The Exercise Prescription for Depression

Medication has been the default treatment people with Major Depressive Disorder for years, but researchers at the University of Texas Southwestern Medical Center have suggest that aerobic and resistance exercise can be equally as effective.     Photo: Dariush M/Shutterstock

Aerobic exercise:

Three to five sessions a week

Each session should be 45 to 60 minutes long

Achieve a heart rate that’s 50 to 85 percent of your maximum heart rate

Resistance training:

A combination upper and lower body exercises

Three sets of eight repetitions

Use weights that are 80 percent of the maximum weight you can lift at one time

We know that a good sweat session can do wonders for your mood, but new research is showing that it can go much farther than that.

Building on previous studies suggesting that exercise could benefit those suffering from depression, researchers at the University of Texas Southwestern Medical Center have suggested a precise aerobic and resistance exercise regimen for people with major depressive disorder (MDD). Following this exercise “prescription” could have anti-depressive effects comparable to medication for some patients.

“All treatments for depression are good but not perfect,” Dr. Madhukar Trivedi, one of the authors of the study, says. “There still remains a huge need for novel treatments.” A slew of studies say that exercise could be a good additional option for people already on an antidepressant, who might be feeling better but not completely well.

Trivedi and Dr. Chad Rethorst wanted to take a more rigorous look at that suggestion. They based their conclusions on existing studies of exercise as part of treatment for patients diagnosed with mild to moderate forms of MDD. That is, patients who exhibit the "most devastating dysfunction associated with the disease." That includes difficulty with personal relationships and loss of appetite, as well as high rates of suicide.

“We wanted to make sure we’re not giving a vague recommendation,” Trivedi says. “And we wanted to stay within the range of something that is doable for most people.”

Dr. Amy Farabaugh, director of psychotherapy research at Massachusetts General Hospital, points out that depression can sap a patient’s motivation to exercise. “This is often a huge clinical challenge,” she says. “You need to encourage them to [exercise] despite not wanting to do it.”

So incorporating a specific exercise “prescription” would be the best way to see if it delivers results. Trivedi acknowledged that patients often skip medication or won’t attend psychotherapy sessions regularly, so they wanted to make sure their recommendations wouldn’t be difficult enough to discourage patients from following through.

To come up with specific guidelines for exercise as treatment, Trivedi and Rethorst looked at studies on patients who had been diagnosed with similar forms of MDD based on standard criteria, like the Hamilton Rating Scale for Depression. Those studies reported the effects of various exercise interventions, often compared to the effects of medication or psychotherapy. Trivedi and Rethorst could then see what kinds of exercises were most effective, and whether higher or lower dosages seemed to have an antidepressant effect.

“If you compare the size of the effect for exercise to the effects of other treatments, it’s very comparable,” Trivedi says. While he noted that exercise clearly does not have a superior antidepressant effect over other interventions, “it seems to augment the effects of medication.”

While it may not work for everyone, Trivedi and Rethorst recommend sticking to the plan for at least 10 to 12 weeks to see if it has any effect. And the data they consulted suggests that patients could even see results in as little as four weeks.

Of course, “most individuals will benefit from maintenance treatment,” Farabaugh says. Ongoing exercise is likely to be the most effective form of prevention. “Twelve weeks is a great start, though.” 

In the sidebar are the recommendations Rethorst and Trivedi have laid out. And it should go without saying, but if you or someone you know suffers from MDD and want to look into this, always consult a doctor first.

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