The Proven Powerful Natural Overlooked Medicine for Depression
The American Psychological Association website reveals: "Exercise…is good for your head. A 1990 meta-analysis of 80 studies… reached the following conclusions:
- Exercise was a beneficial antidepressant both immediately and over the long term.
- Exercise was an equally effective antidepressant for both genders.
- Exercise plus psychotherapy was significantly more effective than exercise alone."
"Exercise is included in the American Psychiatric Association’s [depression] treatment recommendations," writes Dr. Chad D. Rethorst, Department of Psychiatry, University of Texas Southwestern Medical Center, because "research has shown [it's] efficacious as both a stand-alone and an augmentation therapy ("Evidence-based recommendations for the prescription of exercise for major depressive disorder," Journal of Psychiatric Practice, 2013).
Exercising the Evidence
To date, though, the exercise evidence isn’t a slam dunk. Take these 4 very different conclusions from 1990, 2009, 2011, and 2013 depression-and-exercise study reviews:
1990: Effect of exercise on depression
Review: 80 different studies
Conclusions: Exercise significantly reduced depression. Exercising 17+ weeks offered the most benefit.
2009: The antidepressive effects of exercise
Review: 58 randomized trials, 2,982 subjects
Conclusions: Exercisers had significantly lower depression scores than those receiving control treatment. In the 16 trials with clinically depressed patients, 9 exercise groups were classified as "recovered" post-treatment and 3 others as "improved"—that's 12 out of 16 or 75% group improvement.
2011: The effect of exercise in clinically depressed adults
Review: 13 randomized trials of adults with clinical depression
Conclusion: Exercise benefits depression only in the short term. Only 3 studies were assessed as "high quality," and for those, researchers found "no strong evidence of benefit."
2013: Exercise for depression.
Review: 35 studies, 1,356 participants
Conclusion: Moderate improvement in depression symptoms overall. Just 6 studies were assessed as "high quality," and for those, exercise alleviated depression too slightly to be considered statistically significant.
Psychotherapy, Psychiatry, Physicality
So, when is exerting the heart effective in besting the blues?
Interestingly, working out appears to work well when compared to—or, even better, complemented with—psychotherapy and/or medication. Try out these findings:
- In the 1990 review of 80 studies (referenced by the American Psychological Association above), researchers also concluded, "Exercise was as effective as psychotherapy in alleviating depression. " (This result does not appear on the APA website.)
- Researchers at Duke University randomized 156 men and women aged 50+ with major depressive disorder into one of 3 groups—"In a Duke University study, exercise was as effective as medication in alleviating depression."aerobic exercise, antidepressants, or combined exercise and medication. After 4 months, all three groups had significant reductions in depression. At first, the patients receiving medication alone had the fastest response, but at the end of the 16-week trial, lead researcher Dr. James Blumenthal reported, the exercise group had an equivalent reduction in depression symptoms. In other words, exercise was found to be as effective as medicaton for alleviating depression.
- In a subsequent study, Dr. Blumenthal and colleagues randomized 202 other adults diagnosed with major depression to one of 4 groups—supervised group exercise, home exercise, antidepressants, or a placebo pill. After 16 weeks, they noted, the medication (47%) and supervised exercise (45%) groups had similarly higher remission rates, as compared to the home-exercisers (40%) and the control / placebo pill group (31%).
- A 2010 University of Washington Department of Family Medicine study of 28 randomly controlled trials which compared"A University of Washington study found exercise relieved depression symptoms as effectively as cognitive behavior therapy."exercise to no exercise, pharmacotherapy, and cognitive behavior therapy found that exercise relieved depression symptoms as effectively as cognitive behavioral therapy or pharmacologic anti-depressant therapy. The researchers cautioned: "The small size of these studies limits the ability to detect a potentially important clinical difference."
"We'll need a lot more data before we tell people to throw away their medicines," says Carol Garber, immediate past president of the American College of Sports Medicine.
That likely holds true as well for people who could benefit from therapeutic support. And so,
- More recently, researchers G.I. Mura of the University of Cagliari, Italy and colleagues reviewed 13 studies that used exercise as an add-on strategy"Italian researchers found strong effectiveness for exercise combined with antidepressants in treating major depression."in treating major depression. Although they discovered "methodological weaknesses in the majority [of trials]," their findings, published in CNS Spectrums in 2014, showed "a strong effectiveness for exercise combined with antidepressants… We can hypothesize that this strategy could be appropriately and safely translated into real-world practice. "
Physicality, psychiatry, psychotherapy: potent partnerships.
Digging into Depressive Disorders
Researchers are also drilling down on whether and what exercise Rx works for different kinds of depression.
It’s possible, for example, that aerobic labor (exercise) minimizes depression before and after pregnancy labor:
- Post-Partum Depression (after birth): In a newly published study, University of Birmingham, UK researcher A.J. Daley and colleagues randomized 94 women with post-partum depression"Aerobic labor (exercise) might minimize depression before and after pregnancy labor."to receive either usual care or usual care plus a facilitated exercise intervention (2 face-to-face consultations and 2 telephone support calls with a physical activity facilitator to support their engaging in regular exercise). After 6 months, the exercise intervention group had a significant reduction in post-partum depression compared to the usual care group. (This study, however, does not account for the women’s additional social support as a possible factor in their improvement.)
- Antenatal Depression (before birth): After reviewing six studies of exercise treatment for depressed pregnant women, the same UK researchers found that exercise may be effective in treating depression during pregnancy, but noted these results are based on a small number of low to moderate quality trials with wide result parameters.
Notably, exercise seems to also lessen depression in people with mental illness:
- Mental Illness: S. Rosenbaum of the George Institute for Global Health in Sydney, Australia and colleagues examined 39 studies of exercise interventions for people"Physical activity reduced depressive symptoms in people with mental illness."with confirmed mental illness and found "a large effect of physical activity on depressive symptoms" as well as "a large effect in reducing schizophrenia symptoms." Here, too, researchers reported a smaller exercise effect in the higher quality trials than in the lower quality ones, but noted: "The difference was not statistically significant… Physical activity reduced depressive symptoms in people with mental illness."
Work the Mind, Relieve the Mind
Aerobic or weight-bearing exercises are not the only options for depression relief. Mindful exercises with a meditative component, such as yoga, qigong, and tai chi, also appear to help:
- A 2008 review of mindful exercise—12 randomized controlled exercise trials, 6 of which had meditative components (yoga, tai chi, qigong, etc.)—found that all 6 showed a " positive response" to treatment, and 5 had a statistically significant reduction in depression, although most had small sample sizes. The University of Washington’s 2010 systematic review of mindful exercise also found it minimized depressive symtoms.
- More recently, a 2013 systematic review of yoga for depression analyzed 12 randomized controlled trials with 619 participants and found"Yoga had positive effects for individuals with elevated depression levels."yoga had positive effects for patients with depressive disorders and individuals with elevated depression levels. Despite the studies' "methodological drawbacks," researchers at the University of Duisburg-Essen, Germany resolved: "Yoga could be considered an ancillary treatment option."
- In addition, in a 2013 systematic review of quigong on depression, 7 of the 10 randomized controlled trials showed benefits, although researchers at the Dana-Farber Cancer Institute and Harvard Medical School concluded: "Further research using rigorous study designs is necessary."
Get Ready, Get Set, Go… How?
If you’re ready to up your exertion for uplift in mood, follow the science. These 5 practices have the best proven results:
1Mixed exercise (resistance and aerobic) and resistance exercise work better at relieving depression than aerobic exercise alone. A. Gill of the University of Washington Department of Family Practice and colleagues analyzed 23 randomized controlled trials of different kinds of exercises and depression symptoms in 907 adults. Their subgroup analysis, published in the Journal of Family Practice in 2010, found that resistance and aerobic exercise combined, or even resistance exercise by itself (for which there is less research), significantly reduced symptoms of depression more than aerobic exercise alone.
2Exercising 150 minutes/week may maximize mind benefits. Carol Garber, a professor of Movement Sciences and Education at Columbia University and former president of the American College of Sports Medicine, reports that "Most randomized controlled trials of people who are depressed or anxious show starting an exercise program in the [ACSM's] recommended 150-minute/week range reduces feelings of depression/anxiety."
For example, Benson Hoffman and colleagues at Duke University revisited the outcome of their original 4-month study (reported above) of 202 adults with"As exercise levels increased, depression symptoms decreased, up until 180 minutes/week."major depression one year later. They found, and reported in Psychosomatic Medicine in 2011, this relationship between exercise level and depression: As exercise levels increased, depression symptoms decreased, up until 180 minutes/week. At that point the association dropped off, suggesting, researchers said, "the antidepressive benefit of moderate-to-vigorous exercise may diminish after an average of about 3 hours per week."
Garber adds that a "surprising finding" emerged in a study she conducted of 263 men and 641 women: "a very large increase in depression and anxiety among those who exercised considerably more than 150 minutes. Now, these are association data, so we can’t say that over-exertion leads to depression or anxiety, or any other cause and effect. It’s possible that some people who are anxious tend to exercise more. Some literature associates more excessive amounts of exercise with obsessive-compulsive behavior and eating disorders."
3Exercising more frequently—at least 3x/week—may be more effective than exercising less often at the same number of weekly minutes. University of Washington researchers based this conclusion on just one small randomized trial of 23 depressed adults."Participants exercising at least 3x/week had significantly larger reductions in depression symptoms than once-a-week exercisers."Participants who exercised 3 to 5 times a week—30-minute sessions at 60% to 80% of maximum heart rate—over an 8-week period had significantly larger reductions in depression symtoms compared with their counterparts who exercised only once a week, and by the trial’s end, most of them were no longer depressed. The original University of Reims, France researchers surmised why: 1. Frequent, regular exercise may increase fitness levels, making exercise more enjoyable; and 2. Since exercise-induced psychological benefits usually last 2 — 4 hours, more frequent exercise reestablished an enhanced mood more often.
"The more the better" conclusion did, however, not hold true in this 12-week study, published in 2005, comparing 80 adults aged 20−45 with a mild — moderate diagnosis of major depressive disorder who exercised either 3 days or 5 days per week (both totalling 150 minutes/exercise weekly). While there was a significant reduction in all exercising participants' depression, no differences emerged between groups.
Perhaps this means that 3 is the magic number. "Exercise at least 3x a week for 45−60 minutes" is Dr. Chad Rethorst’s prescription in "Evidence-Based Recommendations for the Prescription of Exercise for Major Depressive Disorder."
4 Harder workouts may be more effective. Researchers conducting a 1990 meta-analysis of 7 studies comparing an exercise group to an easier exercise group concluded: "The easier exercise was not an effective anti-depressant." Dr. Rethorst’s later analysis of studies ranging from 50% to 85% of maximum heart rate, however, did not find an intensity difference in depression relief.
Workouts, then, may need to be harder than that to demonstrate a difference. For overall health, the American College of Sports Medicine recommends 150 minutes/week at 64% - 76% of maximum heart rate, which should feel "fairly light to somewhat hard, " or, alternatively, one or more hours weekly at 77% - 95% of maximum heart rate, which should feel "somewhat hard to very hard."
5Keeping up the exercise—for at least 10 weeks—steps up the results. It takes time to build up a fitness level that makes exercising enjoyable and leads to an improved outlook. Dr. Rethorst notes that while reductions in depressive symtoms have been observed in 4-week exercise studies, his meta-analysis found larger effect sizes in trials of 10 weeks or longer compared to 4−9 week exercise trials.
Perhaps, then, the mixed results of the exercise trials/analyses might be because the studies didn’t integrate all 5 best practices. More research is needed.
But for now, a few facts are clear: An exercise prescription does work for a number of depressed adults, often comparably to other treatments for depression, and especially well in conjunction with psychotherapy and medication. It’s why the American Psychological Association says, "Exercise is good for your head."The Proven Powerful Natural Overlooked Medicine for Depression Click To Tweetby