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Can exercise be just as effective as my medication to treat depression?

8/13/2019

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​Depression is one of the most commonly diagnosed mental health conditions in America.  It is estimated that 16 million adults in the US suffer from depression- that is 6.7 percent of all American adults!  About 25 million Americans have been taking antidepressants for at least 2 years, and this is a 60% increase since 2010.  These statistics are staggering.  Despite so many people being on antidepressants, I often hear – I don’t feel any better or I don’t think it works as well as it used to. 
These medications were originally only used to treat moderate to severe depression and only for short periods of time (6 to 9 months).  Now there are many individuals that are using it for mild to moderate depression and they remain on these medications for years.   So, the first question is do antidepressants work for mild to moderate depression? 

Studies have not shown that antidepressants provide much more benefit than placebo when used to treat mild depression.  What is more alarming is the side effects of antidepressants are very unpleasant: sexual dysfunction, decreased libido, erectile dysfunction, insomnia, and weight gain, to name just a few.  Fortunately, there are nonmedicinal options that may also help.  Even something as simple as exercise has been shown to work better (in some cases) than antidepressants for mild depression.  In 2005, the staff at Duke University devised a study where they compared the antidepressant effect of the popular antidepressant sertraline to aerobic exercise for four months.  What they found is rather interesting-the group that exercised at a moderate level about 40 minutes 3 to 5 days a week experienced more of an antidepressant effect than the group that took Sertraline. 

Exercise works in a similar way to antidepressants when combatting depression.  Exercise increases the blood flow to the brain causing the release of endorphins which is essentially the body’s own natural antidepressant.  It also causes the release of neurotransmitters like serotonin naturally.  Antidepressants like sertraline work by increasing the amount of serotonin at receptor sites.  However, over time your body compensates and has fewer receptors available, essentially decreasing the antidepressant effect over time.  So, if antidepressants don’t work very well or for very long for mild depression and have nasty side effects like sexual dysfunction and weight gain, then why do so many people stay on these meds for so long?

​The reason they stay on it for so long is because the withdrawal symptoms are so severe that they are unable to wean themselves off the medication once they feel better.  Also, a lot of patients on antidepressants mistake the withdrawal effects for relapse.  For instance, stopping antidepressants, especially suddenly, can cause depression and anxiety, which can be confused with the original symptoms these medications were used to treat.  Other side effects of stopping depression medications can include headaches, dizziness, fatigue, nausea, insomnia and even flu-like symptoms.

If you suffer from mild depression and feel like your current therapy regimen is not working talk to your health care provider.  There may be other therapy options available for your mild depression like exercise and psychotherapy that could be more effective for treating your symptoms.  That being said, be sure to talk to your provider before making any changes in your current medical regimen, and if you begin to worry about harm to yourself or others, then be sure to go directly to your nearest emergency department.  Remember, you aren’t alone, and there are a number of both nonmedicinal and medicinal treatment options available.  Mental health issues should be taken seriously, so take a minute to discuss any concerns with your healthcare provider.

Dr. Pam
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