Antidepressants are generally safe and effective but we should take this one exercise “much more seriously, as it could be a good—and maybe even better—choice.”
Depression, a prevalent mood disorder, is marked by persistent feelings of deep sadness, lack of joy, or disinterest in activities. While transient moments of sadness are a universal human experience, to be clinically diagnosed with depression, these symptoms need to be evident for a minimum of two weeks.
Triggers like death, illness, or loss can instigate these feelings, but sometimes, they can emerge without a discernible reason or appear disproportionately intense.
Globally, depression stands as a major contributor to disability. Approximately one in ten individuals will face at least one bout of clinical depression in their lifetime.
Historically, depression treatments have centered around medications or therapeutic interventions like cognitive behavioral therapy. However, lifestyle modifications, such as engaging in physical activities, exposure to natural light, or cultivating social interactions, have proven beneficial for many sufferers.
Often, a holistic approach blending different treatments based on the patient’s specific needs and receptiveness yields the best outcomes.
A groundbreaking study recently examined the therapeutic potential of running exercises in comparison to antidepressants. This study’s results, presented at the 36th ECNP Congress, indicate that both treatment modalities offer comparable mental health benefits. Still, a 16-week running regimen stands out for its superior physical health advantages, whereas some antidepressants may slightly deteriorate physical health.
The study, led by Professor Brenda Penninx of Vrije University, Amsterdam, observed 141 participants diagnosed with depression and/or anxiety. They were presented with a choice: a 16-week course of SSRI antidepressants or a 16-week group-based running therapy. Notably, a larger segment of participants gravitated towards running therapy.
Unlike taking a pill, engaging in exercise combats the sedentary tendencies common among depression and anxiety patients. It motivates individuals to embrace outdoor activities, set milestones, enhance fitness, and partake in group interactions.
Post-trial data revealed that both groups saw approximately 44% of participants reporting improved mental states. However, the runners also exhibited better weight, blood pressure, waist circumference, and heart performance metrics, while the medicated group showed marginal metabolic declines.
Penninx added, “Both interventions helped with the depression to around the same extent. Antidepressants generally had worse impact on body weight, heart rate variability and blood pressure, whereas running therapy led to improved effect on general fitness and heart rate for instance. We are currently looking in more detail for effects on biological aging and processes of inflammation.”
“It is important to say that there is room for both therapies in care for depression. The study shows that lots of people like the idea of exercising, but it can be difficult to carry this through, even though the benefits are significant.
“We found that most people are compliant in taking antidepressants, whereas around half of the running group adhered to the two-times-a-week exercise therapy. Telling patients to go run is not enough. Changing physical activity behavior will require adequate supervision and encouragement as we did by implementing exercise therapy in a mental health care institution.”
She further highlighted:
“Antidepressants are generally safe and effective. They work for most people. We know that not treating depression at all leads to worse outcomes; so antidepressants are generally a good choice. Nevertheless, we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them. Our results suggest that implementing exercise therapy is something we should take much more seriously, as it could be a good—and maybe even better—choice for some of our patients.
“In addition, let’s also face potential side effects our treatments can have. Doctors should be aware of the dysregulation in nervous system activity that certain antidepressants can cause, especially in patients who already have heart problems. This also provides an argument to seriously consider tapering and discontinuing antidepressants when depressed or anxious episodes have remitted. In the end, patients are only truly helped when we are improving their mental health without unnecessarily worsening their physical health.”
Offering a perspective, Dr. Eric Ruhe from Amsterdam University Medical Centers commended the study’s revelations about the therapeutic potential of exercise, while emphasizing the importance of individualized treatment plans.
He stressed, “However, several remarks are important. First the patients followed their preference, which is common practice, but ideally we should advise patients what will work best. Following this choice is understandable from a pragmatic point of view when patients have strong preferences, which you have to take into account when doing a study like this.
“The downside is that the comparisons between groups might be biased compared to doing this in a truly randomized study. For example, patients in the antidepressant group were more depressed which might be associated with less chance of persisting engagement in the exercises. So, we have to be careful not to overinterpret the comparisons between groups, which the authors acknowledge properly.
“Finally, a very important finding is the difference in adherence between the interventions: 52% in the exercise group and 82% in the antidepressant group. This shows that it is more difficult to change a lifestyle habit than taking a pill. This is not exclusively found in psychiatry, indicating that we also have to focus on how to improve compliance to healthy behavior. This could have tremendous impact on health care more generally, but also on psychiatric diseases.”
The findings of the study were published in the Journal of Affective Disorders.
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