Ex-professional cyclist Tyler Hamilton (in the news again recently, which you will know unless you were asleep for 60 minutes) claimed in 2009 that his second positive test for doping (DHEA) was the result of his taking a herbal remedy to counter longstanding depression (Bonnie Ford of ESPN as usual does an excellent job of summarising here). Hamilton is not the only professional cyclist to have suffered from depression during or after their career, and I have often wondered about the relationship between training workload as a cyclist and mental health. I recently read two blog posts about depression by active cyclists (Scientist, you’re a failure & Drugs and Mental Healthcare) and this got me thinking about how exercise and mental health interact. In this post I write about my own experiences, share some academic research on the topic, and speculate a bit about depression and cycling in general. I am not a mental health professional (although I am an academic working in the area of empirical psychology) so please take my words with this in mind.
My current training load (if you can call it that) is circumscribed by my role as a parent, partner and academic: I tend to ride once or twice a week, and rarely ride longer than about 60-80 km in a day: most times a ride is 40 km: it is, however, very hilly here so the rides include plenty of variation, and for strength work I have some monster climbs that are easily supplemented with a child on a child seat or a child-stoked tandem. I rarely do intervals, and do most of my riding outside, not on a trainer. This was not always the case: until not long ago I was riding around 100-250 km per week (sometimes further), including interval sessions. Most of my riding at this peak was aimed at building endurance and some degree of speed (I am not naturally fast) to make randonneur events more comfortable and enjoyable, were social rides with my partner, or took the form of randonneur events themselves. Every year for four years my partner and I holidayed in France, conquering big climbs, including the Spandelles (but also some you would be more familiar with). Our bible was altigraph (more on this another day).
I have a family history of depression including bipolar disorder, suicide and clinical depression. Until quite recently I managed my own depression without having to visit a doctor, counsellor or therapist. Although I have taken non-prescription drugs, and still drink alcohol, it is cycling that has often seemed to offer some control over my mood (among other things). Like many suffering from underlying long-term depression, I have learnt when to rest: physical insults (colds and flu in particular) often trigger depressive episodes and need to be watched out for. Since having had Epstein-Barr in my twenties, I have not recovered as well from physical stresses, and I ignore physical illness at my peril, however minor it may seem to others. This means that cycling is both a source of relief, and a danger to me, but it was only recently that this was highlighted to me.
Following the death of my father, I have had two more serious episodes. The first lasted about six weeks and although I was off work, I received some very good help from a counsellor, and was able to rationalise my illness as a response to grief. The second was much more serious, and (if I am to believe the professionals and friends that helped me) mainly triggered by workplace stress. I recovered from this episode and have been ‘well’ since: I took six months off work, received counselling, and spent about two months taking citalopram, an oft-prescribed SSRI in the UK with side-effects I will never forget.
I spent a lot of time in doctors’ offices, but it was an interview with my workplace occupational health practitioner which gave me pause for thought regarding cycling as a kind of self-medication: she reviewed a range of obvious factors in my life which might have impacted on my mental health and was very keen to advise me to moderate my exercise regimen. At the time I only had one child, and had just begun to regain some time to ride, and saw this as a positive influence on my mood.
Since her intervention I have become more aware of the tightrope I walk in relation to cycling: it does make me feel good more often than not, but I have also had experiences before, during and after rides where I have had quite extreme negative episodes which do not seem to be coincidental. Sometimes the stress of getting ready to go out on a ride seems to be a trigger (not being able to find my pump or glasses; realising that the bike I want to use is unroadworthy or unsuitable for the weather); sometimes I have had to stop by the side of the road, completely numb; and sometimes after a ride I have felt like I never want to ride again. I know what the bonk feels like, and I know that these feelings, although sometimes brought about by exertion (or its anticipation) are different.
Cycling (among other forms of exercise) is often seen as a way of rising one’s spirits, a source of pleasure, even an ecstatic pursuit. Indeed, some make big claims for cycling as a way of combating depression:
Since one way to decrease stress, and perhaps even to decrease depression, is to exercise, the cycling community needs information about depression to be able to detect it and when necessary, refer people for appropriate treatment when cycling is not enough.
Nierenberg and Ostacher see their in their article for VeloNews as educative, and never suggest that cycling itself might play a role in instigating or worsening depressive episodes. They even suggest that a sudden reduction in training workload might be factor in triggering depression. Nierenberg and Ostacher are only telling half the story here. Although there is indeed much research that suggests exercise can be an effective part of treatment or prophylaxis for depression (see e.g., Dunn et al, 2005 for a classic controlled study), and anecdotal evidence for this abounds, two systematic reviews (Lawlor and Hopker, 2001; Larun et al, 2006) have found the evidence-base pretty weak, even for the general population, so we should not get to too excited yet about exercise being a magic bullet.
More importantly though, most studies look at the response of untrained people, not at recreational or competitive cyclists (as my partner was quick to point out when I discussed this with her). Indeed, one paper’s abstract (Martensen, 1990) notes that:
In general, depressed patients are physically sedentary. They have reduced physical work capacity but normal pulmonary function compared with the general population. This indicates that the reduced fitness level is caused by physical inactivity and is a strong argument for integrating physical fitness training into comprehensive treatment programmes for depression.
For trained, active cyclists the relationship between mental health and quantity and quality of exercise is undoubtedly more complex. As Nierenberg and Ostacher remind us, competitive cycling itself can be source of stress, although they downplay the double-edged nature of physiological stress: it makes us feel better and builds strength and endurance, but in excess leads to abnormal immune response, chronic fatigue, mood disturbance, and injury. It has even been suggested (Armstrong and van Heest, 2002) that overtraining syndrome (OTS) is so close to clinical depression that it might respond well to the same medications.
Hence it is possible that for athletes suffering from depression, less exercise might be the answer, and not more. It is also possible that within a culture where drugs are regularly used to combat the effects of excessive training or racing load (to maintain hematocrit, for example, or testosterone levels) athletes turn to off-prescription SSRIs or other anti-depressants when they become depressed, or are self-medicating with alcohol or cocaine, rather than changing their workload or getting the psychotherapeutic help that they need. At least two high-profile professional cyclists who seem to have taken this path have ended up dead, and Jesus Manzano, ex-Kelme, is better placed than I to place anti-depressants in this rather grim context:
The drugs lead you to other addictions. The anti-depressants almost automatically accompany other doping treatments. I took up to 8 pills of prozac a day when I was racing… …Prozac cuts the appetite, keeps you in another world, a world where you’re not afraid of what you’re doing. You’re no longer afraid to inject yourself with all the crap. It takes you to a world where you don’t ask any more questions especially you don’t ask your doctor questions either or your sporting director. Then there are periods where you must stop doping you feel like superman. Then one day all of the sudden it stops and you become dramatically depressed. Look at Pantani, Vandenbroucke and all the others we don’t even talk about. They are numerous other cyclists and former cyclists that are addicted to cocaine, heroin and other medications. It’s not just in the world of cycling.
Jesus Manzano, interviewed by Andy Shen in nyvelocity
I don’t race, and no-one is stupid enough to pay me to ride, but I know that for me, exercise is not a simple cure for depression, nor even for feeling unhappy. It can lift mood, but it can also contribute to the problem. The key here is to aim for what a psychobiologist would call ‘optimal arousal’: do enough to make you feel good, and know when to rest. Seems like commonsense, but having sometimes gone over the edge, maybe I needed reminding…
This is a superb piece, really well written and demonstrates the way that there is no “one size fits all” solution to the demon black dogs. I read some of this as if reading my own story which though in part scares me also gives me and hopefully others the same courage.
In respect of cyclists and in particular pro-cyclists and depression the conclusion that time off the bike is a better cure then more time on it isn’t so surprising when you think about it. For me last year’s Tour Ride was almost a new obsession and another potential trigger for a repeat episode (I still struggle with “rest” now!). When we come to pro-cyclists I think you make the implicit connection. For you and others work is a trigger to period of depression or a breakdown. For a pro-cyclist work is the bike. QED? And if you are Tyler Hamilton a) there’s probably a reason why you are taking anti-depressants which lead to a positive test and b) the monkey on the back that he has just rid himself of doesn’t help.
Thanks, Rob, and your reply hits the nail on the head in relation to work. Pro cyclists work when they cycle, but like musicians, they identify so much with their sport it must be hard to stop. Watching Hamilton the other night was painful, and what he said about using epo to maintain training volume when he should be resting was what got me thinking.
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I read your article with great interest. I am psychotherapist and a cyclist. Exercise is so often ‘prescribed’ for good mental health. It is seen as a good thing. But it isn’t as simple as that, as you point out. Thinking of cycling, putting body and mind on a saddle is a complex act. There’s the intention we bring from carefree riding to striving to push limits. There’s our bike, our clothes, from neglected objects to cherished polished extensions of self. There’s the environment, battles with ‘enemy’ cars or a cool breeze on your back, there’s being alone or being with mates. And each and every time I ride there’s an anxiety lurking, an anxiety that I may hurt myself, at worse die. Perhaps there’s subtle acknowledgement of that in a friendly nod from a fellow on a Sunday morning ride, of something that makes us common in a hurly burly world. I like to think so, it gives me hope and lifts my spirits. Your article reminded me of that too so thank you.
Thanks for the thoughtful comments. I think the combative side of cycling is really important: it is a challenge, but one that can be met if one keeps things in perspective and doesn’t take the struggle too seriously! That is what is sad abut many professional racers lives: they have been forced to turn a source of pleasure into work; we are still free to choose how seriously we take the next ride.
Yes I agree. And the challenge is so fierce for the pro’s, How they sustain themselves must be so hard. One of my favourite moments in this year’s Giro was seeing the face of Tiralongo with his win. What was it? 12 years of striving?
Thanks for this post… I used to race in the eighties and experienced the dismantlement of my self-esteem as a direct correlation to my perceived abilities as a bike rider, or in my efforts to improve myself as a “real-racer”… not a good combination. It got so bad, to the point I was afraid of failing so badly, I simply stopped riding and became the quitter I was so secretly afraid of actually being. It took many years for me to actually enjoy cycling again for what it is w/o pressure to judge myself by my mastery of it, or willingness to suffer for it. Anyway… I think there is a balance between using exercise to enhance one’s moods, or to let it dominate one’s feelings (i.e. “I’m a loser because I skipped a work-out” type of thinking). And it’s a fine line at that. Thoughtful piece.
So glad you found it interesting: the comments have been really worthwhile for me. I can only speculate on how ex-racers actually feel, and it is really interesting to me that who we think we are (and want be) has such an effect on how we experience cycling… and how this changes over time.
Thank you for this blog! I have never been diagnosed with depression, but have enough of the symptoms (and, like you, a family history) to know I suffer from it from time to time. I have led a fairly sedentary lifestyle until a few years ago, when I started cycling regularly (for fitness, fun, and to help combat my “moods”). At first it helped immensely, but then I couldn’t understand why there were times that going for a ride would stress me out completely when I love riding and there was nothing I would rather be doing, and also times that I was in a worse mood AFTER the ride. Your comments on getting ready for a ride being a trigger and never wanting to ride again after a ride at least made me realize I’m not crazy! 🙂 I was under the impression that the more exercise the better, and even though I don’t ride NEARLY as much as the “serious folk”, I will now pay attention to my post-ride moods in correlation with how much riding I’ve been doing when they are negative. Although I also find myself stressed and cranky when I don’t get out enough on the bike, so I guess it’s all a fine line of finding the correct balance! 🙂
So glad you found it interesting: it’s interesting to me to find out that others have similar experiences too! Good luck finding your balance…
I, like the rest of my family, have a history of sometimes quite debilitating depression. I have definitely been better since my exercise has increase through cycling and daily dog walking. My doctor has suggested that my increased exposure to daylight is also a factor
I hadn’t considered sunlight exposure at all, that’s a really interestimg factor which could explain why some respond well to exercise. It also might suggest that the gym might not be the best place!
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This paragraph really resonated:
“Sometimes the stress of getting ready to go out on a ride seems to be a trigger (not being able to find my pump or glasses; realising that the bike I want to use is unroadworthy or unsuitable for the weather); sometimes I have had to stop by the side of the road, completely numb; and sometimes after a ride I have felt like I never want to ride again. I know what the bonk feels like, and I know that these feelings, although sometimes brought about by exertion (or its anticipation) are different.”
I am a runner, not a cyclist, but I imagine that makes little difference. I have found that a drop in training can have negative, even catastrophic effects. For me the key has been to regulate intensity. A “workout” (hard, training session – hill reps, track work, etc) can be a stress to far; adjusting to a slow and easy plod seems to always rectify things, the further the better.
I have found that an increase in low intensity exercise, so long as it is not so much as to bring on overtraining, has an almost magical effect. I suspect that often a lesser effect from exercise may be, in part, due to insufficient time exercising. But it is the harder stuff I have had to watch out for – when you are feeling better and thinking about races, goals and PRs it can be easy to lose sight of the more holistic picture.
Thanks for your input – enjoyed reading it.
So glad you found it interesting. I think the volume vs. quantity issue is really fascinating: I’m in uncharted territory this year because I am actually training for a concrete goal. We’ll see how that works out!
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I enjoyed the article
Was also under the impression that excercise sways depression
I am a jogger
After awhile my knees said it was time to find another outlet
Si I landed up in long distance cycling
The struggle to keep 20 km for 9 hours is what got me hooked
I agree with the balance
Ian trying my best to rest more during the week so that I can do a 120km plus
Cycling forced me to talk to God
The solitude forced me to have a a conversation with hi and most of the time I have closure
Crying at times
Screaming at time
I hope you find your balance. Tail winds also:-)
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The reason I am reading this well written article is because I am trying to identify, is there a relationship between training load and depression.
I have been training very hard for the past 3 months, and with 1 month to go before we will taper and peak for the one day climbing event.
The intensity and the amount of training time meant my body is very sore if not painful, everyday. Someday I took painkillers.
Then I broke down and I my doc prescribed SSRI to me to deal with this. I also take sleeping pills for quick nap before training, and before bedtime.
So this is my short story. High Intensity workouts bring soreness and pain, with that we harden the f up continue to do it. Easy aerobic rides are too long they are extremely boring.
Do this routine too long and it blew up on my face.
I am not even a pro, just a guy looking to ride faster, with job, family, stress.
This is not the first time training brings back my depression. I am still learning the to spot the symptoms before it happens but it is very hard. One week I will be totally blasting workouts, enduring pains like its no problem, and the next week suddenly I lost interest to most things around me. Feeling like a heavy heart zombie.
It is really hard to find a formula that works well. I’m still getting it wrong – the important thing for me is to remain open and to keep listening to your body and head. I hope you manage to find a way as cycling can be part of a solution, but it may be that you have to reconsider goals and accepted wisdom about how to get to them. All the best to you.