A common health concern:
Depression disorders constitute one of the major health issues of our time, and their impact is increasing. Depression is a common and important illness affecting at least 1 in 5 people during their lifetime. Major depressive disorder, also known as clinical depression or unipolar depression, is characterized by reduced mood, sadness, and lost enthusiasm for previously interesting activities in daily life. Additional signs and symptoms such as difficulty sustaining weight, sleeping more or less than usual, feelings of muscle weakness, difficulties with concentration and experiencing a sense of worthlessness can also be present. Many of us may not meet the criteria for major depressive disorder, but we have all experienced the highs and lows of life to some extent. Along with the prevalence of depressive disorders, the cost to treat these disorders has also grown. In 2000, the National Institute of Mental Health estimated the cost to treat depressive disorders in the US at $26 billion annually. In addition to the increasing costs associated with treatment, the accessibility and effectiveness of conventional treatments have come under question. Approximately 55% of people afflicted with a depressive disorder are receiving treatment, and only 32% undergoing treatment will see alleviation of depressive symptoms. Furthermore, recent research has found that only 27.5% of depressed participants go into remission with initial medication treatment. These statistics indicate the need for more cost-effective, accessible and alternative treatment options
Treatment options:
Cognitive behavioral therapy and pharmacological interventions are both widely used in the treatment of depression. However, among today’s treatment alternatives, none has been shown to be superior to the others, and different treatments suit different patients. More evidence-based alternatives, such as physical exercise are needed in the fight against mood disorders. In Australia, the government has recently included the services of an exercise physiologist under the nation’s Medicare program, allowing general practitioners to refer patients for a number of medical conditions including depression. A similar movement has begun in the UK where in 2005, the Mental Health Foundation released a report encouraging general practitioners to use exercise as a front-line treatment for mild to moderate depression. Despite these recommendations that all depressive patients should receive an exercise program as part of treatment, many patients still do not receive this type of care.
Exercise is medicine:
Recent studies have reported exercise as more effective than no treatment, as effective as traditional interventions in some instances, and having equivalent adherence rates to medication. A 2009 study reported no significant differences between exercise and psychotherapy or antidepressant medications for depression. Based on the available evidence, and while awaiting further high quality evidence, it would seem appropriate for exercise to be recommended in combination with other treatments. It is reasonable to recommend exercise to people with depressive symptoms, and to those who fulfill the diagnostic criteria for depression. However, we cannot yet give people accurate information about how effective exercise might be, nor can recommendations be made about the relative benefits of aerobic exercise, resistance exercise or mixed exercise, or whether group or individual exercises are better. Although, one could argue that exercise within a social or group setting may provide additional benefits to people with depressive symptoms. Given that the dropout rates from exercise can be a factor, a pragmatic approach should be taken in choosing a form of exercise you enjoy, and one that is accessible to improve adherence and increase the likelihood that it will be continued long-term. Many people would prefer not to take antidepressant medication. Exercise is relatively free of side effects, is a comparatively cheap alternative, and can be performed at the convenience of the individual, in contrast to antidepressants or psychotherapy, which is reliant on a visit to a physician or therapist. Furthermore, antidepressants are known to have a latency period of several weeks before taking effect; exercise in contrast, has the potential to provide immediate psychological benefits. Although adherence to exercise programs has been identified as a concern in depressed populations, several studies indicate that dropout rates from exercise interventions are equal to, or often lower than dropout rates associated with antidepressant treatment. Lastly, while the benefits of conventional treatment for depression typically do not expand beyond alleviation of symptoms, there are many additional benefits of exercise including: (i) reduced risk of cardiovascular disease, high blood pressure, colon, breast and prostate cancers, and type 2 diabetes; (ii) improved mortality rates and cognitive functioning; and (iii) maintenance of normal strength and peak bone mass. Whether exercise is more or less effective as a stand-alone or adjunctive treatment remains unclear. However, while awaiting further high quality evidence, it would appear appropriate for exercise to be recommended in combination with other treatments, or as a stand-alone treatment prior to other the addition of other conventional therapies.
The bottom line:
- Depression is a common and important illness affecting at least 1 in 5 people during their lifetime.
- Exercise appears to have similar effectiveness for the treatment of depression compared with conventional therapies.
- Exercise therapy provides additional health benefits in addition to improvements in depressive symptoms.
- There is a lack of evidence regarding the type, duration, intensity and frequency of exercise that results in optimal therapeutic benefit. So pick an activity you enjoy and try to be active everyday!
- Current evidence suggests that exercise should be included as a front-line and/or adjunct therapy for all patients with mild to moderate depression.
Yet another reason to make daily exercise a part of your regular routine. Enjoy some spring sunshine!
Dr. Steve
References
1) Daley A. Exercise and Depression: A Review of Reviews. J Clin Psychol Med Settings. (2008) 15: 140-147.
2) Eriksson S. & Gard G. Physical exercise and depression (Systematic Review). Physical Therapy Reviews. (2011). 16:4. 3) Ernst C, Olson AK, Pinel JPJ, Lam RW. & Christie BR. Antidepressant effects of exercise: Evidence for an adult-neurogenesis hypothesis? J Psychiatry Neurosci. (2006) 31(2): 84-92. 4) Hetrick SE, Merry SN, Mckenzie J, Sindahl P. & Proctor M. Selective serotonin reuptake inhibitors (SSRI’s) for depressive disorders in children and adolescents (Review). Cochrane Database of Systematic Reviews. (2007). Issue 3. 5) Mead GE, Morley W, Campbell P, Greig CA, McMurdo M. & Lawor DA. Exercise for depression. Cochrane Database of Systematic Reviews. (2009). Issue 3. 6) Moncrieff J, Wessely S. & Hardy R. Active placebos versus antidepressants for depression (Review). Cochrane Databae of Systematic Reviews. (2004). Issue 1. 7) Rethorst CD, Wipfli BM. & Landers DM. The Antidepressive Effect of Exercise: A Meta-Analysis of Randomized Trials. Sports Med. (2009). 39 (6): 491-511.