Can Exercise be as good as Antidepressants?

How exactly does exercise help with depression?

Most of us have heard that exercise can help with depression, but how exactly? The leading hypothesis is the ‘endorphins hypothesis’ where exercise promotes the release of the body’s own opioid peptides in the brain known as β-endorphin. The consequence - reduced pain and general euphoria (Dinas et al., 2011).

But the question is - what kind of exercise best promotes the release of β-endorphin? Dinas and colleagues (2011) did a study (which you can read here) attempting to answer this question. What they found was that aerobic and resistance exercise together generates stronger antidepressant effects than aerobic and flexibility exercise together. Going even further into this question, they found that dynamic and anaerobic exercise promote even stronger amounts of β-endorphin. I had to look that one up because I had no idea what forms of exercise fall under “dynamic and anaerobic.” Apparently it’s any exercise where muscle movements are repeated quickly to where you’re breathing pretty hard and your heart rate is elevated. This could be High Interval Intensity Training (HIIT), Weight lifting, circuit training, power yoga, pilates, etc.

I’m not suggesting you stop running or biking if you’re already doing that, especially if you enjoy it. Every form of exercise is going to promote the release of β-endorphin to some extent, its just that some forms of exercise increase β-endorphin release more than others. So if you’re biking 5 days a week and you love it, do that! Being outside has its own benefits for mental health that I’ll include in another blog post. You can also easily integrate segments of anaerobic exercise into what you’re already doing like HIIT training intervals while you’re out biking or running.

Comparing antidepressants to exercise

So who wins - antidepressants or exercise? This is where it gets really interesting. When I was digging through the research, there were a few studies that compared different kinds of exercise, placebo, and antidepressants side by side to see which one worked best for treating depression.

The first was done by back in 1999 by Blumenthal and colleagues (you can read it here). They assigned 156 men and women randomly into groups of aerobic exercise, antidepressants (sertraline), or combined exercise and medication. After 4 months of treatment, all three groups did equally well. Hmm, thats interesting. The only difference they found was that the people in the antidepressant group seemed to feel better quicker, but they all ended up feeling about the same after 4 months.

The next study (you can read it here), also done by Blumenthal and colleagues this time in 2007 randomly assigned individuals into groups of supervised exercise, home-based exercise, antidepressants (sertraline), and added a placebo group. They found that 46% of the patients in supervised exercise group, 38% in home-based exercise group, and 44% receiving sertraline totally recovered from their depression after 4 months compared to 26% in the placebo group (Blumenthal et al., 2007).

Finally, a study done by Hoffman and colleagues in 2011 looked at how the patients involved in the last study faired after one year (you can read it here). They found that the more patients exercised the less depressed they felt, until 180 minutes per week of exercise when there wasn’t much more benefit added. So if you’re going to exercise to help with depression, aim for about 3 hours/week total.

That’s cool..but I don’t really feel like working out

When you’re depressed, it makes sense that you don’t want to work out. I think there’s a couple options in this case. First, start on an antidepressant to get some relief so you can start feeling a bit more motivated to exercise. Second, most of the data points out that individuals who engage in exercise led by an instructor do better than those who do it on their own (Dinas et al., 2011). That makes sense, right? If you’re not motivated it definitely helps to have someone guiding you through what to do and how to do it. All you have to do is show up. Maybe a combination of these two options would work even better, who knows?

The science of exercise and its positive effects on depression made such an impression on the scientific community that even Dinas and colleagues (2011) recommended “an exercise science specialist may also need to complement the primary care physicians and mental health specialists in order to successfully tackle depression symptoms and episodes.” 🤯 mind blowing. Now personal trainers are actually recommended to be a part of the treatment team for depression.

Hope you got something from this post! Feel free to email with questions or schedule an appointment for more tips on how to integrate these concepts for your own situation.

References:

Blumenthal, J. A., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P., Waugh, R., Napolitano, M. A., Forman, L. M., Appelbaum, M., Doraiswamy, P. M., & Krishnan, K. R. (1999). Effects of exercise training on older patients with major depression. Archives of internal medicine , 159 (19), 2349–2356. https://doi.org/10.1001/archinte.159.19.2349

Blumenthal, J. A., Babyak, M. A., Doraiswamy, P. M., Watkins, L., Hoffman, B. M., Barbour, K. A., Herman, S., Craighead, W. E., Brosse, A. L., Waugh, R., Hinderliter, A., & Sherwood, A. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic medicine , 69 (7), 587–596. https://doi.org/10.1097/PSY.0b013e318148c19a

Dinas, P.C., Koutedakis, Y. & Flouris, A.D. Effects of exercise and physical activity on depression. Ir J Med Sci 180 , 319–325 (2011). https://doi.org/10.1007/s11845-010-0633-9

Hoffman, B. M., Babyak, M. A., Craighead, W. E., Sherwood, A., Doraiswamy, P. M., Coons, M. J., & Blumenthal, J. A. (2011). Exercise and pharmacotherapy in patients with major depression: one-year follow-up of the SMILE study. Psychosomatic medicine , 73 (2), 127–133. https://doi.org/10.1097/PSY.0b013e31820433a5