HJAR May/Jun 2020

26 MAY / JUN 2020  I  HEALTHCARE JOURNAL OF ARKANSAS DEPRESSION supports exercise as an evidence-based treat- ment for depression 4 . Accumulating evidence suggests that exer- cise and antidepressant medications may al- leviate depression via common pathways, such as increasing neurotrophic factors (i.e., brain- derived neurotrophic factor or BDNF), decreas- ing inflammatory biomarkers, and increasing levels of serotonin and norepinephrine. These changes can positively influence the develop- ment of new nerve cells, strengthen connec- tions between nerve cells, and improve blood supply to the brain. Certain structures of the brain (e.g., hippocampus, prefrontal cortex) have lower volumes in depressed individuals compared to people who are not depressed; evidence from randomized experiments shows that exercise increases the volume of these particular areas of the brain 5 . The current data support that exercise is equally as effective as antidepressants and psychotherapy for depression. So why is it not recommended by our doctors at the time we are handed a prescription for Paxil? A re- cent paper addressed just this question, argu- ing that there is a discrepancy between the findings of the review articles and the current practice guidelines for depression from the American College of Physicians, which only include antidepressant medications and cog- nitive-behavioral therapy as frontline therapy 6 . The author reflects that perhaps healthcare providers and academics are reluctant to ac- cept exercise as medicine, even while endors- ing other non-pharmaceutical treatments (e.g., psychotherapy). There may be skepticism that modifiable lifestyle factors impact the bio- chemical pathways that our pharmaceuticals are designed to target. If you think or know that you are depressed, it is important to talk to your doctor. They may want to run some basic blood work or other tests to rule out medical conditions that can cause or mimic symptoms of depression, such as thyroid disorders or sleep apnea. Never stop a prescribed medication without speaking to your doctor first. Discussing the risks and ben- efits of starting or stopping a certain therapy is a necessary component of shared decision- making between patients and their providers. Some medications should be weaned off prior to discontinuation. The benefits of exercise on both mental and overall physical health are immense. But increasing our level of physical activity can be time-consuming, and it requires motivation and discipline. What if we all thought of regular physical activity as our medicine, just as valid, useful, and evidence-based as the pills we may pick up from the pharmacy? This simple shift in perspective may help us to make the choice to move our bodies even when we may not want to, so that tomorrow we may feel better, stronger, and more at peace. n SOURCES 1 Hasin ,D.S.et al.Epidemiology ofAdult DSM-5Major Depressive Disorder and Its Specifiers in the United States. JAMA Psychiatry 75, 336–346 (2018). 2 Cooney, G. M. et al. Exercise for depression. Co- chrane Database of Systematic Reviews (2013) doi:10.1002/14651858.CD004366.pub6. 3 Kvam, S., Kleppe, C. L., Nordhus, I. H. & Hovland, A. Exercise as a treatment for depression: Ameta-anal- ysis. Journal ofAffective Disorders 202,67–86 (2016). 4 Schuch, F. B. et al. Exercise as a treatment for de- pression: A meta-analysis adjusting for publication bias. Journal of Psychiatric Research 77,42–51 (2016). 5 Gujral, S.,Aizenstein, H., Reynolds, C. F., Butters, M. A.& Erickson,K.I.Exercise effects on depression: Pos- sible neural mechanisms. General Hospital Psychiatry 49, 2–10 (2017). 6 Netz, Y. Is the Comparison between Exercise and PharmacologicTreatment of Depression in the Clinical Practice Guideline of the American College of Physi- cians Evidence-Based? Front Pharmacol 8, (2017). “What if we all thought of regular physical activity as our medicine, just as valid, useful, and evidence-based as the pills we may pick up from the pharmacy?”