Can Running Help If We Run Out of Antidepressants?

Clinical practice guidelines often prioritize medication over exercise, in the treatment of depression raising questions about its underutilization.

Highlights:

Exercise has emerged as a potent treatment for depression, supported by extensive research and evidence
Studies reveal that exercise, either alone or in combination with antidepressants, significantly reduces depressive symptoms
Despite this, clinical practice guidelines often prioritize medications over exercise, raising questions about the underutilization of this intervention

Depression, in particular, has become a major global concern, being the leading cause of disability worldwide. While antidepressant medications have traditionally been the primary treatment for major depression disorder (MDD), their effectiveness and side effects have led clinicians and patients to explore non-pharmacological alternatives. One such alternative is physical exercise ().

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Exercise as a Medicine

Extensive research has examined the impact of exercise on depression, generating a substantial body of literature. Surprisingly, recent clinical practice guidelines have predominantly recommended antidepressants over exercise for the treatment of depression, despite the growing evidence supporting the efficacy of exercise.

The concept of exercise as medicine has been studied across various health conditions. Notably, studies have shown that exercise can have a similar potential to extend longevity as certain pharmacological treatments in conditions like heart failure, stroke, and diabetes. Consequently, exercise interventions are increasingly considered as viable alternatives or complementary treatments to drug therapy.

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Depression and Antidepressants

Major depression disorder (MDD) is most commonly treated with antidepressant medications, particularly second-generation antidepressants. However, not all patients respond well to these medications, and many experience side effects.

Additionally, the placebo effect can make it challenging for new drugs to demonstrate their effectiveness. As a result, both clinicians and patients have been seeking non-pharmacological options for treating depression, with physical exercise being one of the most promising candidates.

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Biological Mechanisms Linking Exercise and Depression

Several biological mechanisms have been proposed to explain the link between exercise and reduced depressive symptoms.

One key factor is hippocampus plasticity, with depression often associated with neuron atrophy in this brain region. Aerobic exercise has the potential to promote neuroplasticity and improve hippocampus function.

Additionally, research suggests a connection between neurogenesis and mood, with exercise potentially enhancing hippocampal neurogenesis and thereby alleviating depressive symptoms. The brain-derived neurotrophic factor (BDNF) has also been implicated, with exercise leading to increased BDNF levels, which may mediate the action of antidepressants.

Similarly, exercise can influence serotonin levels, a neurotransmitter targeted by many antidepressant medications. These interactions between exercise and various neurobiological mechanisms contribute to its potential as a treatment for depression.

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Comparing Exercise to Antidepressants

Several RCTs compared exercise to antidepressants in older adults and adults with MDD or minor depression over periods ranging from 4 months to 1 year. These studies consistently reported that exercise and antidepressants were equally effective in reducing depressive symptoms.

Numerous RCTs investigated exercise as an adjunctive treatment to antidepressants in patients with MDD or minor depression.These studies showed that exercise, when combined with antidepressants, led to significant improvements in depression compared to antidepressants alone.

Discrepancies in Clinical Practice Guidelines

Despite the strong evidence supporting exercise as an effective treatment for depression, recent clinical practice guidelines have largely favored antidepressants over exercise.

Several factors may contribute to the reluctance to endorse exercise as a treatment for depression in clinical practice guidelines:

Skepticism: Some academics and healthcare practitioners may be skeptical about viewing exercise as medicine and may hesitate to prioritize it over pharmacological treatments
Lifestyle Changes vs. Medications: There might be resistance to accepting that lifestyle modifications, such as exercise, can have a comparable impact on biological mechanisms as pharmacological treatments

The evidence supporting exercise as an effective treatment for depression is robust and growing. Despite this evidence, clinical practice guidelines have not fully embraced exercise as a primary or adjunctive treatment for depression.

As the understanding of exercise's mechanisms of action and its role in mental health continues to evolve, it is essential for healthcare practitioners to consider exercise as a valuable tool in the treatment of depression, either as a standalone intervention or in conjunction with pharmacological treatments.

By doing so, the medical community can provide patients with a more comprehensive and personalized approach to managing depression, ultimately improving the overall well-being of individuals suffering from this debilitating condition.

Reference:

Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based? - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430071/)

Source-Medindia