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Peter Rutherhagen/Getty ImagesCan a stroll help ease depression? That questionpreoccupied Dr. Madhukar H. Trivedi, a professor of psychiatry at theUniversity of Texas Southwestern Medical Center in Dallas, after several of hispatients, all suffering from serious depression, mentioned that they felthappier if they went for a walk. The patients in question were taking thewidely prescribed antidepressants known as S.S.R.I.'s, for selective serotoninreuptake inhibitors, but not responding fully. They remained, by clinicalstandards, depressed. Dr. Trivedi and his colleagues began to wonder if addinga formal "dose" of exercise would increase their chances of getting better.
Certainly the possibility was worth investigating.Clinical depression, as anyone who has experienced or watched a loved onestruggle with the condition knows, can be stubbornly intractable. Even ifpatients have been taking an antidepressant for months, recovery rates tend tohover below 50 percent.
In order to increase the odds of improvement, doctorsfrequently add a second treatment — often another drug, like lithium or anantipsychotic — to the S.S.R.I. regimen at some point, Dr. Trivedi said. Mostpatients ultimately require at least two concurrent treatments to achieve remissionof their depression, he said. Studies have shown that these secondary drugtreatments help an additional 20 to 30 percent of depressed patients toimprove, but the medications can be expensive and have unpleasant side effects.
Which prompted Dr. Trivedi to look to exercise. Hisinvestigation joins a growing movement among some physiologists and doctors toconsider and study exercise as a formal medicine, with patients given aprescription and their progress monitored, as it would be if they were prescribeda pill.
In this case, Dr. Trivedi and his collaborators, whoincluded researchers at the Cooper Institute in Dallas, the PenningtonBiomedical Research Center in Louisiana and other institutions, recruited 126people with depression who had been using S.S.R.I.'s for a minimum of twomonths, without achieving remission. None of the patients exercised.
Dr. Trivedi and his colleagues divided thesevolunteers into two groups. One began a gentle aerobic exercise routine, underthe tutelage of Cooper Institute researchers, which required them to burn acertain amount of calories per session, depending on their weight. How thesubjects expended the energy was up to them. Some walked for about 10 minutes aday, on a treadmill or by strolling around the block, at a pace of three milesan hour. Others chose an equivalent easy cycling workout.
The second group was more energetic, walking brisklyfor about 30 minutes a day at a pace of four miles an hour, or the cyclingequivalent, a regimen that meets the current exercise recommendations from theAmerican College of Sports Medicine.
Each volunteer exercised for four months, whilecontinuing to take an antidepressant. At the end of that time, according to thestudy published recently in The Journal of Clinical Psychiatry, 29.5percent had achieved remission, "which is a very robust result," Dr. Trivedisaid, equal to or better than the remission rates achieved using drugs as aback-up treatment. "I think that our results indicate that exercise is a veryvalid treatment option" for people whose depression hasn't yielded toS.S.R.I.'s, he said.
As with most scientific findings, though, there arecaveats.
One is practical. More patients improved in the groupthat completed the longer, brisker workouts than in the group assigned theeasier exercise, but more of them also dropped out of the study. "We need tofind ways to support people's efforts to exercise," Dr. Trivedi said. "It's notgoing to be enough to casually say, 'Go for a walk.'" Exercise, if it's to bemedicinal in depression treatments, will have to be monitored, he said, so itcan't be shrugged off.
Even then, many people will not respond. Almost 70percent of the volunteers in this study did not achieve full remission. Failurerates were particularly high for women with a family history of depression,perhaps as a result of some as yet unknown genetic quirk. And women in thatgroup who did recover were more likely to succeed using the lighter exerciseprogram than the more strenuous routine.
Then there is the issue of a control group, whosemembers would have continued with their S.S.R.I.'s but not exercised. Thisstudy did not have one, making interpreting the results tricky, said James A.Blumenthal, a professor of psychology and neuroscience at Duke University who wasnot involved with this study but who has written extensively about exercise and depression.Perhaps four additional months of S.S.R.I. treatment raised people's moods, andthe exercise was incidental. "Evidence is accumulating that exercise may be aneffective treatment for depressed patients who are receptive to exercise as apossible treatment and who are able to safely engage in exercise," he said. Butthe evidence is by no means definitive.
Still, Dr. Trivedi said, althoughadditional studies certainly are needed, there's no reason for people withunyielding depression not to talk now with their doctors about exercise as atreatment option. "Side effects are almost nonexistent," he said, "while youget additional benefits, in terms of improvements in cardiovascular health andreductions in other disease risks," things antidepressant drugs do not provide."Plus," he pointed out, "the cost profile is very favorable." Exercise, as medicinesgo, is cheap.
Source : http://well.blogs.nytimes.com/2011/08/31/prescribing-exercise-to-treat-depression/
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