Exercise such as antidepressants for moderate depression

A new study published in British Journal of Sports Medicine, It found that exercise was just as good at treating depression as antidepressant medication, at least for those with mild or moderate symptoms. Adding antidepressant medication to exercise did not increase effectiveness – exercise alone worked well.

The researchers wrote, “Exercise relieves depressive symptoms to an extent similar to antidepressant treatments alone or combined with exercise.”

They add, “These findings suggest that exercise can be used as an alternative therapeutic approach for the management of non-severe depression in adults.”

They note that guidelines in Europe, Canada, the United Kingdom, and Australia already list exercise as a potential initial treatment for depression. However, US guidelines are lagging behind, including only antidepressant medications and psychotherapy as first-line treatments.

The study was a network meta-analysis of 21 randomized controlled trials, including a total of 2551 participants. The researchers looked at experiences of exercise, antidepressants, and their combination compared to each other or to a control/placebo group.

Since the majority of people who are prescribed antidepressants have mild to moderate symptoms, and antidepressants have significant negative effects, the researchers suggest that patients should be informed that exercise is a legitimate alternative that can provide the same amount of relief, with far fewer adverse effects.

The problem, they suggest, is that exercise requires more effort.

“Exercise is physically demanding and difficult to implement compared to standard drug treatments. On the other hand, antidepressant treatments are associated with greater adverse effects, higher costs, and social stigma.

Perhaps for this reason, people were more likely to drop out of the exercise group than the antidepressant group before the end of the study, which the researchers took to indicate that exercise was less acceptable as an intervention.

However, negative effects were reported by 22% who took antidepressants, compared to only 9% who took an antidepressant.

The results were robust, with the conclusion remaining consistent after the researchers controlled for study quality and other factors.

“The results were confirmed by rigorous sensitivity analyzes that took into account the quality of the studies as well as the types of participants and interventions,” they wrote.

This finding is consistent with a study conducted earlier this year, in which exercise was associated with a 25% lower risk of depression. In another study, those who exercised had significantly lower relapse rates after 10 months than those taking antidepressant medication.

A major limitation of this study is that it focused only on mild to moderate depression – so we still don’t know if exercise would be as good as antidepressants for those with severe symptoms. However, a 2016 study found that exercise has a significant effect in improving major depression.

The researchers also did not include any studies of yoga, tai chi, or other interventions that may have psychological aspects beyond simple exercise – so they could be more effective.

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Recchia, F., Leung, C.K., Chin, E.C., Fong, D.Y., Montero, D., Cheng, C.P.,. . . & Siu, PM (2022). Comparative efficacy of exercise, antidepressants and their combination in the treatment of non-severe depression: a systematic review and network meta-analysis of randomized controlled trials. Br J Sports Med. Published online September 16, 2022. doi: 10.1136/bjsports-2022-105964 (full text)