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Can Exercise Chase Away the Blues?
Feeling depressed? Research shows exercise may help. But first it helps to define "depressed"--and it's also good to know what is meant by "exercise."
Psychiatrist Matthew Rudorfer, who heads the National Institue of Mental Health (NIMH) Somatic Treatments Program, addressed these and other issues in his recent hour-long presentation to NIH'ers on what scientists know about the effects of exercise on mood.
"The real question for us," he said at the outset of his Seminar Café talk at the Neuroscience Center, "is, 'Is exercise good for mood?'" The simple answer, he said, can be summed up in two short words: "Yes, but..." It's an undisputed yes, he said, if you're in a low mood because of a bad day, and perhaps also if you meet the official criteria for major depression with mild symptoms. However, the "but" applies to several factors not yet clearly defined.
For instance, because the published studies to date primarily involve participants who were exercising in group settings, could the antidepressant effect have come from something other than the exercise itself, such as the social support or even the physical environment (health club, the outdoors, etc.)? Possibly.
Rudorfer gave the example of a woman in her 40s in conventional treatment for depression (medication and psychotherapy). She arrived for a therapy appointment "with a new bounce in her step and a smile on her face," he said. She'd been to the gym and met some new people, one of whom she eventually dated. "Freeze frame," said Rudorfer. Was her upbeat mood a result of the exercise or something else, like the medication or therapy beginning to take effect? Or could her renewed optimism possibly be due to her renewed hope in friendship?
"This illustrates the challenge we're up against" in providing a definitive finding on exercise as a treatment for mood disorders, though it doesn't exclude the possibility that exercise may be an important treatment tool.
Another factor, Rudorfer said, that probably contributes to reports that exercise improves mood may be the people who join the studies; these study populations are mostly comprised of people whose depression is less severe, as well as those who are interested in exercise, since they're the ones who respond to the study-recruitment advertisements. "There appears to be an inherent self-selection bias that accompanies many of these studies," he said. "Those with moderate or more severe depression seem to be less inclined to volunteer because of the intensity of symptoms, like fatigue, apathy, aversion to being around people, and lack of motivation, so they don't sign up. That's one reason it's hard to know whether exercise would help moderate to severe depression."
The most reliable and comprehensive study showing promise for the psychotherapeutic benefits of exercise, Rudorfer said, was a controlled clinical trial by NIMH grantee Dr. James Blumenthal and others at Duke University. The 4-month study compared the efficacy of three randomly assigned treatments: aerobic exercise (for 45 minutes, three times a week), a commonly prescribed antidepressant (75-200 mg of Zoloft), and a combination of both. Interestingly, by the end of the study, exercise proved to be as effective as medication, though the drug did improve symptoms sooner. And those in the combination group also fared well, with patients who had the mildest symptoms responding the quickest.
Does that mean "an exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons," as the authors concluded? Maybe, but not yet, in Rudorfer's view. For one thing, people in the exercise arm were not only in group settings, they also had eight times more interpersonal contact with the study's professional staff than the medication-only patients since they saw the researchers each of the 48 exercise sessions.
Clearly, one can't know how the exercise patients would have fared if they had worked out in a room by themselves. In his current study of older patients with depression, Blumenthal is adding a control group and eliminating the social setting for exercisers, in efforts to address this research limitation.
For now, Rudorfer said, exercise should not be considered an alternative to conventional treatment for moderate to severe depression. "Exercise is showing a lot of promise as a potential adjunctive--and maybe even sole treatment--at the milder end of the depressive spectrum," he said. "But certainly for those who are more than mildly depressed, it's not ready for prime time."
Source: National Institute of Mental Health
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