HJAR May/Jun 2020

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2020 25 impacts on your life due to low mood. In many cases, you will also be asked if you have inter- est in pursuing psychotherapy (i.e., meeting with a therapist or counselor). The recommendations you receive for man- aging your depression will likely stop there, and understandably so. The American College of Physicians practice guidelines recommend that physicians and patients should choose between cognitive behavior therapy (a type of psychotherapy) and antidepressants for initial treatment of major depressive disorder. However, there is sufficient data to show that exercise is just as effective as antidepres- sants and psychotherapy. This is particularly important for patients who have considerable side effects with antidepressants, wish to avoid taking a daily medication, or simply prefer a more natural approach to improving mood and function. Side effects of SSRIs are com- mon, and can include weight gain, gastrointes- tinal upset, sexual dysfunction, insomnia, dry mouth, withdrawal symptoms when discontinu- ing the medication, and more. The side effects of exercise, on the other hand, are welcomed: improved metabolism, cardiovascular health, bone health, longevity, and the list goes on. In a 2013 Cochrane review that examined the impact of exercise on depression, seven randomized controlled trials (RCTs) compared exercise with psychotherapy; no significant difference between the effects of these two treatments were found. Four RCTs compared exercise with antidepressants, and again there were no significant differences in the measured outcomes. Based on 37 RCTs, the authors stat- ed that exercise appears to have a moderate clinical effect on depression; due to bias (e.g., inability to blind participants to exercise inter- ventions), they acknowledged that the effect of exercise may be small 2 . A later meta-analysis expanded upon the above findings by including more recent tri- als published since the time of the Cochrane review. Authors also limited the studies to those involving participants with a clinical diag- nosis of major depressive disorder. The analy- sis of 23 randomized controlled trials showed that exercise has a moderate to large impact on major depression. Exercise significantly im- proved depression compared to no interven- tion, and the impacts of exercise on depression did not significantly differ from those of anti- depressants and cognitive behavioral therapy. The authors concluded that exercise can be recommended as a stand-alone or adjunctive therapy for depression 3 . Another meta-analysis further refined the efficacy of exercise on depression, while ad- justing for publication bias. The authors found that exercise has a large and significant anti- depressant effect in people with depression, and previous meta-analyses (e.g., the 2013 Cochrane review) underestimated the impact of exercise on depression due to publication bias. The authors state that their data strongly “There is sufficient data to show that exercise is just as effective as antidepressants and psychotherapy. This is particularly important for patients who have considerable side effects with antidepressants, wish to avoid taking a daily medication, or simply prefer a more natural approach to improving mood and function.”