Depression has always been a common condition and has likely increased in recent years. And while there are effective treatments, not all treatments are effective for every person. A new study, the largest of its kind to date, finds that physical “interventions” appear to reduce symptoms of depression about as much as traditional treatments like drugs and therapy. The authors recommend that their findings be considered by organizations writing clinical guidelines that do not currently consider exercise as a first-line treatment for depression.
In the new meta-analysis published in British Journal of Sports Medicinethe authors collected data from 41 previous studies involving more than 2,200 participants. Each of the study participants had either started exercise routines of different types or remained inactive (as a control group). Overall, the effects of exercise were statistically classified as moderate to large – comparable to the effect sizes of standard treatments such as antidepressants or talk therapy. Certain types of activity had a greater effect — peer-supervised exercise, group exercise programs, and moderate and aerobic exercise — but even light exercise was effective.
The authors explain the effect size as follows: If 100 people were in the exercise group and 100 in the control group, about half of the people in the exercise group would experience a significant reduction in their depression symptoms, compared to just 20 in the control group.
The new study is encouraging not only because it is the largest of its kind, but also because it addresses some of the experimental biases that make the results difficult to interpret, such as B. flaws in study design, movement in the control group, and so on. The authors note that more research is needed, including studies specifically designed to show that exercise is no worse than standard treatments (non-inferiority studies) and to find out which types of exercise are most beneficial for which subgroups of people are most effective. “Future large-scale research studies should also examine which patients benefit most from which exercise condition,” they write, “and identify any groups for whom exercise may not be the optimal treatment option.”
Nonetheless, the authors believe their study results should lead to clinical recommendations to include exercise as a primary treatment rather than just as an adjunct. “Updated guidelines, as well as routine clinical decisions about interventions to treat depression, should take into account the current evidence,” they write. Especially, as they point out, since about two-thirds of people with depression don’t receive treatment.
Regardless, a new study by Amsterdam UMC, published in Journal of Mood Disorders, antidepressants and an ongoing intervention put them head to head. People with depression and/or anxiety received either antidepressants (escitalopram or sertraline) or participated in a running group (45 minutes, twice/week) for 16 weeks. At the end of this period, people in both groups had similar rates of remission from their depression and anxiety: the rate of remission for people taking antidepressants was 45% and for the running group it was 43%. (Not surprisingly, those in the exercise group also experienced some physical benefits, like weight loss and lowering blood pressure.)
Like the authors of the first study, this team suggests increasing exercise as a treatment option and making it “standard practice for people with depression and/or anxiety disorders.”
As with other treatments, exercise is not for everyone. But more research, particularly more detailed research, can begin to figure out who might benefit and who might do better with other treatments. The more we learn from well-designed studies, the more tailored treatments will be possible, and hopefully treatment success rates for people with depression will increase.
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