Exercise and Depression

As the weather turns cold and we are forced indoors, I more often find myself having the occasional case of the winter “blues.” That feeling you get when you aren’t outside getting all the benefits of the outdoor activities not to mention the warm sunshine (and the Vitamin D that comes with it)!  I also love running outdoors and while I have the cold weather gear and have used it, recent low temperatures and ice have made it hard to get out consistently.  I have found in my own personal experience that exercise helps minimize the frequency and intensity of these moods and for even more extreme cases, exercise can be a highly effective approach to managing mild to moderate depression and we are gathering more and more of the medical proof to back it up!  You have probably heard that exercise releases endorphins giving those who are physically active a natural “high”.  This is medically significant!

Endorphins are chemicals produced in the brain, which bind to neuro-receptors to give relief from pain. Discovered in 1975, endorphins are believed to: relieve pain; enhance the immune system; reduce stress; and delay the aging process. Exercise stimulates the release of endorphins, sending these chemicals throughout the body. Endorphin release varies from person to person; some people will feel an endorphin rush, or second wind, after jogging for 10 minutes. Others will jog for half an hour before their second wind kicks in. You don't have to exercise vigorously to stimulate endorphin release: meditation, acupuncture, massage therapy, even eating spicy food or breathing deeply - these all cause your body to produce endorphins naturally.
Beyond the release of endorphins, common wisdom holds that exercise boosts your mood in other ways while adding the obvious benefits your physical health.  If you are a person who exercises regularly, or if you know someone who does, you will likely be aware of this bonus that comes along with vigorous physical activity.
In the last couple decades, there has been some interest in looking at the mental health value of exercise. Until recently, however, studies investigating the effectiveness of exercise in the treatment of mental health have not been conducted with the same level of scientific rigor as the clinical trials used to bring anti-depressant medications to the market. Limitations of previous studies have included the absence of a control group, individuals not being randomly assigned to study groups, and testing the effects of exercise on individuals who were not suffering from a mood disorder.
But a recent placebo-controlled study conducted by James Blumenthal, professor of psychology at Duke University and published in the September issue of the journal Psychosomatic Medicine compared exercise to a common antidepressant medication in a group of individuals diagnosed with major depressive disorder, and found that exercise was as effective as the drug at alleviating symptoms of the disorder. In this study, 202 depressed adults were randomly assigned to one of four groups: one that received the antidepressant sertraline, one that worked out in a supervised group setting three times a week, one that worked out at home, or one that received a placebo pill. Sixteen weeks later, 47% of the group that took the antidepressant, 45% of the supervised exercise group, and 40% of those that exercised at home no longer met the criteria for major depression based on a standard measure of depression symptoms. Although the percent of improvement in the group that exercised on their own was less than that of those that exercised in a supervised group, and the percent improvement in the supervised exercise group was slightly less than that of the group that took the antidepressant, the differences between these three groups were not statistically significant. All groups improved a statistically significant amount over the placebo group, 31% of which no longer met the criteria for depression at the end of the study. This study provides powerful evidence that exercise may be a viable alternative to antidepressant medication and/or psychotherapy in the treatment of major depressive disorder.
Other studies have found that the benefits of physical activity can be realized in individuals who are not depressed, but who feel, as is common in our fast-paced culture, that they are mentally worn out and need more energy. Even seasonally induced “blues” like I mentioned earlier such as S.A.D. or Seasonal Affective Disorder can be more easily managed and prevented with exercise.  In his book, “Calm Energy: How People Regulate Mood with Food and Exercise” Dr. Robert E. Thayer describes how exercise can be used as a personal mood-regulator, and cites one of his studies in which it was found that as little as ten minutes of brisk walking raised the mood and increased the energy levels of the subjects in the experiment for up to 2 hours after the walk.
More research is needed to replicate these types of studies and further define the mental health benefits of exercise. Questions  yet to be answered include what types of exercise (e.g., cardiovascular or weight training), what level of intensity and duration, and what frequency of exercising will produce the most benefits. Additionally, gender or age differences may need to be taken into account when structuring an exercise program aimed at boosting mood.
With this much potential for positive mental health benefits, and with the most likely side effect being better physical health and possible weight loss, it is easy to imagine that if exercise were a marketable drug, it would be at the top of the drug companies’ lists of products to promote. If more research emerges that clarifies and confirms the potential of exercise in the treatment of disorders such as depression, we may soon hear doctors say, “Run two miles and call me in the morning” to their patients who complain of feeling down.  Until then, go run the two miles anyway…  you’ll be feeling good for hours afterwards and doing your mind and body good! 
Sources:
Psychosomatic Medicine, September 2007;
Calm Energy: How People Regulate Mood with Food and Exercise. Robert E. Thayer, Ph.D., Oxford University Press, 2001.
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