Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder

Abstract

Objective-To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls. Methods-BetweenOctober 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50-200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D).Results-After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of <8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise = 45%; home-based exercise = 40%; medication = 47%; placebo = 31% (p = . 057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p = .23).Conclusions-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. 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.

Physical activity in the prevention and treatment of anxiety and depression

“…After 4 months, 42% achieved remission, and patents receiving active treatments tended to have higher remission rates. There were no significant differences between the two forms of exercise and antidepressant medication (19).…”

Recovery From Depressive Symptoms Over the Course of Physical Therapy: A Prospective Cohort Study of Individuals With Work-Related Orthopaedic Injuries and Symptoms of Depression

“…Related research suggests that physical exercise can be as effective as cognitivebehavioral therapy or antidepressant medication in regulating dysphoric mood. 9,20 In addition to these findings, research from the field of psychology suggests that variance in nonspecific aspects of treatment, such as therapeutic alliance, perceived empathy, and treatment expectations, can have an influential effect on treatment outcomes. 30,41 In certain cases, these nonspecific effects have been shown to explain more variance in patients' response to treatment than the type of intervention administered.…”

Depression and Use of a Health Plan–Sponsored Physical Activity Program by Older Adults

“…[21][22][23] Evidence from controlled studies on carefully selected depressed adults and older adults suggest that exercise training improves depressive symptoms in the short term. [23][24][25][26][27][28][29] Prompted by the promise of health benefits with physical activity, many organizations, including health plans, have in recent years expanded their prevention benefits to include formal physical activity programs. Because such benefits can be costly to finance, decision makers need information on who actually use these benefits, barriers associated with use, and what pattern of use results in improved outcomes at the population level.…”