The first-ever trial to compare the benefits of antidepressants versus exercise has found that the latter may be better for your mental and physical health overall — if you can stick to it.
Both treatment strategies were found to have equivalent benefit when it came to mental health, report researchers from the Netherlands.
However, the team found, a 16-week program of running was associated with an improvement in physical health among study participants.
In contrast, a course of antidepressants over the same period of time was found to lead to a slight worsening of physical health.
Exercise didn’t produce perfect outcomes, however, as the researchers found that the subjects were more likely to give it up — whereas antidepressants had a much lower drop-out rate.
The study was undertaken by psychiatric epidemiologist Professor Brenda Penninx of Vrije Universiteit Amsterdam, in the Netherlands, and her colleagues.
Professor Penninx explained: “We wanted to compare how exercise or antidepressants affect your general health — not just mental health.”
To do this, the researchers recruited 141 patients with either anxiety, depression, or both, and gave them a choice of treatments — either SSRI antidepressants or group-based running therapy (involving 2–3 45 minute sessions each week) for 16 weeks.
(SSRIs — short for “selective serotonin reuptake inhibitors” — are a commonly-used type of antidepressant that work by ensuring more of the neurotransmitter serotonin are kept available to pass messages between the nerve cells in the brain that regular emotion.)
Of the subjects, 45 chose antidepressants, and 96 took up running therapy. The researchers noted that the group that chose the medication were slightly more depressed than the group that chose the exercise therapy.
The professor added: “This study gave anxious and depressed people a real-life choice — medication or exercise.
“Interestingly, the majority opted for exercise, which led to the numbers in the running group being larger than in the medication group.”
At the end of the trial, the team’s analysis revealed that around 44 percent of patients in both the antidepressant and exercise groups showed an improvement in anxiety and depression levels.
However, those in the running group also exhibited improvements in blood pressure, heart function, waist circumference and weight — while these metrics showed slight declines in the antidepressant group.
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Prof Penninx said: “Both interventions helped with the depression to around the same extent.
“Antidepressants generally had a worse impact on body weight, heart rate variability and blood pressure, whereas running therapy led to improved effects on general fitness and heart rate, for instance.
“It is important to say that there is room for both therapies in care for depression. The study shows that lots of people like the idea of exercising, but it can be different to carry this through, even though the benefits are significant.”
In fact, only 52 percent of people in the running group stuck with the exercise, compared to an 82 percent adherence rate for the SSRIs.
The professor continued: “We found that most people are compliant in taking antidepressants, whereas around half of the running group adhered to the two-times-a-week exercise therapy.”
The researchers cautioned, however, that telling people to “go run” is not enough — instead, patients require encouragement and supervision of the kind provided by group exercise therapy.
Professor Penninx added: Antidepressants are generally safe and effective. They work for most people. We know that not treating depression at all leads to worse outcomes — so antidepressants are generally a good choice.
“Nevertheless, we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them.
“Our results suggest that implementing exercise therapy is something we should take much more seriously, as it could be a good — and maybe even better — choice for some of our patients.”
Exercise therapy could also have benefits in sidestepping some of the side effects of antidepressants, the team noted.
The professor explained: “Doctors should be aware of the dysregulation in nervous system activity that certain antidepressants can cause, especially in patients who already have heart problems.
“This also provides an argument to seriously consider tapering and discontinuing antidepressants when depressed or anxious episodes have remitted.
“In the end, patients are only truly helped when we are improving their mental health without unnecessarily worsening their physical health.”
Dr Eric Ruhe, a psychiatrist at the Amsterdam University Medical Centres who was not involved in the present study, said: “These are very interesting results that again show that physical health can influence mental health and that treatment of depression and anxiety can be achieved by exercising, obviously without the adverse effects of antidepressant drugs.
“However, several remarks are important. First the patients followed their preference, which is common practice, but ideally we should advise patients what will work best.
“Following this choice is understandable from a pragmatic point of view when patients have strong preferences, which you have to take into account when doing a study like this.
“The downside is that the comparisons between groups might be biased compared to doing this in a truly randomized study. For example, patients in the antidepressant group were more depressed which might be associated with less chance of persisting engagement in the exercises.
“So, we have to be careful not to overinterpret the comparisons between groups, which the authors acknowledge properly.”
Doctor Ruhe continued: “Finally, a very important finding is the difference in adherence between the interventions: 52% in the exercise group and 82 percent in the antidepressant group.
“This shows that it is more difficult to change a lifestyle habit than taking a pill. This is not exclusively found in psychiatry, indicating that we also have to focus on how to improve compliance to healthy behavior.”
He concluded: “This could have a tremendous impact on healthcare more generally, but also on psychiatric diseases.”
The full findings of the study were published in the Journal of Affective Disorders, and were recently presented at the European College of Neuropsychopharmacology Congress, which is being held from October 7–10 in Barcelona, Spain.
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