distancing, science says there’s a good reason for it. Plus, how one Well+Good writer used her wearables to hack her anxiety.
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