Exercise For Depression – from my book “A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t, and Why – Foreword by Dr. Bernie Siegel”

You can order ‘A Doctor’s Guide to Alternative Medicine’ from melborins.com or Indigo.ca.

Depression is one of the most common problems I treat in clinical practice. Even though drug therapy and psychotherapy is effective at alleviating symptoms much depression remains undiagnosed and inadequately treated. Sometimes patients refuse to take medications. Oftentimes combining psychotherapy, medication and other treatment modalities give better results.

HOW IT WORKS

Exercise may have biochemical affects via release of endorphins and other neurotransmitters. Often exercise is done in groups or with a trainer and the social contact may be critical. If the exercise is done outside or in an area other than the person’s own home the very act of getting out and doing something may be therapeutic. Exercise also acts as a diversion for negative thinking and helps to take the patient out of the helpless, withdrawn, “dark” state of mind.

WHAT’S THE EVIDENCE?

A meta-analysis of 80 studies (regardless of their methodological quality) showed that exercise decreased depression scores significantly when compared to controls. The antidepressant effect occurred with all types of regular exercise, independent of sex or age, and it increased with the duration of therapy. ⁱ

Another meta-analysis looked at 72 potentially relevant studies. Only 14 studies fulfilled the inclusion criteria. There were important methodological weaknesses; randomization was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. When compared with no treatment, exercise significantly reduced symptoms of depression. The effect size was significantly greater in those trials with shorter follow up. The authors concluded that “the effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up”. ⁱⁱ

Martinsen and Stephens identified 8 experimental exercise-intervention trials in clinically depressed patients, and exercise was associated with reductions in depression scores in all of the studies. ⁱⁱⁱ

156 adult volunteers with major depressive disorder were randomly assigned to a 4-month course of aerobic exercise, sertraline therapy, or a combination of exercise and sertraline. After 4 months patients in all three groups exhibited significant improvement; the proportion of remitted participants was comparable across the three treatment conditions. After 10 months, however, remitted subjects in the exercise group had significantly lower relapse rates than subjects in the medication group. Exercising on one’s own during the follow-up period was associated with a reduced probability of depression diagnosis at the end of that period. ^iv

It is often hard to manage elderly patients who are depressed. Regular physical exercise in the elderly is associated with decreased depressive scores. In one study those moderately depressed elderly subjects who were randomly allocated to walking exercises, showed a significant decrease in depression compared to controls at 6 weeks. ^v

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Many people in northern climates suffer from seasonal affective disorder. A randomized controlled trial on 120 indoor employees in southern Finland was done. The subjects were allocated to supervised fitness training under bright (2500-4000 lx) or ordinary (400-600 lx) light conditions in a gym 2-3 times weekly for 8 weeks, or supervised relaxation training once a week over the same period as active placebo. Fitness training in bright light resulted in greater relief from atypical depressive symptoms and more vitality than in ordinary room light. This effect was unrelated to the history of season-dependent symptoms, being noticeable among healthy individuals. ^vii

ⁱⁱ Lawlor DA. Hopker SW. The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. BMJ 2001; 322(7289):763-7

ⁱⁱⁱ Lawlor DA. Hopker SW. The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. BMJ 2001; 322(7289):763-7

^iv Babyak M. Blumenthal JA. Herman S. Khatri P. Doraiswamy M. Moore K. Craighead WE. Baldewicz TT. Krishnan KR. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months.Psychosomatic Medicine. 2000;62(5):633-8

^v McNeil JK, LeBlanc EM, Joyner M. The effect of exercise on depressive symptoms in the moderately depressed elderly. Psychol Aging 1991;6:487-488

^vi McNeil JK, LeBlanc EM, Joyner M. The effect of exercise on depressive symptoms in the moderately depressed elderly. Psychol Aging 1991;6:487-488

^vii McNeil JK, LeBlanc EM, Joyner M. The effect of exercise on depressive symptoms in the moderately depressed elderly. Psychol Aging 1991;6:487-488