When was the last time you recommended exercise to one of your depressed patients?
Too often, we tend to be too selective with our patients, choosing to talk up the drugs, and choosing not to talk about the other things that can help.
It’s a problem not confined to clinicians: 2014 seems to be the Year of the Obscure Depression Treatment. The American Journal of Psychiatry has published papers on ketamine and NSAIDs. The New York Times ran an op ed suggesting that mushrooms may be the future of treatment (citing the British Journal of Psychiatry, no less).
And with such attention-grabbing remedies, exercise seems so much less dazzling.
Exercise? I doubt I mentioned it once to a patient during my 5-year residency. I was too busy feverishly talking about pills.
But more and more evidence supports exercise for its antidepressant qualities. That’s not to suggest that I’ve ever stopped talking about (and prescribing) medications. It’s a recognition, though, that there is more to our field than a prescription pad.
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In picking a Reading of the Week, I look for clearly written papers — papers that are easy to understand and concise in their message. And a crisp graph or two doesn’t hurt.
This Reading breaks all the rules. The paper is dense; there are so many numbers; the tables may be more confusing than the paper itself; and, unfortunately, there are no pretty graphs.
But it’s worth the read.
Pereira et al. report: “At most ages, we found a trend of fewer depressive symptoms with more frequent activity; for example, per higher frequency of activity per week at 50 years of age, the mean number of symptoms was lower by 0.06 (95% CI, -0.09 to -0.04).”
That sentence (and the incredible evidence in this paper that backs that sentence) should give us all pause to think about how we interact with our patients, and the advice we give them.
- The study authors analyzed data from the 1958 British Birth Cohort, considering depressive symptoms and physical activity at different ages (23, 33, 42 and 50). The data set includes 11,000 people. (!)
- Overall, the study finds that at most ages, increased physical activity is matched by lower depressive symptoms.
- Better still: when people went from inactive to active (3 times per week), it “predicted fewer depressive symptoms.”
Papers considering depression and exercise aren’t exactly new; a quick PubMed search of these two terms yields over 11,000 hits, including some in very prestigious journals. There’s even a recently written Cochrane Review on this topic.
For the record, JAMA (in another article) summarizes the Cochrane Review lit review with this graph:
(Many papers, one common theme: exercise helps reduce depressive symptoms.)
Pereira et al.’s JAMA Psychiatry paper goes much further. It doesn’t just show that exercise can help with a depressive episode, it shows that exercise has preventative qualities. What further sets this JAMA Psychiatry paper apart from so many others? The long span of study coupled with the flushing out of depressive symptoms. It’s an impressive paper.
Note the authors: “Our findings emphasize the potential importance of activity to prevent and alleviate depressive symptoms in adulthood and, in turn, depressive symptoms before midlife could be a barrier to activity.”
Of course, this doesn’t quite answer the basic questions of clinicians like you and me: what exercise should we recommend and at what intensity? The study speaks to neither question. And we can ponder a deeper question: why is exercise so useful? A new paper in Cell may provide a clue, suggesting that in mice PGC-1alpha1 levels (an enzyme produced in mice and human exercise) may be connected to clearing kynurenine (a substrate produced by stress and linked to inflammation and possibly depression).
Frustrated by the Pereira et al. paper? Well, the Mental Elf (a website dedicated to reviewing recent psychiatric literature) does offer a concise explanation here:
Interested in reading more about exercise and depression? The New York Times provides a nice summary on the Cell paper here:
Reading of the Week. Every week I pick a reading — often an article or a paper — from the world of Psychiatry.