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Exercise: the Other Antidepressant

Psychologist urges prescribing physical activity

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Michael Otto, a College of Arts & Sciences professor of psychology, says that a significant percentage of people with depression could improve dramatically with exercise alone. Photo by Vernon Doucette

“Go out for a walk; you’ll feel better.”

That’s long been a trusty bit of wisdom for relieving stress and lightening mood. But now that there’s a persuasive body of hard science to back up the antidepressant function of exercise, Michael Otto, a College of Arts & Sciences professor of psychology, says clinicians should consider physical activity as important and valid a treatment for depression as antidepressant drugs and talk therapies. Otto argues that numerous clinical trials have shown that people with major depression who embrace routine exercise get better at the same rate as they do with antidepressants.

Depression is a fierce adversary for clinicians; according to the National Institute of Mental Health, it affects nearly 15 million Americans over 18 and is the leading cause of disability for those ages 15 to 44. A significant percentage of them could improve dramatically with exercise alone, and for patients who still require medication, it can increase the benefit, says Otto, one of a group of researchers calling for psychologists to include exercise programs in treating not just depressives, but people with anxiety and eating disorders. Otto, coauthor, with Jasper A. J. Smits of Southern Methodist University, of the clinical guide Exercise for Mood and Anxiety Disorders (Oxford University Press), is working on a book about exercising for improved mental health for lay readers. BU Today spoke with him about the antidepressant effects of exercise and the challenge of motivating people who may be immobilized by sadness.

BU Today: It’s long been known that exercising makes us feel better. What’s new about the link between physical activity and depression?
Otto:
In recent years there are more findings documenting just how effective exercise is. Its effects rival antidepressants in head-to-head studies. Another new thing is the potential adoption of exercise as a part of clinical practice. We thought, how come we don’t see this connection in the hard literature? We decided to make the strength of these findings clear to people in mental health circles. There were no treatment manuals until ours to help clinical practitioners incorporate exercise programs. It’s time to attend to this.

Isn’t the link between exercise and mood intuitive? Most of us exercise because it makes us feel good.
A lot of intuitive things just aren’t true. There’s no scientific evidence for a lot of the stuff that goes around in the popular culture, like the merits of magnets or the belief that vitamin C helps you not get a cold. People like me tend to distrust popular opinion. If you go for a run you may be less stressed, but research showing it can treat something like major depression — a bad, debilitating disorder — that’s where the news is.

Is there a bias among clinical psychologists against prescribing exercise as being too simple?
The beauty of exercise is that it appeals to holistic thinking and there’s evidence. Those two things don’t often go together. Our manuals help clinicians get comfortable with the exercise prescription and support treatment by giving information to patients, helping them adopt the intervention themselves.

How does exercise for health or anti-aging differ from exercise for improving mood?
The problem with exercise for health is you have to wait nine months to a year for results, before your abs and your hips look better. It’s a tremendous commitment. The beauty of exercising for mood is you get the payoff right now. The other kicker is, being in a bad mood is why a lot of people don’t exercise, and this becomes precisely the reason to exercise.

Severely depressed people often have trouble just getting out of bed. How can a therapist get patients to take those first steps?
What’s important is that we can add exercise to the treatments that work, such as cognitive and interpersonal therapy and antidepressants. We now know that exercise works, but getting people to exercise is an art. Let’s be frank — Americans are abysmal at adopting exercise. So our approach is to use cognitive behavior therapy to target exercise adoption and help people really stick with it.

My colleague Jasper Smits and I have devised a number of activity-based treatments that break exercise up into small, useful steps. When you’re on your couch, there may be no way you’re going to get up and go running. But if you get up and put on your workout clothes, you’ll feel, I may as well move a bit, and then decide just to go outside. These small gains keep a person going, which is important because we’re working against poor motivation and the feeling that nothing matters. We prepare people for the kind of thoughts you have when you wake up in the morning — like, I really should exercise but don’t. We tell patients they need to make decisions with their awake mind, not their asleep mind.

How much exercise should depressed people do for sustained results?
We think that bouts of exercise are important, not just random physical activity during the day. We’re talking about half-hour chunks, the time necessary to get people past ruminative thinking. For me, for example, my brain shuts off at around 22 minutes into a run. And we know what’s worked in the trials is getting the heart rate up for 20 to 45 minutes of sustained activity. We’re staying where the research is.

Taking pills to feel better seems to be a powerful force in our culture. Will exercise be a hard sell for clinicians treating depressed or anxious people?
My colleagues who have med-based practices don’t talk about exercise. In my practice, people want to avoid taking medicines, or patients are struggling with just meds or therapy and not getting better. They want more active components. For all those therapists who are not offering drug or cognitive therapy, this provides a new choice. We have to change everybody’s biases — both doctors’ and patients’.

Is there any concern that if exercise proves to be a cure, it will put Ph.D.s out of business?
We’d be so lucky to run out of cases. A few more people might go for care who otherwise don’t go. Conventional treatment for depression works about half the time no matter what the therapy is. Smits and I are writing a book so depressed people can pick up the exercise program by themselves.

How important is the social aspect of exercise?
Depression is an isolating force, and once you’re isolated with a bad mood, it feeds on itself. Exercise returns you out into the world. It feeds you in ways over and above the health benefits.

What are the limitations of exercise therapy? Is it effective for thought disorders like schizophrenia?
Depression is where the bulk of the findings are. Second are anxiety and panic disorders, and there are new exercise applications for substance dependence. But there’s no evidence that exercise can treat thought disorders or delusions.

Can anything be psychologically bad about exercise?
Any behavior can be overdone. With exercise, you can overdo it and get injuries or overdo it so it crowds out other aspects of your life. There’s the risk of exhibiting that uniquely human ability to redefine success in a way that you’re failing all day long: I ran three miles — I could’ve run five.

Susan Seligson can be reached at sueselig@bu.edu.

10 Comments

10 Comments on Exercise: the Other Antidepressant

  • Anonymous on 04.13.2010 at 9:32 am

    With the negative side effects of antidepressants, it seems that more and more people are growing wary of them. I think that with depression, since it affects such a wide array of people, it’s important to have options (as far as treatment goes).

  • Anonymous on 04.13.2010 at 9:51 am

    Where are the endorphins I heard about decades ago? Has that been disproved, or is it not considered relevant, or just forgotten?
    When I was young and single, I went running 3 times a week (only for 3 miles, but more than doubled my heart rate for 20 – 25 min.) I clearly got “high” from it and this clearly helped my mood. (The reward also motivated maintaining the 3 x week schedule.) Due to surgery in my mid thirties, I can’t do this anymore, and for me the difference has been obvious.

  • Anonymous on 04.13.2010 at 10:31 am

    The drug industry makes no profit from running, only meds. This connection is not mentioned in the article.

  • Anonymous on 04.13.2010 at 10:49 am

    It's not 100%

    I think exercise is good and it’s helpful if doctors prescribe something specific instead of saying “you need more exercise”. But I’ve been through a couple bouts of depression where exercise didn’t help my mood a bit, it just made me sleep better at night.

  • Allison E. on 04.13.2010 at 10:55 am

    Thank you for this article.

    I have entered mild to severe bouts of depression and know exactly how important exercise has been in helping to relieve my state of mind. Jogging, swimming or biking really anything that makes me break a sweat always puts me in the mentality of: “If I can do this, then I can slowly start tackling my life.”

    I personally have not resorted to pharmaceutical antidepressants, partially because several of my friends and peers are prescribed and I see the backlash.

    Often times they become so reliant on a drug’s ability to balance serotonin levels, patients forget that antidepressants are only a supplement. In order to get out of depression, the person who suffers must be willing to make changes in their daily life habits.

    This translates into a more holistic approach to self healing which includes evaluating your eating, sleeping, and exercise habits. It also includes evaluating your peers, family, friends and creating a support group for yourself.

    Humans are social beings and part of survival is based on your ability to interact with your surroundings. Setting up that social network, and I’m not exactly referring to social networking websites, but a network of people who love and care about your well-being is one of the most important things a person can do for oneself.

    If you are suffering, be aware of a few things:

    1. If you want to stop suffering, you will have to make personal changes to your daily life habits

    2. Drugs do not solve your problems

    3. Be wary of any doctor or psychiatrist that is easily or quickly willing to prescribe you. Though it may seem like a solution, especially coming from a respectable source, pharmaceuticals like any choice, have their consequences – over-prescription, worsening side-effects.

    4. In order to make progress, you must be honest with yourself. This does not mean indulging in self hatred or deprecation, it means identifying your short-comings and making small reasonable goals for yourself. If you are the type that’s too hard on yourself, cut yourself some slack. If you find yourself blaming others and outside sources for your problems, realize that the only person you can hold accountable for his or her actions is yourself. This will force you to look within and make the changes you want to see.

  • Anonymous on 04.13.2010 at 4:37 pm

    Oh how I wish this article spoke the whole truth. I’ve been on an SSRI to treat anxiety and depression for a few months shy of a year now. After I started feeling better a few months back, I decided it was time for me to slowly get off the meds-easier said than done. Almost immediately I started feeling that edge of anxiety again so I turned to exercise for help. It started off innocent-a half hour at the gym 5 days a week-but that quickly turned into an hour, two hours, sometimes three hours seven days a week. I even took up a yoga class to supplement my time on the treadmill and elliptical. But no matter how long or how hard I worked, I could not “shut my brain off” as you put it. Exercise quickly became an obsession, a drug for me. In a way, it hurt me. For some, it’s not as easy as just going outside for a run.

    • paul turner on 11.10.2012 at 8:57 am

      the article isnt supposed to address every aspect of the topic,i think youll find your situation is very rare in depressed patients,those with eating dosorders or OCD for which exercise isnt a proven treatment would be far more liklely to become exercise obsessed.In fact its been shown by research that people prone to depression are the least likley to enjoy exercise in the first place.

  • Anonymous on 04.14.2010 at 9:25 am

    re: Where are the Endorphins?

    In my opinion, Endorphins should have been mentioned because an endorphin rush is a chemical ‘high’. Self-medicating by endorphins is arguably dangerous.
    Endorphins need to be managed carefully, like other mood altering drugs.

    In my personal experience, the addictive lure of endorphins is about on a par with alcohol – greater than cocaine and marijuana and less than cigarettes. This is a measurement of the potential to ‘get hooked’, not the potential physical damage.

    A lot of people have done temporary and permanent damage to their bodies by running. One of the contributing factors would be the desire to “over-achieve” or “push their limits”. Another factor would be “chasing a runners high”

    I am not saying no one should run. I am saying that many people are unable to run responsibly just as others are unable to drink responsibly. Which returns to the original point.

    I agree that endorphins should have been mentioned, because the chemically-based negative effects of excercise should be discussed when the chemically-based positive effects are discussed.

    • paul turner on 11.10.2012 at 9:02 am

      youre mistaking endogenous endorphins for opioid drugs ,the effects arent exactly the same and nowhere near the same extent.Also the dopamine system is what determines the craving for a behaviour not the endorphin response,exercise doesnt have anywhere near the same dopamine response as most addictive behaviours.

  • Anonymous on 04.15.2010 at 11:19 am

    It Helps!

    I have been dealing with anxiety disorder for years. A year ago I started having panic attacks and was prescribed an SSRI. It has helped a lot but a daily program of moderate exercise helps as well. There is no magic solution but rather a combination of initiatives including exercise. I could have authored the email from “Oh How I Wish This Article…” but would respond by saying don’t despair but don’t put all your efforts into one initiative. The solution is finding a balanced approach over the long term. Exercise and Yoga are great initiatives and should be continued but are not the total answer. Keep going!!

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