Antidepressant medications are currently the standard treatment for major depression. Ongoing research has not yet proven beyond doubt the effectiveness of exercise in relieving depressive symptoms, but it nevertheless is widely believed to have a positive effect. Treatment of major depressive disorder typically requires individualized care by a physician who can develop a treatment plan that may include medication, psychotherapy, exercise, or a combination of treatments depending on your needs and response.
Antidepressant Medications
Antidepressants often take weeks to demonstrate their effectiveness, and it often requires a trial-and-error process before one is found that works for a particular individual. Their ability to relieve depressive symptoms, however, has been demonstrated repeatedly in clinical studies. They are believed to work by altering the function of neurotransmitters in the brain, mostly serotonin, norepinephrine or dopamine. Examples of antidepressant medications now being prescribed are selective serotonin reuptake inhibitors, such as Zoloft, Prozac and Celexa, and serotonin and norepinephrine reuptake inhibitors including Effexor and Cymbalta. Older, but still often effective medications, include tricyclics and monoamine oxidase inhibitors.
Comparing Exercise and Medication
Between 2000 and 2005, James A. Blumenthal, Ph.D., of the Department of Psychiatry at Duke University, et al. directly compared the effectiveness of exercise with the antidepressant medication sertraline in 202 adults suffering from major depressive disorder. As described in their paper "Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder," published in the September 2007 issue of "Psychosomatic Medicine," they divided patients into four groups. For four months some exercised at home, some exercised in supervised groups, some received antidepressant medication and some received a placebo pill. Inclusion of a placebo group in this study distinguished it from many previous studies. While the experimental design called for comparison with just one antidepressant medication, it is possible that the use of other antidepressants might yield different results.
Results
More than four out of every 10 patients improved enough to be classified as being in remission by the end of the study. Those who received active treatment did best: medication helped 47 percent, supervised exercise helped 45 percent, home-based exercise, 40 percent and placebo, 31 percent. The authors of the study, which appeared in the 2007 issue of "Psychosomatic Medicine," concluded that "the efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD [major depressive disorder]. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, ongoing symptom monitoring, attention, and other nonspecific factors."
Caveats
Dr. Blumenthal and his colleagues believe that limitations of the methods used to conduct their own and other studies make it "impossible to definitively conclude that exercise is efficacious for treating MDD." Although definitive proof is lacking, studies strongly suggest that that exercise may be an effective way to relieve symptoms of depression. It appears to be a good idea to include an exercise program in the lifestyle changes you make to counter symptoms of depression, but do so in consultation with a physician. It can take time to find the best treatment or combination of treatments for major depression and the seriousness of the disease makes it essential that you get good professional care.
