Add Exercise or an Antidepressant for Depression?

Although the psychological benefits of exercise are well recognized, the role of exercise in the treatment of psychological disorders is less clear.  Randomized control trials are limited and so clinicians are left without much data to advise patients on the proper role of exercise in a comprehensive treatment program.

Madukar Trivedi and colleagues recently published a study of exercise therapy in a group of individuals with major depressive who had not reached complete remission of depression despite treatment with a first-line pharmacological intervention using a selective serotonin reuptake inhibitors.

Subjects were randomized into a relatively high intensity aerobic program (16 kilocalories per kilogram per week) or a relatively low intensity program (4 kilocalories per kilogram per week) for 12 weeks through a program conducted at the nationally known The Cooper Institute in Dallas, Texas.

Here are the key outcome findings from the study:

• Both exercise groups showed improvement in depression scores over the trial
• There was a trend for the high-intensity group to have more improvement in depression
• High-intensity exercise appeared to produce higher remission rates in men
• High-intensity exercise appeared to produce higher remission rates in women without a family history of mental illness

Of note, the high-intensity group demonstrated a lower adherence rate than the low intensity group.

The authors note the size of the effect for adding exercise to single antidepressant drug appears similar in magnitude to that of offering a second antidepressant drug.  Second drugs commonly in use for the treatment of depression include antidepressants such as bupropion (Wellbutrin) or the newer atypical antidepressant drugs such as aripiprazole (Abilify).

For a 70 kilogram individual, 16 kilocalories per week of added exercise would be approximately 12 miles of walking per week.  The high intensity regimen in this study would approximate general exercise recommendations for physical health, (30 minutes per day of moderate exercise most days of the week).  So it seems reasonable to recommend this level of exercise for men with depression.  Lower levels of exercise may help some women with depression.  When higher levels of exercise prove difficult to attain, lower levels are better than none.

A key issue with exercise in depression is motivation and compliance.  Some individuals with severe depression face big hurdle in getting active.  For these individuals, use of a personal trainer or group exercise may provide the structure needed for higher exercise adherence.

Photo of Juno Beach Florida sun rise through filter from the author's collection.

Trivedi, M., Greer, T., Church, T., Carmody, T., Grannemann, B., Galper, D., Dunn, A., Earnest, C., Sunderajan, P., Henley, S., & Blair, S. (2011). Exercise as an Augmentation Treatment for Nonremitted Major Depressive Disorder The Journal of Clinical Psychiatry, 72 (05), 677-684 DOI: 10.4088/JCP.10m06743