Depressed? What's more effective: medication or exercise?

Mental health issues are rampant in today’s stressful realities. In the past several decades, many Americans, old and young, got used to going to a doc for a script to treat depression, especially if it was severely life-debilitating. More and more though, information reveals that the long-term use of many of these meds is linked to increased heart health issues, severe hair loss, and even more problems, especially sexual dysfunction.

Going back to the basics, better food choices, more water, and taking up regular exercise, makes a lot of sense. It’s the jump-starting yourself when you are already severely down or anxious.

I came across this article, comparing running as an exercise, versus taking anti-depressants. One stunning factoid grabbed my attention (as I was sitting on a plane to Atlanta). Running was equally as effective as antidepressant meds for treating both depression and anxiety. There is equal benefit from either meds for bad moods, or running for bad moods. However, running provides so many other benefits while anti-depressant meds can worsen many domains of your health in the short or long run.

"Both interventions helped with the depression to around the same extent," study presenter Brenda W.J.H. Penninx, PhD, professor of psychiatric epidemiology at the VU University Medical Center in Amsterdam, the Netherlands, said.

However, medication "generally had worse impact on body weight, heart rate variability, and blood pressure, whereas running therapy led to improved effect on general fitness and heart rate."

Yet, antidepressant medication is considered a "standard first-line treatment" alongside psychotherapy.

The study comparing running versus anti-depressants is the Mood Treatment with Antidepressant or Running (MOTAR) study. It was a 16-week interventional period. With 141 patients with depression and/or anxiety. The average age was 38.2 years and 58% were women. Participants were offered a choice of treatment: 16 weeks of treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram (Lexapro) or a 16-week group-based running therapy.

Patients without a strong preference for treatment allocation were randomly assigned to either antidepressant medication or running therapy, while those unwilling to be randomized were allocated to their preferred intervention. A total of 36 participants chose antidepressant treatment, while 83 chose running therapy.

Running therapy involved 16 weeks of supervised 45-minute outdoor running sessions with a target of two to three sessions per week. That’s a long time running! I rather kayak, go to the gym, or dance. But hey, any movement that you like and will do and makes you sanely “pink in the face” is the way to go!

The investigators note the more favorable physical health changes in the running therapy group were due to "larger improvements in the running therapy group but also due to larger deterioration in the antidepressant group." Meaning that many of those on anti-depressant meds were still not feeling as good inside themselves as they wanted. Or they were actually getting worse.

If you are suffering from severe mood issues, why not work with a psychologist who looks at the gestalt of your life? Helping to sleuth out why you might be in this pickle at all. And add moving more. Find some way to move that you enjoy, then just do it. From bowling to pickleball to running. From walking with one-pound weights to gymnastic intimacy or add a rebounder in your living room. There are a multitude of options!

Untreated depression may lead to worse outcomes so you need to do something about very consistent debilitating blue/black moods. One of the study’s authors suggests that running therapy could be tried ahead of treatment with antidepressants if patients prefer physical exercise and can adhere to it. However, these findings also suggest that an increase in physical activity should accompany any treatments for depression and anxiety, even if you are taking antidepressant medications.

Don’t just take a pill. Make a life change, too. Then perhaps you won’t need to be on those pills for so long. It’s long-term anti-depressant use that is potentially linked to nasty health outcomes. But in the shorter term, some on these meds complain of sexual dysfunction, fatigue, and/or a flattening effect.

Exercise is one of those non-negotiables - like brushing your teeth. You just gotta make it part of your life. It can’t be something you stop because you’re traveling, overwhelmed, raising a clump of kids, writing a thesis, or even facing a court case. Even if you are having severe walking issues, you can use your upper body, try vibrational plates, or get arm cycles. Just figure out a way, even if you have limitations, to get beyond them and move. It may be challenging but it is always worth it.

Can’t say that about everything!

Exercise:

• Has to be hard-wired into your schedule.

• Keeps you sane.

• Keeps you bright.

• Benjamin Buttons you.

• Inspires your offspring.

• Slows down the tincture of time and stress.

• Befriends you, if you befriend it.

• Makes everything else way better. Especially your self-esteem and your moods.

• Gets you more energy in the long run.

• Helps you sleep better.

• Makes you smile more.

• Is lots of fun, once you give yourself a sane amount of time to acclimate to doing it.

The trick is to find things you actually like doing. Activities that keep you moving, more in touch with nature, and certainly more in touch and comfy inside your own body suit. Get moving!

Dr. B.

What do you do, on a regular basis, to get healthfully pink in the face?

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References:

36th European College of Neuropsychopharmacology (ECNP) Congress: Abstract S01.03. Presented October 7, 2023.

J Affect Disord. Published online May 15, 2023. Full text

Running vs Meds for Depression: Is There a Clear Winner? - Medscape - Oct 10, 2023.