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Outwalking Depression

Consider exercise when the antidepressants have not helped

There is a great deal of evidence that exercise not only improves mood and enhances well being but also is an effective intervention for depression. That is, well-conducted clinical trials have repeatedly shown mood benefit from exercise in adults with clinical depression. Indeed, there is evidence that exercise provides benefits at levels similar to that found for antidepressant medication.

Now, there is new evidence for the power of exercise when other treatments for depression have not provided adequate help. A recent study, published in the August, 2011, issue of the Journal of Psychiatric Research provides data that exercise can provide benefits when medication alone does not. Specifically, researchers in Portugal examined the effects of exercise-in this case programmed episodes of walking for 30-45 minutes five times per week-on depressed adults who failed to respond to two previous trials of antidepressant medication. In the study, all patients remained on their antidepressant medication, and two-thirds of the sample received the program of regular (walking) exercise.

The results were dramatic. Of those patients who received only medication, no average changes in depression mood ratings were seen over the next 12 weeks. In contrast, clear improvement was seen in those who exercised, with 10 of the 19 patients who exercised showing a response or full remission in symptoms during this time.

Although this was a small study, the results were consistent with previous exercise studies. These studies underscore the importance of considering combined treatment strategies for patients who do not respond to one type of intervention - if one treatment does not work, consider using other resources with evidence for success. In the case of treatment of depression, these resources prominently include psychotherapy (with a wealth of studies indicating that specific forms of psychotherapy like Cognitive Behavior Therapy or Interpersonal Psychotherapy can bring about timely relief of depression), a range of medication treatments, or, with increasing evidence, regular exercise. Within these choices there is not a clear cure-all option, but, importantly, there are a range of options to be pursued to try to find the right fit for any particular person suffering from depression.

A number of important features of the Portuguese study deserve additional note. First, the study provided additional evidence that high intensities of exercise are not required to bring about mood changes. Moderate exercise is adequate for mood benefit (see my next blog for information on why moderate rather than high-intensity exercise may be important for starting and keeping the exercise habit over time). Second, the study used an exercise program that relied on the individual efforts of the patient. Exercise was performed on a treadmill at the treatment center for one out of the five weekly sessions; the rest of the sessions were up to the individual. This individual program of exercise helped show that the mood effects of exercise were not simply due to the social contact from a group of patients exercising together. It also showed that moderate exercise is an accessible option even for chronically depressed individuals. Third, the exercise prescription included the use of regular reminders for exercise: keeping walking shoes in a visible location, having support for the walking program from family, or arranging for written or cell phone reminders for walking session. As we will talk about in subsequent blogs, simple reminders like these can have a powerful effect on helping people keep up with any new habit.

Depression is an insidious disorder that harms our mood, our goals, and our relationships. Having another tool for intervening with depression is deeply important. Exercise is an intervention with particular broad reach. It is not only for those who are focused on keeping a mind-body balance; it is an important option to be considered as an addition to psychotherapy or medication treatment, as well as an option for anyone with mood challenges who is looking for help. As always with exercise, it is important to start slow and to meet with your physician to find out which type and level of exercise is right for you.

Copyright Michael Otto

Drs. Michael Otto and Jasper Smits are authors of Exercise for Mood and Anxiety Disorders: Proven Strategies for Overcoming Depression and Enhancing Well Being.

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