Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=166355
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There is evidence that exercise can help improve depression symptoms and manage daily stressors.


Exercise can help keep depression symptoms at bay

by Amber Lindke and Kelly C. Doherty
June 03, 2010


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Amber Lindke and Kelly Doherty/MEDILL

Exercise is a way to help manage stress.

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Amber Lindke and Kelly Doherty/MEDILL

Participants in a workout program at Atlas CrossFit Chicago say that the variety of challenging exercises helps keep them motivated.

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Major depressive episode (MDE) is used to describe a collection of symptoms of major depressive disorder (MDD). In this 2004 study, conducted by the National Survey on Drug Use and Health, the subjects were asked if they experienced a two-week period of depressed mood, loss of interest or pleasure and at least four other symptoms that indicate a change in functioning such as problems with sleep, eating, energy, concentration and self-image. Source: NSDUH, 2004 Data

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“Without exercise, I’d be taking an extra handful of pills or I’d still be sick,” said Kevin, a Chicago-area salesman who has dealt with depression for more than half of his life.

Kevin, 42, who asked that his last name be withheld, is among the approximately 15 million adults suffering from depression in the United States.

Researchers have known about the link between exercise and an improvement in mental health for years, but they have recently acknowledged its effectiveness as a part of a larger treatment plan in the field of mental health.

The notion that exercise can help combat symptoms of depression is one that has been researched widely by Jasper Smits, an associate professor of psychology at Southern Methodist University in Dallas.

He and his colleague, Michael Otto, a psychology professor at Boston University, conducted an analysis of multiple studies that demonstrate that there is “strong evidence” that exercise helps improve symptoms for patients with mild to moderate forms of depression.

“Providers need to take a more holistic approach to healthcare by incorporating exercise into treatments,” Smits said.

Smits and Otto realized that the research on this topic had been conducted, but the information had not been interpreted for mental health practitioners to use in their practice. After reviewing the studies, they created a guide for therapists, called Exercise for Mood and Anxiety Disorders, “in order for exercise to be a part of a treatment plan” for their patients, Smits said.

Although people may suffer from mild or temporary periods of sadness or exhibit depression symptoms, doctors identify the more severe and persistent form of depression as major depressive disorder.

“Major depressive disorder is a serious illness. The World Health Organization has rated its health burden as one of the top health conditions that impact people’s well being world wide,” said Dr. Stephen Dinwiddie, a professor of psychiatry at the University of Chicago.

Symptoms of major depressive disorder include sustained low mood, loss of interest in daily activities, changes in sleep patterns and appetite, lack of energy and social withdrawal. “The most worrisome symptom is starting to think more about death, not wanting to go on…suicide,” Dinwiddie said.

It is important to recognize the difference between major depressive disorder and normal periods of stress, sadness and low mood, he said.

Nancy Molitor, a clinical psychologist of 23 years, is familiar with Smits and Otto’s analysis and said their work “verified what I see in my practice.”

“When people embark on a carefully thought-through plan of exercise, it really is almost as effective as prescribing [medicine],” said Molitor, an assistant professor of clinical psychiatry and behavioral science at Northwestern University’s Feinberg School of Medicine.

Molitor and other experts agree that exercise should be a part of a combination of traditional treatments that may include medication, counseling and forms of psychotherapy.

Murray Ardies, an exercise science professor at Northeastern Illinois University, said exercise alone shouldn’t be “the treatment, but I think it should be an adjunct treatment.”

Considering that “most people with depression are pretty sedentary,” Molitor encourages her patients to adopt exercise as a form of therapy.

She has seen results in her patients who have started off with small amounts of exercises, such as walking for 10 minutes a few times a week.

For exercise to benefit depression sufferers in the long term, their exercise plan needs to be a consistent part of their lives, Smits said.

Kevin said he generally works out five days a week, alternating between aerobic activity and strength training. He stays dedicated, even exercising during vacation in order to avoid feeling “vulnerable to depression.”

He said he believes implementing exercise into his treatment plan has improved his depression symptoms. He has suffered three major depressive episodes since his teens, and although he said his medication is the most important part of his treatment, he attributed his consistent exercise routine to maintaining a healthy mental state. He said he has been “completely asymptomatic” since his last episode, which ended in 2004.

“I would credit [exercise] with keeping me well, specifically with keeping me mentally healthy,” Kevin said. “It kept me well this time around.”

However, not all who suffer from depression have experienced the benefits of exercise.

Jamillah Taha, 39, a beauty consultant from Melbourne, Australia, said although she agrees that exercise can help with depression symptoms, she has had difficulty incorporating it into her own life.

“I just can’t get myself to get motivated,” said Taha, who was diagnosed with depression and anxiety at 21.

She, like many people with depression, leads a more sedentary lifestyle. “I sleep all day and don’t go out of my house, where I feel safe and no one is going to hurt or judge me,” she said.

Molitor said exercise allows people with depression to socialize, break out of a worried and stressed mindset and gain physical health benefits as well.

Weight increase is often a side effect of medications for depression, Dinwiddie said, so exercise is helpful with managing weight.

When discussing exercise plans with patients, Molitor said, “The key is breaking it down for people so they don’t see it as all or nothing…working slowly to help them break out of that sedentary lifestyle in very small, clear ways that don’t seem overwhelming.”

She also said that there is no particular type of exercise recommended; instead, patients should choose an activity they enjoy and will commit to.

Although doctors caution the use of exercise solely as a treatment for people with depression, Smits said it provides an outlet for those who cannot or will not receive traditional therapies.

Depression often carries with it a negative connotation, causing some people to refrain from seeking treatment.

“Exercise, unlike psychotherapy, doesn’t have the social stigma associated with it,” Smits said.

Other challenges that hinder the ability to receive traditional treatments include cost, lack of access and concerns about taking medication to treat depression.

Molitor stressed that depression is “very treatable.” She advises people who recognize symptoms of depression in themselves or others, to seek treatment as soon as possible. More than 80 percent of people show a response to their treatment within two to three weeks, she said.

Kevin said for him personally, exercise has been a significant component of the treatment plan that has kept him symptom-free for the past six years.

 He quipped, “I’m not a much better specimen [physically] than I was before 2004, because I work out for the sake of my brain.”