Exercise and antidepressants may be the most effective combo for treating depression

The researchers, who reviewed data from more than 200 studies, found that the more vigorous the activity is done, the better, but low intensity exercise also is beneficial. 

Reality of depression

About 300 million people worldwide have depression, according to the World Health Organization. Feeling worthless, helpless, and overall emptiness are common symptoms. Depression can also exacerbate other health conditions, and mortality from things like diabetes, heart disease, and cancer is up to 50% more likely if coupled with depression. Though psychotherapy and drug treatments often help ease or limit depressive episodes, they aren’t always accessible—either financially or in proximity. 

This study’s purpose was to uncover whether pairing exercise with the aforementioned treatments or using exercise as the sole treatment can benefit those with depression, and researchers set out to uncover what exact exercises and in what “doses” could do this best.

How the study was done

The data consisted of randomized controlled trials that included 14,170 participants across multiple countries, who were either clinically diagnosed or self-reported as depressed, and exercise as treatment for their depression.

Researchers quantified the effects against established treatments (like selective serotonin reuptake inhibitors (SSRIs) or cognitive behavioral therapy), active control conditions (like social support or placebo tablets), and utilized a waitlist control group, who are participants that don’t immediately take part in a study, but will eventually. They are used to look at an untreated control group in an experiment or study and serve as a benchmark.

Things like exercise frequency, intensity, type, and time were recorded. Age, sex, the presence of other conditions, and the severity of depression were also factored in.

The study measured the impact on mental health of the participants who did the following:

• dance
• cycling
• mixed aerobic exercises
• aerobic exercise and strength
• aerobic exercise and therapy
• tai chi or qigong
• walking or jogging
• physical activity counseling
• relaxation
• exercise and took SSRIs
• strength-training
• yoga
• cognitive behavioral therapy
• SSRIs alone

Which exercises help best?

“Compared with active controls, large reductions in depression were found for dance and moderate reductions for walking or jogging, yoga, strength training, mixed aerobic exercises and tai chi or qigong,” says The BMJ in a press release about the study.

The study also states that overall a greater intensity was more effective, but even low intensity exercises like walking and yoga were beneficial. 

Strength training was more effective for women, with yoga or qigong being more effective for men. Younger people found strength training more effective, versus older people seeing yoga to be more impactful.

Group exercise was generally not more effective than individual exercise aside from yoga. The combination of strength training and aerobic exercises, as well as strength training alone, were more effective for individuals than groups. 

How exercise compares to antidepressants

Arguably the most interesting finding, though, is that the effect of exercise on depressed people appeared superior to antidepressants. Yet, when combined, the effect of the drugs improved.

“Our findings support the inclusion of exercise as part of clinical practice guidelines for depression, particularly vigorous intensity exercise,” the researchers say. “Health systems may want to provide these treatments as alternatives or adjuvants to other established interventions, while also attenuating risks to physical health associated with depression.”

“Primary care clinicians can now recommend exercise, psychotherapy, or antidepressants as standalone alternatives for adults with mild or moderate depression,” adds Juan Ángel Bellón, professor at the University of Malaga Department of Public Health and Psychiatry, Faculty of Medicine.

Exercising may be the last thing on a depressed person’s mind, though. Bellón says studies are needed to evaluate physical activity programs for people with depression. He urges local and national administrations to “provide enough resources to make individualized and supervised exercise programs ‘accessible’ to the entire population,” in every sense of the word.

It’s important to do what makes the most sense for you, and if you are experiencing depressive episodes or have other mental health concerns, consult a mental health professional.