Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Wed, 26 Mar 2025
This episode is brought to you by BiOptimizers, Cozy Earth, and Fatty15. When we think about treating depression, we rarely consider exercise. Yet emerging research shows it can be a powerful tool for managing mild to moderate depression, and it works well alongside other therapies—including medication. Today’s guest shares the science behind exercise and explores why more practitioners aren’t incorporating it into treatment conversations. Today on The Dhru Purohit Show, Dhru sits down with Dr. Nicholas Fabiano to explore the powerful role of exercise in treating depression. Dr. Fabiano introduces the FITT protocol for prescribing exercise and sheds light on the disconnect between physicians and patients when it comes to exercise recommendations. Dhru and Dr. Fabiano also discuss how research funding can shape treatment perspectives, the benefits of combining medication with lifestyle interventions, and the emerging role of creatine in brain energy and its potential impact on depression. Dr. Fabiano emphasizes why exercise is essential for mental health and advocates for a holistic approach to treating depression—one that includes lifestyle pillars like diet and sleep. Nicholas Fabiano is a psychiatry resident and researcher at the University of Ottawa. Drawing from his personal background in weightlifting and competitive soccer, Nicholas developed a strong interest in the use of exercise as a treatment for mental disorders, particularly depression. His research focuses on the intersection of mental and physical health, with a special emphasis on lifestyle psychiatry—exploring how exercise, diet, and sleep influence mental well-being. In this episode, Dhru and Dr. Fabiano dive into: Exercise can be as effective as therapy in treating depression (00:27) The importance of finding a provider who exercises and understands its benefits (01:57) The impact of exercise on both the brain and body (04:53) The misperception that all patients want quick fixes (11:11) The side effects of medication and how lifestyle interventions can help counter them (19:18) The FITT protocol and how to prescribe it effectively (23:56) Reframing exercise as an intervention that empowers patients (31:54) Heart rate variability, and why doing what you enjoy matters (31:42) The benefits of stacking exercise with creatine (38:33) How to incorporate creatine into your diet (44:24) Exercise recommendations for beginners, family, and friends (45:02) A lifestyle protocol that can actually induce depression (49:33) Advocating for and educating the public on foundational principles (59:06) An entrepreneurial approach to solving the mental health crisis (01:03:21) How Dr. Fabiano became passionate about brain health (01:05:59) His advice for beginners and how to follow his work (01:11:27) Also mentioned in this episode: John Abramson's book - Sickening Try This: Three Super Crazy Facts about Big Pharma Study on BPA in pregnant women For more on Dr. Fabiano, follow him on Instagram, X/Twitter, LinkedIn, and his Website. This episode is brought to you by BiOptimizers, Cozy Earth, and Fatty15. Go to bioptimizers.com/dhru now and enter promo code DHRU10 to get 10% off any order of Sleep Breakthrough and find out this month’s gift with purchase. Right now, get 40% off your Cozy Earth sheets. Just head over to cozyearth.com/dhru and use code DHRUP. Fatty15 is offering an additional 15% off its 90-day subscription Starter Kit. Go to fatty15.com/dhru and use code DHRU to replenish your C15 levels for long-term health. Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: Can exercise really treat depression effectively?
Dr. Nicholas Fabiano, welcome to the podcast. You know, there is a pretty mind-blowing belief that you have about treating depression. And that belief is that most people, including many medical practitioners, have no idea that exercise can be as powerful as a tool to treat depression as talk therapy and medication. Can you expand on that?
Traditionally, we viewed exercise as a treatment for many different things, more so in the physical realm. So you often hear your doctor talking to you about these things for diabetes or weight loss and stuff of that sort.
But it's been more mainstream recently as the research just came out to show that exercise, just similar to, as you mentioned, therapy or even antidepressant medications, can have similar antidepressant effects if prescribed correctly. So I think this notion for some people is received very well, for others, maybe not so well.
But even for providers, for instance, in Canada here, it's one of the first line treatment options that we have in our guidelines. But many people aren't aware of that. So I think with that, we have the evidence for it. We know its benefits. The next part is really educating people and also the providers about how to do that. And that's where that disconnect really lies.
Well, we're gonna get into that, but right away, I wanna take a quick tip that you have for anybody who's listening, who might be dealing with some spectrum of depression. There's mild, medium, severe, or even people that find themselves in more of a depressive or low mood, but maybe don't have a clinical diagnosis.
And you have an important tip that I'll steal from one of other podcasts that you were on. And that tip is, if you as the patient are looking for a provider.
Ideally, if you can find somebody who has some background in working out themselves, because if they, as a physician or a healthcare provider is working out, they're more likely to be prioritizing and recommending this as part of their treatment program. Can you expand on that?
Research has shown at a family or primary care physician level that, as you mentioned, people that are exercising more, so the providers, are more likely to have that discussion with their patients. And that extends to things like depression. And that's important.
As you mentioned, when you're looking for a doctor, if that's something you want to talk about, it's hard if the physician that you're speaking with isn't open to that discussion. So there's that disconnect there. But the other part stems even deeper beyond people that have their own experience with exercise and want to prescribe it.
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Chapter 2: What is the FITT protocol for exercise?
You can imagine when you exercise and people have probably all have this experience where after you have a good session at the gym or if you go for a run or if you go climbing with friends or some sort of sport, immediately after you have this sense of, you know, increased drive, motivation, those stresses that you were worrying about maybe aren't there anymore.
And that's important as well, too, because that can provide you with the momentum to continue to maybe get that task done you've been waiting and holding off on or even to look forward to that next session. So that psychological aspect is important too.
And then an often forgotten part of exercise too is the social part or the social aspect of that three-pronged approach where particularly in populations that are more prone to being isolated or alone, particularly during the COVID pandemic or older populations, exercise may be the only time where people are in a group setting doing something.
So whether again, that's at the gym, just talking to other people. whether you're on a sports team talking to other people. And we know that this social connection as well, too, has antidepressant effects, too, because loneliness in itself has been perceived to be a disease and increased the risk of dementia and cognitive decline and even depression.
So looking at these three different lenses, we really see how exercise can fit in and may alleviate someone's depression, even without knowing the full scope of what causes depression per se.
You know, one of the things that you talk about online is that there is a little bit of a problem that's there. And that problem is because of the research that typically gets funded and how that research makes its way to physicians who largely are all well-intentioned and want to help patients. There becomes this jaded view that many physicians have that.
which is that if I'm going to suggest physical activity, even if I know about it, the patient's not going to do it. Patients just want quick fixes. They just want a pill to deal with the issue. Talk about that idea and why it's wrong or incorrect or missing the full picture. One of the most overlooked areas of weight loss is not your diet, it's actually your sleep.
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Chapter 7: What is the role of creatine in mental health?
Like you said, as physicians... With our training, a lot of our formal teaching and comfortability comes with medications. So you have someone with depression, the two-pronged simple approach is therapy, medications, maybe both. And that's where maybe that comfort level comes in. I think the other part too with exercise and sometimes people wanting this quick fix is
Sometimes there's this misperception because in depression, innately, there's this amotivation. A lot of people experience that.
So sometimes the provider kind of rather than speaking with the patient in front of them and seeing what might work for them, just automatically kind of assumes that and jumps to the other treatment options rather than entertaining that discussion, which I think is an important barrier as well, too.
Which is important to really make sure, you know, is this patient wanting to talk to me about exercise? And then that brings up the other point of the severity level of depression too. So as a provider, you have a responsibility, you have different treatments to offer, but exercise and where most of the research lies is in people that have a mild or moderate depression.
Versus someone that has a severe depression. And to give a picture of what that looks like, someone with a severe depression is someone that is completely bedbound. They're not able to do their activities of daily living. Stuff is really, really hard.
And offering exercise to someone in that setting maybe isn't inappropriate, but perhaps it can be kind of this bridged approach where maybe other interventions can be offered first and then having that discussion about exercise.
But I think before you go into that discussion with a patient, I think you also need to understand that, as you alluded to before, people have probably had poor experiences with other physicians, whether it be a psychiatrist, whether it be a primary care doctor, surrounding exercise. So if you came in with a physical ailment and you were told just go exercise,
that's not very actionable and it can feel that a finger is being pointed at you if you're the patient, that you're being blamed for this condition. So the patient already walking into this encounter with you, the psychiatrist, can already have that view of exercise or lifestyle metrics in general. So it's important to kind of Presented in a way that it's not confrontational.
You're not blaming someone for having depression or something because of their diet or because of their exercise regimen or lack thereof. More so framing it in an educational view and feeling if the patient seems interested at this moment.
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Chapter 8: How to start exercising if you're feeling depressed?
I know that's not your area of expertise, but you do pay attention to it a lot based on your posts on Twitter and anything else. So what would be the perfect protocol to induce depression in a group of 50 people?
To reverse kind of the things I would do, how I view kind of the fundamental pillars of your health are your exercise, your diet, and your sleep patterns. So if we're to flip those upside down and want to induce a depression, for exercise, I would say, you know, remain completely sedentary. Don't even get off the couch. Just Uber eat stuff straight to your couch.
And what you're eating too, that leads to the next point, is purely ultra-processed foods. So just eating the most processed stuff you can have. So whether that's fast food, stuff with maximum amount of calories packed into small amounts of food, that would be kind of the exercise diet.
And then sleep wise, I would say completely have no schedule to your sleep, kind of fall asleep whenever, try to stay up during the day and have your circadian rhythm be all messed up.
And with those three things, and the reason why I say this is as a resident physician, some of these things happen to us indirectly sometimes where we're on a 24-hour shift, we haven't eaten, we haven't had the chance to exercise in a week because it's so busy. And again, not to say and discredit someone that's experienced a depression, but in these states, It's so hard.
You feel that mental burden on you, especially if it's prolonged for a period of time, that I can imagine how if someone's lifestyle was like this day after day, week after week, year after year, how it would be almost impossible not to develop symptoms of depression or an overt clinical depressive symptom.
And that's why I think beyond just the medication therapy and what our standard is, we need to make sure that we have these fundamentals in check because it's hard to... piece someone back together if you don't have that foundation there.
And that's why it's so important, not necessarily to perfect it, but to at least restore some balance to it and not just have this bandage approach of, oh, here's a medication. This will make stuff better. And maybe it translating will, but it won't solve that foundation and prevent relapse and different things of that sort.
I appreciate you mentioning that. And also the fact that even at some points of time in your career, you know, becoming a physician, that you've gone through a routine that looks not too far off from that. Maybe not exactly. It was unfortunately a necessary part of your training. I have a lot of physicians in my family, and I know that they've gone through many similar things.
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