Exercise ‘may be better than drugs for depression’
Doctors should think twice before prescribing drug therapies when faced with someone battling depression, as exercise may be more effective, according to a new study.
A meta-analysis of 218 randomised clinical trials published in the British Medical Journal suggests that walking, jogging, yoga, and strength training were the most effective forms of exercise, matching talking therapies and outperforming antidepressants.
However, the best results seemed to come when exercise was combined with medication, and there were only a few head-to-head trials, so the relative merits of exercise and drug therapies need further study.
Exercise should now be considered alongside psychotherapy and antidepressants as “core treatments” for depression, according to the authors of the paper, who were led by Michael Noetel of the University of Queensland in Australia.
There were other notable findings in the study, including that there was a “dose-response” with the intensity of exercise correlating with the level of effect, although, even mild exercise had a beneficial effect.
It seemed to be effective regardless of the severity of depression, and group exercise was no more effective than training carried out alone. Previously, it has been suggested that the effects of exercise could be attributed to increased social contact during sessions.
In the UK, primary care doctors can already recommend exercise, psychotherapy, or drug treatment for patients with mild to moderate depression under NICE guidance, but exercise is rarely prescribed in practice, commented Professor Jonathan Roiser, a neuroscience and mental health specialist at University College London (UCL).
The new findings could elevate the status of exercise, which can help with other conditions like diabetes, obesity, and high blood pressure, is more freely available than psychotherapy, and avoids the risk of side effects seen with antidepressant drugs.
“What is needed is a cultural shift in the way we think about treating depression, which emphasises the important role that physical activity can play, alongside standard treatments like medication and therapy,” said Prof Roiser.
On the other hand, taking regular exercise can be a struggle for people with depression, who can experience fatigue, low energy, and poor motivation, according to an editorial accompanying the BMJ study by mental health specialist Juan Ángel Bellón of the University of Malaga in Spain.
“Randomised controlled trials and observational studies […] are needed to evaluate physical activity programmes for people with depression using real-world data,” he said.
Another specialist, UCL consultant psychiatrist Professor Michael Bloomfield, said the paper adds to the evidence that exercise can be helpful for people with depression, but he added: “It is not possible to say at this stage that exercise on its own is better than existing treatments, including medication and psychological therapies.”
One issue – acknowledged by the study authors – is that many of the studies of exercise were at risk of bias, as it is difficult to blind subjects in trials randomised to an exercise arm.
“Depression is often caused by a range of factors and it is more helpful to think about the pros and cons of a range of treatments, including medication, talking therapy, and exercise, that can be offered to patients, rather than an unhelpful division of medication vs talking therapy vs exercise,” said Prof Bloomfield.
