Easing Depression with Exercise
For those who are battling depression, research suggests that exercise, specifically walking, running, or resistance training, can potentially ease some symptoms of the disease and help patients achieve remission.
The Frequency of Depression and its Symptoms
Although there are many different types of depression, Major Depressive Disorder (MDD) is the one that is the most commonly diagnosed, with approximately 16.5 million adults in the United States over the age of 18 reporting that they had an MDD episode at least once during the last year.
According to the Anxiety and Depression Association of America, those diagnosed with MDD have at least five symptoms of the disease, one of which is an overpowering feeling of sadness or a loss of interest or gratification in one’s normal activities.
Other symptoms of MDD include:
- a change in appetite
- insomnia or hypersomnia (sleeping constantly)
- an increase or decrease in mental and physical activity
- constant fatigue
- feelings of excessive or inappropriate guilt or feelings of worthlessness
- frequent thoughts of death or suicide (with or without a plan for committing suicide)
- cognitive problems, such as a diminished ability to think rationally, concentrate or make decisions
Those who suffer from MDD have symptoms that last at least two weeks and often find that social, occupational, educational, or other significant functioning is impacted. For instance, those battling MDD may frequently miss school or work or stop attending their usual social activities.
How Depression is Treated
Singularly, antidepressant medication or psychotherapy both are effective methods to treat depression. In complex or severe cases of depression, a combination of medication and psychotherapy has been associated with the greatest improvement in symptoms.
Because there are a number of different antidepressant medications and because each individual may react to one better than another, it may take some time to discover which medication is right for a specific individual. And once prescribed, antidepressant medications can take anywhere from two to four weeks before patients begin to see an improvement in symptoms.
Although there are a wide variety of psychotherapies, cognitive-behavior therapy (CBT) and interpersonal therapy (IPT) have been found to be effective in treating depression.
CBT is based on the idea that clinically depressed individuals have a negative view of oneself, one’s life experiences and one’s future. This is known as the cognitive triad. CBT focuses on helping individuals identify and change negative behavior and thinking patterns. CBT often involves researching the problem, keeping notes about feelings and behaviors between appointments and completing “homework” assignments during which methods learned in treatment are practiced. Patients are taught new skills during therapy sessions that must be practiced consistently to see an improvement in symptoms.
IPT is a time-limited, supportive treatment, usually consisting of a one-hour session each week for 12 to 16 weeks. IPT focuses on the behavior and interaction that the patient has with family, friends, classmates, and co-workers—people who the patient might see on a daily basis. The goal of IPT is to improve the patient’s communication skills and increase self-esteem, which can enhance the quality of the patient’s current relationships with others. Positive social interactions can help alleviate or eliminate depressive symptoms, particularly those caused by loss of a loved one and grief; conflicts in relationships with others; important life events such as divorce; social isolation or loneliness; or role-in-life transitions such as becoming a mother or a caregiver.
How Exercise Helps
For many seeking help with depression, primary caregivers are the first line of defense. Studies have shown that patients receiving care for depression at the primary caregiver level, most often receive a prescription for medication. And although some do receive referrals for concurrent CBT and/or IPT, many patients are not educated on the benefits of treatment using both antidepressant medication and psychotherapy.
Fewer still are made aware of the connection between exercise and its benefits for those battling depression. A 2004 meta-analysis of medical research published between the years 1996 to 2003 uncovered a large number of studies that corroborate the benefits of adjunctive exercise for depressed individuals. According to “The Benefits of Exercise for the Clinically Depressed” published in The Primary Care Companion to the Journal of Clinical Psychiatry, research suggests that the benefits of exercise in helping alleviate depression may be long-lasting, with one study asserting that after a 12-week program of exercise, participants continued to feel the positive impact of the program throughout the 12-month follow-up period.
The analysis purported that while most of the studies employed a walking or jogging program, there is some research that suggests resistance training programs such as weight-lifting may have the same benefits.
The “Why” of Exercise
So what is it about exercise that helps ease some of the symptoms of depression? Although consistent research has confirmed the connection, the specific cause behind the benefits of exercise in the depressed population remains undefined. There are several hypotheses however which attempt to explain the cause.
- The thermogenic hypothesis suggests that the rise in core body temperature and the subsequent temperature increase in certain areas of the brain following exercise are responsible for a general feeling of relaxation and a decrease in muscle tension.
- The endorphin hypothesis, associated with the “runner’s high,” predicts that an increase in endorphins released in the brain after exercise leads to a more positive mood and overall heightened feeling of well-being.
- The distraction hypothesis is the most simple of them all. It suggests that exercise serves as a distraction from the worried minds of depressed individuals. The use of distracting activities is used as a method for coping with depression and some studies suggest that it may have greater positive outcomes than more self-focused methods, such as journaling.
- The self-efficacy hypothesis asserts that through exercise depressed individuals realize that they have the necessary skills and self-confidence to complete a task, in this case, a workout or even training for something like a road race. Throughout the process of exercising and training, mastery of skills and self-confidence are enhanced, leading to better coping self-efficacy.
- Among all the hypotheses, the monoamine hypothesis is the most promising. The science behind this hypothesis is based on the possibility that exercise increases the availability of neurotransmitters—such as dopamine and serotonin—in the brain. These neurotransmitters are diminished in those suffering from depression. Unfortunately, further research into this hypothesis is hampered by the invasive procedures required to test for the neurochemical changes in the brain.
Exercise Can Be Part of the Plan
Regardless of which hypothesis or combination of hypotheses is the mechanism behind the positive impact of exercise on those with depression, it is important to note that exercise alone is not a cure-all for MDD. Exercise is considered an adjunctive therapy to be combined with either prescription medication or psychotherapy or both.
If you or a loved one suffer from depression, it is important to consider all treatment options with a medical/health professional when devising a therapeutic plan for remission. Exercise can be an important part of treatment.
And of course, if you are or a loved one is having suicidal thoughts or tendencies, seek professional help immediately or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or visit suicidepreventionlifeline.org.