Might Physical Activity be an Effective Antidepressant? By Judith Wurtman, PhD on 12/11/18 - 11:40 AM

The well-known recommendation to exercise in order to relieve and /or improve a wide variety of health problems may sometimes seem exaggerated. One might ask whether going to the gym or chopping wood will truly improve sleep, cognition, fragile bones, cholesterol levels, high blood pressure, and decrease vulnerability to developing diabetes, obesity, heart disease, cancer and Alzheimer’s disease. That is a lot to ask of a daily bout of physical activity. However, many studies over the past several decades have confirmed these positive relationships. Exercise is not going to prevent us from eventually exiting this world but engaging in physical activity may make us healthier while we are still in it.

Relieving depression should be added to the long list of benefits of physical activity-depressed patients may benefit as much from routine exercise as they do by taking antidepressants. Several years ago, an extensive review on the effects of an exercise program on clinical depression strongly indicated that physical activity may effectively reduce stress, anxiety, and depressed mood.

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A woman came to me for weight loss counseling because she had gained about 27 pounds while being treated with an antidepressant. With the consent of her therapist, she decided to stop taking the drug and instead signed up for a four-month exercise program with a personal trainer. After several weeks she not only lost weight but her depression went into remission. Her personal experience reflects that described in many studies in which depressed patients enrolled in programs of frequent physical activity such as walking, resistance training or a combination of both show improvement in their mood. Indeed, in another study, patients receiving medication (sertraline), exercise and the medication, or just exercise had the same rates of remission.

However, if exercise is to be treated like any other therapeutic intervention, do we know the most effective program? Should the exercise be mild or intense? Is it better to exercise outside in the fresh air and sunlight or does it not matter? Might yoga or other group exercise be more beneficial than solitary workouts or a walk because exercise classes diminish social isolation? Is there some way of identifying patients at the onset of their depression who might benefit from exercise rather than antidepressants therapy? How long should it take for an exercise program to produce a lessening of depressive symptoms? Many antidepressants take several weeks before they seem to have an effect. Should the patient wait the same amount of time to see if exercise relieves their symptoms?

These are questions that can be answered fairly easily with additional studies. What is more difficult is how to translate these findings to the real world. To begin with, who is going to treat these patients? Therapists are rarely, if ever, trained as exercise physiologists. And exercise physiologists may not have any training or experience working with depressed clients. Do these professionals even communicate with each other? A therapist may be able to refer a patient to a physical therapist for an initial consultation as to what kind of exercise the patient can do without injury or pain. But how should the patient follow up? Where will she exercise? Does he have to join a gym or a local Y to exercise? Who will determine the type of exercise program? What oversight is available to make sure the exercise program is carried out effectively and without injury or pain from overused muscles? Who will help /motivate the depressed patient to participate over several weeks rather than dropping out? And finally, even if exercise can be as effective as medication for depression, who will pay for it? Now visits to a therapist and medication may be paid for in their entirety, or at least in part, by health insurance. Therapeutic visits with an exercise physiologist rather than a prescription for an antidepressant is probably not covered under billing codes for mental illness and thus may be an out-of-pocket expense.

And yet, exercise should not be overlooked or discarded as an effective way of managing depression. Its value in increasing general health, sleep efficacy, and increased physical fitness in addition to relieving the symptoms of depression without the side effects of drugs cannot be overstated or overestimated. Isn’t it about time to figure out how to apply this knowledge?  

File under: The Art of Psychotherapy, Musings and Reflections