Blog | Tuesday, September 6, 2011

QD: News Every Day--Exercise efficacious as adjunct for major depression

Most patients with major depression require a second medication. A psychiatrist suggests that exercise could fulfill that need, too.

Because most patients with major depression don't fully respond to just one drug, it's common to try a second drug or cognitive behavioral therapy. But the rate of non-response in this group is prompting researchers to look for an intervention that most patients could do and that would add to current therapies.

Moderate and intense levels of daily exercise can work as well as administering a second antidepressant drug, as long as the intensity of the work-out is tailored to the characteristics of patients, including their gender and family history of mental disorders, researchers reported in a press release.

Researchers enrolled people ages 18 to 70 diagnosed with nonpsychotic major depression who were taking a selective serotonin reuptake inhibitor and were treated between two and six months. None of the patients was currently exercising. 126 people were randomized to high-dose (16 kcal per kg per week) or lower-dose (4 kcal per kg per week) exercise regimens for 12 weeks while maintaining the SSRI.

Participants, whose average depression length was seven years, exercised on treadmills, cycle ergometers or both, kept an online diary of frequency and length of sessions, and wore a heart-rate monitor while exercising at home. They also met with a psychiatrist during the study.

The primary outcome was remission, defined as a score of 12 or less on the Inventory of Depressive Symptomatology, Clinician-Rated. Results appeared in the Journal of Clinical Psychiatry.

There were significant improvements for both groups, according to the study. Adjusted remission rates at week 12 were 28.3% in the heavy exercise groups and 15.5% in the light exercise groups, leading to a number needed to treat of 7.8 for heavy vs. light exercise.

By the end of the investigation, almost 30% of patients in both groups achieved full remission from their depression, and another 20% significant displayed improvement, based on standardized psychiatric measurements. Moderate exercise was more effective for women with a family history of mental illness, whereas intense exercise was more effective with women whose families did not have a history of the disease. For men, the higher rate of exercise was more effective regardless.

Authors noted that adherence to the lighter work-out was better, indicating that it may be more tolerable to a wider spectrum of patients. Future research should be designed to include effects among a group of non-exercisers, as well as look at the effects of the exercise on physical health as well as mental health, researchers noted.