If you are diagnosed with depression, the chances are you will be prescribed one of a number of selective serotonin re-uptake inhibitors, or SSRIs for short. These are the most prescribed drugs for depression and among the highest selling in the medical world.
SSRIs cause a whole range of side effects, so looking at exercise to help combat depression is definitely a better alternative. A number of studies have been carried out, and researchers have come to the conclusion that exercise is just as effective as antidepressant drugs for treating depression.
American psychologist James Blumenthal and his colleagues at Duke University in Durham, North Carolina, US, have conducted a number of studies comparing aerobic exercise with one of the more popular SSRIs.
In the first trial, known as the SMILE (Standard Medical Intervention versus Long Term Exercise) study, 156 men and women with clinical depression were randomly assigned to one of three treatments: 45 minutes of group exercise three times a week; the SSRI; or a combination of the two.
After four months, there were no significant differences in depressive symptoms across all three groups, suggesting that exercise and anti-depressants were equally effective. A further study was conducted with heart disease patients and they came up with the same findings. There was no difference between the results of exercise and SSRIs.
However, researchers looked into the long-term impact of the treatments. Among the 83 patients declared free of depression, at the end of the first SMILE study, those who had been in the ‘exercise only’ group were less likely to have seen their depression return during the six-month follow-up. Only eight per cent of them relapsed, when compared to 31 per cent of the ‘medication and exercise’ group. Additionally, those who had continued to exercise over the follow-up period were more than 50 per cent less likely to be depressed than the non-exercisers.
A year later they were reassessed. Those who had continued to exercise were the least likely to be depressed even after a year.
A multi-pronged, holistic approach offers the best chance of success
Another study at the Wake Forest School of Medicine in North Carolina used a small pilot study of patients with mild depression. They were given an hour of exercise (this included a combination of aerobics and resistance training) for three times each week over a four-month period. Once again, this proved to be just as effective as the SSRI for controlling depression. The researchers noted that the exercise group also had the added benefit of improving physical functioning.
There are several plausible reasons why exercise works against depression. Initially, physical activity can have a positive physiological effect, by boosting ‘feel good’ chemicals in the brain and lowering levels of the stress hormone – cortisol.
Social contact may also have something to do with it, especially as most of the exercise studies involved group exercise, and finally, exercise can serve as a diversion from negative thoughts.
In contrast, the whole theory behind SSRIs – that depression is related to low levels of serotonin in the gaps between the cells in the brain – has never been proven and could even be wrong, according to latest research (Neurosci. Biobehav. Rev., 2015).
However, the most important difference between exercise and SSRIs is the safety of the patient. Although some exercise-related injuries have been reported in trials, exercise is generally safe and beneficial for health. With additional advantages for the heart, lungs, brain, bones and muscles, the list goes on.
SSRIs, on the other hand, have been linked to a long list of side effects, including insomnia, headaches, muscle pain, even increased risk of stroke and premature death. Some drugs are associated with aggressive and suicidal behaviours.
In conclusion, the evidence suggests that exercise is a viable and valuable treatment option for depression – at least for mild to moderate depression. The benefits are long-lasting and have a positive impact on all aspects of health.
Unsurprisingly, a number of experts are now recommending exercise as a useful non-drug approach for depression. The key point is that exercise should be treated as a medicine. If possible, a suitable programme should be planned in conjunction with the patient, doctor and trainer. This will give a goal and help motivate the patient.
According to Madhukar Trivedi, professor of psychiatry at the University of Texas Southwestern Medical Centre in Dallas, “the dose of the treatment is very important; you can’t just go for a stroll in the park”. He recommends three to five sessions each week, lasting 45 to 60 minutes. The level of exertion should push patients to 50-85 per cent of their maximum heart rates.
Trivedi added that there should be constant monitoring of the symptoms. If the treatment is not working, it should be adjusted or other options looked at. Besides exercise, a number of non-drug therapies have been proven to work for depression, including ‘talking therapies’, nutritional supplements and herbals such as St John’s Wort. Ultimately, a multi-pronged, holistic approach offers the best chance of success.
kathryn@maltanet.net