In his masterpiece, “Against Depression,” Peter Kramer (the author of “Listening to Prozac”) talks about the similarity between how tuberculosis was discussed before it’s cause was understood and how depression is discussed now. Tuberculosis was considered a rather romantic illness, associated with people of weak constitutions and fragile sensibilities. Treatment was bed rest. Likewise, depression is spoken of as a kind of disorder of the emotions, and its cause associated with a lack of psychological resilience. “Mopey” and “glum” are cartoon feelings: round faces with upside down smiles. I get glum when my internet connection is too slow for Hulu to work.

We know now, of course, that tuberculosis is a disease. It’s treated with antibiotics. Once antibiotics were discovered, TB was essentially erradicated. If you contracted TB today, no one would say you did so because you had a fragile constitution: you caught a disease and need to get treated immediately.

Likewise, Kramer argues, we now understand depression to be an actual disease. Its course — it actually destroys brain tissue — can be viewed using MRI technology — which didn’t exist 15 years ago. Some treatments are effective, some aren’t: science hasn’t found the cure yet, but doctors have an array of very effective tools. I’m not sure that St. John’s Wort is at the forefront of that arsenal.

If you had prostate cancer, the statement, “I haven’t been very productive,” would be met with raised eyebrows. It would be, as we say these days, an inappropriate response to what is obviously a debilitating disease. I guess I’m raising my eyebrows about this post. “Things will be fine. IÂ’ll be exercising. IÂ’ll be eating well. IÂ’ll feel good about myself. Then, one day, IÂ’ll have no motivation. IÂ’ll stay in bed half the morning, reading or surfing the web. IÂ’ll stop at the convenience store for Sno-Balls.” These aren’t the symptoms of someone who is mopey. These are the symptoms of someone who is depressed.

In a recent Get Rich Slowly post, you talked about nearly having a panic attack while sitting in your office, as a consequence of feeling isolated. You felt better after going down to the coffee shop and spending some time among people.

Something serious is happening here, JD. I know from past experience that I’m likely to get an e-mail from you telling me that I’m over-reacting. Exercise generates endorphins, among other things: your mood will undoubtedly improve if you start exercising. The chain of causation that you describe here, however (“Things will be fine. IÂ’ll be exercising. IÂ’ll be eating well. IÂ’ll feel good about myself. Then, one day, IÂ’ll have no motivation.”), suggests that you’re fighting a disease that is going untreated, not that you let your level of exercise decline below some optimal level that holds mopiness at bay.

Different subject: “When I bike, I make it into this huge gearing-up thing, and thatÂ’s a very real barrier. I need to get on the damn bike and go!” This statement has Muney’s fingerprints all over it. Good! You still haven’t told us whether biking creates more heel pain or not. I hope you’ll let us know.

The only thing worse than an injury is a re-injury. I don’t know how things are in the States, but in Canada a visit to a clinic is covered, and they can quickly tell you if you need to be referred to a physiotherapist, require an x-ray, or should just get more rest. If nothing else, getting an accurate diagnosis will at least set your expectations for how long you will be off the track.

Re: running – make sure that you have good footwear, and avoid jogging on cement/concrete when possible. Aim for grass and chip-trail whenever possible. Some people complain that it’s harder to run on a chip-trail, but harder is better when it means you’re making your body work more, and we only get one set of knees, so I think we should do everything in our power to preserve them (and this generally means letting them rest and wearing adequate footwear, rather than taking supplements with vague claims of healing your knees, such as glucosamine).

http://blog.penelopetrunk.com/2009/07/08/how-to-have-more-self-discipline/

I especially like her points (not unfamiliar but worth repeating) that our efforts snowball, whether we’re tackling debt or fitness or diet, and that when you fall off the wagon, so to speak, you need to find an accessible point of re-entry.

I’m certain that the lack of exercise has affected my mood. I suspect the poor sleep patterns have played a role, as well. And I wouldn’t be surprised if the St. John’s wort had some impact. I cannot deny that when I use the St. John’s wort, my mood is much more even-keeled.

But yes, as Adam suggests, I’ve decided to return to biking. I like running more (I never thought I’d say that), but the fact is I can’t do it right now. I think I can bike, though, and so I will. I need to find a way to not make it a “production”, though. When I run, I can just strap on the heart-rate monitor and head out the door. When I bike, I make it into this huge gearing-up thing, and that’s a very real barrier. I need to get on the damn bike and go!

JD, your choices are completely up to you. Be careful though! Do you know how St. John’s Wort interacts with every other OTC drug you take? Caution in all things.

You’ve always taken an approach that I’ve deemed to be fairly well grounded in critical thinking (I’m reminded of the excellent article you wrote about Women’s World, the magazine for women by people that apparently hate women). However, this latest bit seems out of character and like a bit of a void in your skepticism. Additionally you mentioned that you’re taking melatonin to aid your sleeping. Has this been prescribed? I think it’s always worth turning a skeptical eye towards actions that we undertake where we attempt to use medication as the means to solve a problem, rather than to look for the deeper underlying problem and solving that (why aren’t you sleeping well? Could it be because you haven’t been exercising enough, and thus being worn out and ready for the reward of a comfy bed at the end of the day?)

Fortunately, I think you’ve really nailed the main issues here – quality/quantity of sleep, and exercise. There’s a third one there as well, and that’s a healthy diet (not diet as in a temporary change in eating habits to lose weight, but as in the food you are consuming daily as part of your lifestyle).

If you feel that you may legitimately suffer from depression or sleeping difficulties, definitely go and see a professional that can help with this. Otherwise, stick with the remedies that make the most sense – healthy eating, physical activity, and lots of sleep.

Have you considered taking up other sports as a way to supplement running and going to the gym? I notice that you often struggle with long breaks from the gym. Perhaps this activity isn’t for you? I strongly recommend giving biking a try (check my post here for some of the reasons I think it’s a fantastic choice: http://adamquiney.com/public_html/blog/2009/06/biking-is-awesome.html), or checking out some racquet sports.

Stick with it!