Everyone knows exercise is great for depression. Studies show physical activity has an equivalent effect to medication for Major Depressive Disorder. As helpful as these findings are, they are of no use when people are unable to get motivated to exercise. So many people with depression feel they are lazy when they don’t exercise. This self-criticism makes them feel worse and, in a vicious cycle, leaves them feeling even more depressed.

Nonetheless, there are many reasons people with depression find it difficult to work out, none of which include laziness. Below are only a few. If you have depression, you can use the insights to better understand the condition and forgive yourself when you have trouble getting motivated to exercise.

1. Your Dopamine is Low

Depressed people don’t have motivation because they are low in dopamine, the neurotransmitter that makes you feel excited and enthusiastic. When you have decreased levels of this neurotransmitter, you feel apathetic and fatigued. This state is not “lazy” any more than someone with any other ailment is “lazy.” Your brain chemistry is literally telling you not to get up and move.

2. You are Experiencing “Leaden Paralysis”

In atypical depression — which actually isn’t atypical but is the name for the type of depression more common in women and in bipolar depression — symptoms include “leaden paralysis,” which means your limbs feel heavy and unable to move. This sensation is more intense than a normal level of tiredness.

3. You are Anxious About How Others Will Perceive You

There are many reasons for this. Individuals with depression can also experience anxiety, including social anxiety. The idea of going to a gym where others may judge you is not high on the list for people who worry about being evaluated even at the grocery store.

Many people with depression gain weight because they use food to self-soothe. When you couple this weight increase with a lack of exercise, this combination can make people even more reluctant to put on workout gear and hit the gym.

4. Starting a New Routine Can Feel Insurmountable

For people with depression, motivation is a major issue in all aspects of life. Exercise isn’t a one time deal, and you’re smart enough to know that benefits accrue over time. But committing to a whole new routine may feel completely impossible when you’re struggling with depression and even very small tasks become harder.

5. Lack of Social Support

Some people can start a new exercise routine with support from a friend who becomes their workout buddy. But many people with depression let their friendships slide, because they don’t feel able to keep up conversations or interact in a cheerful or energetic way with others. This situation means that when it comes time to start hitting the gym, you may be going it alone, which can feel even more depressing.

6. Negative Self-Talk

When people are depressed, it is like there is a constant stream of mean self-talk in their heads, telling them they can’t do anything right, that they are failures. This mindset means that instead of feeling positive about any exercise they do accomplish, a depressed person will think it isn’t good enough. Hopelessness might stop them from trying again.

Thankfully there is hope, and most of it comes in the form of moderating expectations. Instead of focusing on beginning a whole new regimen, it may be enough to start walking a few minutes every day. This exercise routine can often kickstart your mood, and you’ll end up feeling better simply because you pushed yourself a bit.

Thinking outside the box can also help. While you may not feel sociable enough to have a friend join the gym with you, maybe an online group can provide you with social support and keep you accountable. You might feel too self-conscious to work out around other people, but using an exercise video on YouTube as your trainer is possible.

Online therapy and medication can also help a great deal with the fatigue, apathy, and leaden paralysis that are symptomatic of depression. No matter what, though, when starting exercising during or after a depressive episode, you will have to consciously refrain from beating yourself up when you don’t reach the exercise goals you think you “should” be able to achieve.

Depression is a physical illness as well as a mental one. Self-compassion can make all the difference.