Can exercise work as well as drugs for depression?

A recent NIH blog on antidepressants and weight gain struck me for what it didn't say. “Weight gain is one of the most common side effects of antidepressants,” states the NIH Research Matters blog. Nothing new there. However, if your doctor told you, "take this pill and you’ll likely gain weight" wouldn’t you be more disinclined to start with that medication?

Not being informed regarding the weight gain side effect of antidepressants is frustrating enough, but medical professionals also often fail to inform patients that exercise performs at least as well as antidepressants in treating (non-major) depression. Furthermore the efficacy of antidepressants is short-lived (averaging just a couple of months for the 50% of patients that respond at all). Meanwhile the vast majority of people stay on those meds indefinitely (wondering why they aren't feeling better) while having gained 10, 20, or even more pounds on the scale.

Part of the problem is that over time medical professionals develop a strong expectation of non-compliance regarding the likelihood of their patients actually making lifestyle changes. Then (partly because medical professionals are always short on time) they get in the habit of skipping straight to a pill. Of course there are also patients that come in specifically to ask for medications and some doctors may feel that if they don't prescribe it the patient will just find another doctor who will. Either way, the patient isn't provided with all the information they need.

So the physical activity option, which costs nothing and only has positive side effects, isn't discussed. That's too bad since most people will agree that they feel better both physically and emotionally when they exercise.

Here's the summary of a comprehensive review study on exercise and depression:

"... exercise appears to be an effective treatment for depression, improving depressive symptoms to a comparable extent as pharmacotherapy and psychotherapy. Observational studies suggest that active people are less likely to be depressed, and interventional studies suggest that exercise is beneficial in reducing depression. It appears that even modest levels of exercise are associated with improvements in depression, and while most studies to date have focused on aerobic exercise, several studies also have found evidence that resistance training also may be effective. While the optimal “dose” of exercise is unknown, clearly any exercise is better than no exercise. Getting patients to initiate exercise ---and sustain it – is critical."(1)

You can avoid antidepressants, and their associated weight-gain, by developing an activity plan that fits your life.

The good news is that there is no right or wrong way to do this. Personally I’m a huge fan of walking, no special equipment, or membership, necessary and you can do it anywhere. Outside activities also have the added benefit of full spectrum light, nature, and fresh air.

The NIH National Institute of Diabetes and Digestive and Kidney Diseases has a good check-list for getting started with regular walking, see: How do I start?

The bottom line is that while we wish there were, there simply are no magic pills, and physical activity remains the best prescription in the medicine chest for much of what ails us.

All the best!
-Dorene

References:

1. Is Exercise a viable treatment for depression? ACSM Health Fit J 2012;16(4):14-21.
2. Pharmacological management of obesity: an Endocrine Society clinical practice guideline.
   J Clin Endocrinol Metab 2015 Feb;100(2):342-62.

Weight Loss Plateaus: How to reignite your weight loss

A common development after a few weeks of losing weight is that your weight loss stalls, or stops. The scale isn’t budging. This situation—a weight loss plateau—has all kinds of mythology attributed to it.

When you start a diet, you reduce your intake of calories and a big part of that reduction is from carbohydrates. The reduction in carbohydrates leads to the depletion of glycogen (how your body stores sugar) from both your muscles and liver. Each gram of stored glycogen normally holds 3- to 4-grams of water with it.^[i],[ii]

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We know cake isn't diet food--but 1,600 calories in a slice!?!

Aside from burning off more calories through physical activity, the only other control you have over calories lies in the food you eat and the beverages you drink.  

Amazingly, most of the thousands of books and programs on weight loss do a very good job of avoiding teaching you anything useful about calories. Most don’t address the subject at all. Worse yet, some tell you that calories don’t matter… that some special combination of foods, nutrients, etc., is the secret to weight loss. Understanding the calories in food however, is fundamental to weight management.

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No “magic formula” here, right?

There are “Masters of Weight Control” who have lost an average of 25% of their body weight and kept it off for an average of 5 years. Data collected on these “successful losers,” was among the first to become broadly recognized for illuminating methods and techniques associated with successful maintenance of significant weight loss. The “Weight-Loss-Mastery-Skills” drawn from this and other data are:

1. Physical activity
2. Food & calories
3. Record keeping
4. Stimulus control
5. Support

No “magic formula” here, right? Right. Nothing sexy, and nothing that gets authors to the top of the “Best Sellers List!” It’s just, roll up your sleeves and get-on-with-it common sense.