Exercise as an Augmentation Strategy for Treatment of Major Depression

Abstract

The use of augmentation strategies among patients with major depression is increasing because rates of complete remission with standard antidepressant monotherapy are quite low. Clinical and neurobiological data suggest that exercise may be a good candidate for use as an augmentation treatment for depression. This pilot study examined the use of exercise to augment antidepressant medication in patients with major depression. Seventeen patients with incomplete remission of depressive symptoms began a 12-week exercise program while continuing their antidepressant medication (unchanged in type or dose). Individual exercise prescriptions were calculated based on an exercise dose consistent with currently recommended public health guidelines. The exercise consisted of both supervised and home-based sessions. The 17-item Hamilton Rating Scale for Depression (HRSD17) and the Inventory of Depressive Symptomatology-Self-Report (IDS-SR30) were used to assess symptoms of depression on a weekly basis. Intent-to-treat analyses yielded significant decreases on both the HRSD17 (5.8 points, p < 0.008) and IDS-SR30 (13.9 points, p < 0.002). For patients who completed the study (n = 8), HRSD17 scores decreased by 10.4 points and IDS-SR30 scores decreased by 18.8 points. This study provides preliminary evidence for exercise as an effective augmentation treatment for antidepressant medication. This is a lower-cost augmentation strategy that has numerous health benefits and may further reduce depressive symptoms in partial responders to antidepressant treatment. Practical tips on how practitioners can use exercise to enhance antidepressant treatment are discussed. Longer-term use of exercise is also likely to confer additional health benefits for this population.

The Bidirectional Relationship Between Body Mass Index and Treatment Outcome in Adolescents with Treatment-Resistant Depression

“…Therefore, although obese adolescent patients with depression may respond as well as nonobese patients to evidencebased treatments for depression, treatment of obesity requires additional interventions. However, feasibility studies in adolescents and adults suggest that aerobic exercise may be considered as either a stand-alone or an augmentation treatment for depression (Trivedi et al 2006;Dopp et al 2012;Rimer et al2012). Clinical trials in overweight and obese adolescents have shown that aerobic exercise, in addition to contributing to weight loss, also reduces depressive symptomatology, even in those with clinically significant depressive self-reported symptoms (Daley et al 2006;Petty et al 2009).…”

Physical Exercise and Antidepressants Enhance BDNF Targeting in Hippocampal CA3 Dendrites: Further Evidence of a Spatial Code for BDNF Splice Variants

“…Since physical activity has a recognized antidepressant effect, both experimentally and in human patients with major depression (Bjornebekk et al, 2005;Russo-Neustadt et al, 1999;Trivedi et al, 2006;Vaynman et al, 2004), we decided to evaluate the role of physical activity on BDNF expression in the hippocampus of exercising, lockwheel, and sedentary mice (see Materials and methods) after 4 weeks of treatment. Exercising animals ran an average distance of approximately 4.80 ± 0.56 km per day and accessed the running wheel preferentially at night (1900-0700 hours).…”

Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions

“…149 Risk factors are felt to be similar to those in able-bodied persons, as well as the extent of the neurological impairment and the presence of medical comorbidities. 150 It has been well documented that there may be an inverse association between physical inactivity and mental health in both men and women 151 and that physical exercise has significant antidepressive effect [152][153][154][155] and may even improve cognitive function. It is known that SCI disturbs the hypothalamic-pituitary-adrenal axis, 156,157 which affects production of various hormones, including neuroendocrine stress hormones, for example, cortisol, growth hormone, endorphins and norepinephrine.…”