Exercise Treatment for Bipolar Disorder: Potential Mechanisms of Action Mediated through Increased Neurogenesis and Decreased Allostatic Load

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104

Background: Exercise training may be especially helpful for patients with generalized anxiety disorder (GAD). We conducted a randomized controlled trial to quantify the effects of 6 weeks of resistance (RET) or aerobic exercise training (AET) on remission and worry symptoms among sedentary patients with GAD. Methods: Thirty sedentary women aged 18–37 years, diagnosed by clinicians blinded to treatment allocation with a primary DSM-IV diagnosis of GAD and not engaged in any treatment other than pharmacotherapy, were randomly allocated to RET, AET, or a wait list (WL). RET involved 2 weekly sessions of lower-body weightlifting. AET involved 2 weekly sessions of leg cycling matched with RET for body region, positive work, time actively engaged in exercise, and load progression. Remission was measured by the number needed to treat (NNT). Worry symptoms were measured by the Penn State Worry Questionnaire. Results: There were no adverse events. Remission rates were 60%, 40%, and 30% for RET, AET, and WL, respectively. The NNT was 3 (95% CI 2 to 56) for RET and 10 (95% CI –7 to 3) for AET. A significant condition-by-time interaction was found for worry symptoms. A follow-up contrast showed significant reductions in worry symptoms for combined exercise conditions versus the WL. Conclusions: Exercise training, including RET, is a feasible, low-risk treatment that can potentially reduce worry symptoms among GAD patients and may be an effective adjuvant, short-term treatment or augmentation for GAD. Preliminary findings warrant further investigation.

Section: Discussionmentioning

confidence: 99%

Feasibility of Exercise Training for the Short-Term Treatment of Generalized Anxiety Disorder: A Randomized Controlled Trial

Herring

Jacob

Suveg

et al. 2011

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104

“…This is particularly relevant for individuals with bipolar disorder who tend to have a sedentary lifestyle, which increases their morbidity and mortality [116]. Exercise improves a number of important risk factors, such as cardiorespiratory fitness, weight, high-density lipoprotein cholesterol level, and fasting insulin level [117,118] and has been associated with improvements in mood and functioning [119]. Thus, adjunct exercise has the dual potential to substantially improve acute and long-term health and psychiatric outcomes for patients with bipolar disorder [119].…”

Section: Discussionmentioning

confidence: 99%

“…Exercise improves a number of important risk factors, such as cardiorespiratory fitness, weight, high-density lipoprotein cholesterol level, and fasting insulin level [117,118] and has been associated with improvements in mood and functioning [119]. Thus, adjunct exercise has the dual potential to substantially improve acute and long-term health and psychiatric outcomes for patients with bipolar disorder [119]. Psychosocial interventions adjunctive to pharmacotherapy help to improve a number of psychiatric outcomes [120,121] and could enhance both psychiatric and physical outcomes by incorporating health and wellness teaching.…”

Section: Discussionmentioning

confidence: 99%

Nutrient-Based Therapies for Bipolar Disorder: A Systematic Review

Sylvia

Peters

Deckersbach

et al. 2012

Self Cite

Background: Pharmacotherapy is the first line of treatment for bipolar disorder, but many patients continue to experience persistent subthreshold symptoms. Alternative adjunct treatments, including nutritional therapies, may have the potential to alleviate residual symptoms and improve the outcomes of standard pharmacotherapy. The aim of this paper is to critically review the current clinical evidence and mechanisms of action of nutrient-based therapies alone or in combination with commonly used pharmacotherapies for mania and bipolar depression. Methods: We conducted a Medline search for clinical trials conducted with humans, published in English from 1960 to 2012 using nutritional supplements such as n–3, chromium, inositol, choline, magnesium, folate and tryptophan alone or in combination with pharmacotherapies for the treatment of bipolar disorder. Results: Preliminary data yields conflicting but mainly positive evidence for the use of n–3 fatty acids and chromium in the treatment of bipolar depression. Limited evidence found that inositol may be helpful for bipolar depression, but larger sample sizes are needed. Preliminary randomized, controlled trials suggest that choline, magnesium, folate and tryptophan may be beneficial for reducing symptoms of mania. Conclusions: Given the potential public health impact of identifying adjunct treatments that improve psychiatric as well as physical health outcomes, nutritional treatments appear promising for the management of bipolar disorder but require further study.

“…A recent meta-analysis found that family involvement resulted in significantly better health than standard treatment for several outcomes in chronic physical disease [38]. Psychological interventions should also consider the benefits of adding physical exercise to the research protocol [39]. Recent studies have demonstrated that the remission rates in randomized controlled trials can be affected by study type and its duration, with longer randomized controlled trials showing greater response rates [40].…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Cognitive Behavioral Group Therapy for Bipolar Disorder

Gomes

Abreu

Brietzke

et al. 2011

Background: This study evaluated the effectiveness of adjunctive cognitive behavioral group therapy (CBGT) to prevent recurrence of episodes in euthymic patients with bipolar disorder. Methods: A randomized controlled single-blind trial was conducted with 50 patients with bipolar disorder types I and II followed up for at least 12 months in an outpatient service and whose disease was in remission. An experimental CBGT manual was developed and added to treatment as usual (TAU), and results were compared with TAU alone. Results: Intention-to-treat analysis showed that there was no difference between groups in terms of time until any relapse (Wilcoxon = 0.667; p = 0.414). When considering type of relapse, there was still no difference in either depressive (Wilcoxon = 3.328; p = 0.068) or manic episodes (Wilcoxon = 1.498; p = 0.221). Although occurrence of episodes also did not differ between groups (χ² = 0.28; p = 0.59), median time to relapse was longer for patients treated with CBGT compared to TAU (Mann-Whitney = –2.554; p = 0.011). Conclusions: Time to recurrence and number of episodes were not different in the group of patients treated with CBGT. However, median time to relapse was shorter in the TAU group. Studies with larger samples may help to clarify whether our CBGT approach prevents new episodes of bipolar disorder. Our findings also indicated that CBGT is feasible in euthymic patients with bipolar disorder and should be investigated in future studies. To our knowledge, this is the first publication of a controlled trial of CBGT for euthymic patients with bipolar disorder.