Exercise – the best anti-depressant

Well, who would have thought that a tweet on yesterday’s three minute mini-walk would excite such a storm?

“Exercise is the best anti-depressant,” I said, “anyone can do it” – and linked to the short, easy deskside walk you see on the blog right here.

Cue first a storm of people taking issue with the idea that exercise is an anti-depressant, that anyone can do it, and that it’s the best anti-depressant.

But all three statements are true.. I was then inundated with people telling me how exercise had alleviated their own or a loved one’s depression /bipolar/ odd /anxiety, and by another set of people telling me that to say exercise was an effective treatment for depression was a nonsense and was minimising depression. It was a fascinating debate as I sat getting my hair done, which I hate, but I had roots as long as a gnarly oak tree so eventually you have to sit through the tedium.

First, the idea that anything other than a drug is an anti-depressant. This is semantics, but in common terminology exercise is often referred to that way. A handful of links:

http://www.huffingtonpost.com/dr-tian-dayton/exercise-the-best-antidep_b_106683.html

http://psychcentral.com/news/2013/05/11/new-guidelines-for-using-exercise-as-an-antidepressant/54728.html

http://www.bu.edu/today/2010/exercise-the-other-antidepressant/

but there are innumerable examples. So much for the semantics.

Next, to the idea that saying “exercise is the best anti-depressant” is minimising depression. It isn’t; not in any way. Depression is an incredibly dehabilitating illness, often recurring, and afflicting vast swathes of the population – and women more than men (less testosterone). Depression is characterised as mild, moderate and severe. The severely clinicially depressed often feel that they cannot get out of bed. They lose interest in everything around them. Mild and moderate cases of depression are varying degrees of joylessness, rumination, thoughts of death and all the other symptoms that go with the disorder. It is not the same as sadness, and can afflict anyone – the rich and famous as much as the unemployed or poverty stricken. It is not sadness; it is a disease.

Rather, to say “exercise is the best anti-depressant” is to acknowledge the science on the efficacy of regular exercise in fighting depression. Those telling me “you’re not a doctor” were un-swayed by the UK’s National Health Service saying the same thing:

http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/Exercise-for-depression.aspx

“Exercise can help people recover from depression and prevent them from becoming depressed in the first place….Anyone with depression can benefit from doing regular exercise, but it’s especially useful for people with mild depression.”

Anyone with depression.

I tweeted that exercise was good for mild to moderate depression, but not severe depression. In this I may have been too pessimistic. Here is a study that tested exercise on older patients with Major Depressive Disorder:

http://archinte.jamanetwork.com/article.aspx?articleid=485159

“Although antidepressants may facilitate a more rapid initial therapeutic response than exercise, after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD.”

and here is one examining exercise as a factor in suicide risk amongst veterans suffering PTSD:

http://onlinelibrary.wiley.com/doi/10.1111/sltb.12014/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

“While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk… in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was associated with fewer depressive symptoms and better sleep patterns, each of which was, in turn, related to lower suicide risk.”

So, if you want to see the hard evidence on exercise as an antidepressant, Google Scholar can help you out. Here is page after page of clinical studies: dive in, read up.

http://tinyurl.com/lm6y5sd

OK, so science says exercise is a highly effective anti-depressant for ALL types of depression, including Major Depressive Disorder.

But was I saying exercise could “cure” depression? Or that you should throw away your medication? Certainly not. Many depressive and anxiety disorders require multiple interventions; medication, cognitive behavioral therapy (CBT), talk therapy – and exercise. A doctor can best determine the needs of the individual. Since exercise is shown to have such a clinically beneficial effect on all types of depression, it can be fruitfully ADDED to any program of anti-depressant interventions – and it will probably help.

It can certainly do no harm. The NHS guidelines say “to be healthy, adults need to exercise moderately 150 minutes a week.” Did you notice that? The NHS is recommending half an hour Monday to Friday – FIVE times a week, not three, and half an hour, not twenty minutes. Although you could chop it up.

But what about those suffering from major depression who can’t get out of bed? Well, their doctors will prescribe to their needs – medication, CBT. And using CBT, the depressed patient may then be able to start a gentle programme of exercise.

Indeed the fury of those tweeting (with clearly no knowledge base) that exercise was not good enough for depression jusrt had not read the science. You cannot go here

http://tinyurl.com/lm6y5sd

and not be overwhelmed by the evidence for exercise against this hated and often deadly disease.

But OK, OK, you say, even if I *am* swayed by all these studies you still can’t say it’s the BEST anti-depressant.

I think you can. What one therapy can be applied to all types of depression? Has only beneficial side effects? Can be undertaken by almost everybody? (I was given the example of people with disabilities so severe they could not move at all – fair enough, but almost everybody can exercise, and the general point stands. “Everybody can do it” is a pretty general statement. I don’t get furious tweets when I say “everybody can try BB cream” from people pointing out that some have no arms or hands and cannot apply BB cream – the obvious generality is taken as read).

Prozac may be for one patient. Zoloft for another. St. John’s Wort for a third. Adderall for a fourth (it has off-label uses as an antidepressant). CBT and meditation for yet another. But what one therapy can be of benefit to all these patients and all those suffering depression?

Exercise. It’s not necessarily a cure, but it is a help, and if done with intensity and frequency, it is a major help. The evidence base is unchallenged. It can assist on its own, it can assist in combiation with therapy and it can assist in combination with medication.

If you feel you suffer from depression – of whatever severity – do not suffer alone. Go to see your doctor, and while you are there, ask him/her if adding regular exercise to your program of treatment is a good idea for you.

Oh, and one thing that will NOT help depression, of any severity?

Alcohol. It’s a depressant.

http://www.webmd.com/depression/alcohol-and-depresssion

Go for a jog – not a glass of wine.

photo by Mike BairdImage

One comment

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