Treating Depression with Exercise
Getting active helps us to feel more in control of our lives.
Posted March 11, 2019
Several randomized controlled trials have shown that physical exercise is as effective at treating depression as medication, specifically compared to treatment with second-generation anti-depressants. The mechanism for the effectiveness of exercise may have to do with increased neuroplasticity in the hippocampus, a feature embedded in the frontal lobe responsible for learning and memory, mood and appetite. Atrophy in the hippocampus is associated with many neurological conditions, including Alzheimer's disease and epilepsy. Given that depression is often associated with sedentary states and is also associated with the hippocampus, it makes sense that physical activity could help to reverse its effects.
While medications are certainly effective for many people, others may not respond to drug treatment or find that antidepressants have serious side effects. According to a 2017 meta-analysis, "Almost all the reviews examining exercise vs. other treatments of depression, including antidepressants, support the use of exercise in the treatment of depression, at least as an adjunctive therapy" (Netz). The HUNT cohort study of 33,908 adults, followed over 11 years, found that physical exercise actually has a protective function when it comes to mental health. The study found that even minimal amounts of physical activity—as little as one hour per week—could prevent 12 percent of future cases of depression.
None of this research is really all that surprising: We all know that we are supposed to get daily exercise, and we know that we feel better when spending time outdoors or going to the gym. The problem comes when we try to put this advice into practice. After all, depression makes us feel like, well, not doing anything. There is a Catch-22 problem here: Depression makes us lethargic, but, in order to feel better, we have to get moving. Breaking this cycle would seem to require some sort of interruption in the links of the chain of sedentary behavior leading to low mood leading to more sedentary behavior. Getting a lot of physical activity goes against the grain of consumer society, which encourages or even requires lots of screen time and sitting behind the wheel of a car.
In my book, The Boundless Life Challenge, I give 90 days' worth of suggestions for reversing the cycle of sedentary behavior. It helps to turn the lunch break into an exercise break, for instance, using at least some time during the day to get some steps. We can also make our technologies work for us by using diet and exercise apps. Meditation and visualization can also help to clear the mental blocks that keep us stuck in our same old, lame old routines. Getting active helps us to feel more in control of our lives, which naturally leads to a brighter mood. This then has spillover effects for increased happiness at work and at home.
A lot of change needs to be implemented on the societal level as well to combat depression, and this new research suggests that an emphasis on physical activity would help. Cities need to do more to make trails for walking, running, and cycling. More urban streets should have sidewalks and bike lanes. Employers should not only have a gym on the premises but also actively encourage employees to take frequent walk breaks or have walking meetings. We can also take more time with our families and friends to get out into nature rather than sitting around the house.
It appears that depression is an indoor disease, a disorder that thrives on sedentary behavior. The link between inactivity and depression is a chicken-and-egg dilemma: Are depressed people depressed because they are sedentary or sedentary because they are depressed? Note: This is not to say that depressed people cannot be highly active in their lifestyle choices, only that the connection between mental health and physical fitness needs to be better understood. Undoubtedly, depression is a highly complex phenomenon that involves many factors, including genetic predisposition and individual variation. It would be too simple to say that simply by getting more exercise, we can cure depression. Medication will remain a part of the treatment package, but exercise should be included as an important part of recovery.
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Anand, K. S. and V. Dhikav. "Hippocampus in health and disease: an overview." Annals of Indian Academy of Neurology 15. 4 (2012): 239-246. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548359/
Harvey, S. B., Øverland S., et al. "Exercise and the prevention of depression: Results of the HUNT cohort study." American Journal of Psychiatry 175. 1 (2018): 28-36.
Netz, Yael. "Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based?" Frontiers in Pharmacology 8 (2017): 257. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430071/