Exercise, Medication, and Depression 🏃♀️
Hey friends, this week I am returning to a subject that we have touched on a few times before, because it is profoundly underappreciated.
Major depression is one of the most costly health conditions in the United States, and the situation does not seem to be getting a whole lot better. The economic burden of major depressive disorder among U.S. adults was an estimated $236 billion in 2018, an increase of more than 35% since 2010.
Much of this burden is not due to direct expenses of treatment, but the indirect toll that the disease takes on productivity (not to mention suicide). Essentially, a staggering proportion of us are unable to fully engage with the world and realize our potential. Even if you don’t struggle with depression yourself, you are no doubt impacted by this.
Part of the problem, of course, is that treatments for depression just aren’t very good.
US clinical guidelines promote pharmacotherapy as the initial treatment approach. But as University of Michigan’s Elissa H. Patterson and Jay Kayser have discussed extensively, nearly 3 out of 4 people who use antidepressant medications fail to achieve remission from depression. Consequently, these individuals are deemed as having "treatment-resistant depression," which is pretty discouraging.
Meanwhile, lifestyle interventions, like physical activity, are characterized as "complementary alternative treatments." But a huge new review of more than a thousand studies suggests that exercise may actually elicit improvements in symptoms comparable to or even surpassing current available medications (plus added physical benefits). Which raises this question: should activity interventions actually be part of the first-line treatment for depression?
This Week’s Research Highlights
🦶 Individuals with depression who start running regularly show similar improvements in depressive symptoms as those who take medications – but with additional physical benefits.
Researchers in the Netherlands recruited 141 patients with depression at mental health clinics who were not currently taking psychoactive drugs or regularly exercising. Those who did not have a strong preference were randomized to either antidepressant medication or running therapy, meaning supervised 45-minute outdoor running sessions 2-3 times per week. Others who agreed to participate but were unwilling to be randomized were allocated to their preferred intervention. (Yeah, this is a clear limitation of the study but I'm guessing that the researchers knew they wouldn't be able to achieve good adherence if they tried to make depressed people take drugs or run when they were strongly opposed to it.). Anyway, after 16 weeks, the rate of remission from depression was similar in the antidepressant group (44.8%) and the running group (43.3%). So in terms of mental health, both interventions seem to have elicited similar beneficial responses. However, when the researchers compared physical parameters in the two groups, they saw some big differences. The runners showed a significant decrease in their resting heart rate (average -3.2 bpm) and their waist circumference (-1.0 cm), as well as an increase in lung function (+29.4). The antidepressant group enjoyed none of these health benefits. Instead, the medication group saw a significant increase in weight (average +3.2 kg), waist circumference (+1.5 cm) and C-reactive protein (+1.59 mg/L), as well as a decrease in heart rate variability (-17.0 ms). So, to sum up, running 2-3 times per week led to similar improvements in depressive symptoms compared to antidepressants, but also improved body composition and physical fitness. Those who took antidepressants, in contrast, experienced weight gain, reduced HRV, and an increase in systemic inflammation.
🦶 A massive analysis of findings from more than a thousand randomized trials found that physical activity is highly beneficial for depression and anxiety.
To synthesize evidence on the effects of physical activity on depressive symptoms, researchers affiliated with the University of South Australia performed an umbrella review – basically meaning a review of systematic reviews – of randomized controlled trials that were designed to increase levels of physical activity and that measured depression or anxiety. They collected a total of 97 reviews, comprising a total of 1039 unique trials and 128119 participants. The meta-analysis found that physical activity is effective for improving depression and anxiety across a wide range of populations. In fact, the effect size was comparable to, or slightly greater than, the magnitude of effect observed for psychotherapy and pharmacotherapy (lining up nicely with the study described above). All modes of physical activity were beneficial, although resistance exercise had the largest effects on depression. Furthermore, higher intensity physical activity was associated with greater improvements in symptoms, perhaps because intense exercise tends to have a stronger impact on expression of neurotrophic factors and systemic inflammation. As the researchers summarize: "In conclusion, physical activity is effective for improving depression and anxiety across a very wide range of populations. All physical activity modes are effective, and higher intensity is associated with greater benefit. The findings from this umbrella review underscore the need for physical activity, including structured exercise interventions, as a mainstay approach for managing depression and anxiety."
Better Brain Fitness with Dr. T
In a recent Pew Research Center survey, two-thirds of parents claimed that raising children today is more challenging than it was two decades ago. The primary culprit? Technology.
It seems safe to say that the smartphone era has brought about the fastest and most radical shift in the life of a typical child in all of human history. And the effect that has on a developing brain is still an open question. No wonder that it's an issue many parents lose sleep over. It's also the question that Drs. Turknett and Wood wrestle with on the latest episode of the Better Brain Fitness podcast.
Random Trivia & Weird News
If you studied engineering or physics, you are probably already familiar with the story of Galloping Gertie.
The first bridge that spanned the Tacoma Narrows Strait received this ominous nickname when construction workers noticed that the deck would bounce in windy conditions – an alarming propensity that continued even after the bridge was opened to the public. On November 7 1941, merely four months after opening, the bridge collapsed spectacularly.
Clark Edridge, the lead project engineer, left and went to work for the US Navy in Guam. Of course, the United States entered WWII around this time, and he was quickly captured by the Japanese. But even trapped in a prisoner of war camp in Japan, he was not able to escape the worst moment of his career. One day, a Japanese officer approached Eldridge and exclaimed, “Tacoma Bridge!” 💀
Podcasts We Loved This Week
- Andrew Coggan: Zone 2 training -- why all the talk? Via Inside Exercise.
- Susan Rossell: Psychedelics for depression and PTSD. Via The Proof.
Products We Are Enjoying
If you’re trying to boost physical activity levels, a tracker can be massively helpful. Can’t manage what you don’t measure, right? Fitbit is a perennial favorite in this space, and it is one that we continue to rely upon here.
(And of course, you can easily sync your Fitbit data to your humanOS Dashboard for a more complete view of your activity patterns over the course of time).
humanOS Catalog Feature of the Week
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This week we’d like to highlight one of the lessons from our Daily Performance Program. A while back, we discussed a study examining how decreases in daily physical activity, due to the pandemic, were associated with higher rates of depression.
One quote that stuck in my mind was from co-author Sally Sadoff, who said, “...our results clearly show that those who maintained physical exercise throughout the pandemic were the most resilient and least likely to suffer from depression."
In this micro-lesson, Dan explains how exercise is a stressor, but it also buffers us from stress. Exercise doesn’t just make our muscles stronger – it makes our brain stronger too.