Treating depression can be complicated and financially draining.
Seeing a psychologist can leave a big hole in your wallet, and anti-depressants can have such debilitating withdrawal symptoms that some people have to take them indefinitely.
But what if there was one more treatment option you could consider?
There is; it’s exercise. And a new study suggests it can actually be more beneficial than antidepressant medication alone.
But the type you do, and how you do it, matters.
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Australian researchers recently completed a major review of 200 randomised trials on exercising to treat depression. It meant analysing over 14,000 people with clinical depression, which is characterised by at least two weeks of feeling low.
After concluding exercise was an effective treatment, they went further and compared specific types of exercise.
So let’s unpack what they found.
And just quickly, before we do that, it’s important to note anti-depressants and cognitive behavioural therapy are effective for some people and anyone changing their treatment plan should talk to their doctor.
Walking or jogging, yoga and strength training are about as effective as cognitive behavioural therapy and more effective than anti-depressant medication alone.
But we can narrow it down further.
The review found yoga and qigong (a Chinese system of physical exercises and breathing control) are likely to be more effective for men, and strength training is best for women.
Yoga is somewhat more effective for older adults and strength training can lead to greater improvements among younger patients.
Dance is also great at lowering depressive symptoms.
“I think that’s because it has that social interaction, vigorous exercise, uplifting music and so it seems a really promising avenue for research,” says Michael Noetel, lead researcher and senior psychology lecturer at the University of Queensland.
However, most studies on dance are on young women so Dr Noetel says there needs to be more varied research before it’s recommended more widely.
Interestingly, the review found stretching to be the least helpful type of exercise for treating depression.
The Australian guidelines suggest supervised group exercise for 30 to 40 minutes three times a week for a minimum of nine weeks.
But this new review found it didn’t matter how many minutes or sessions of exercise people did per week (as long as they did some).
The effect of exercise was also the same whether you had mild or severe depression.
However, the intensity of the activity does matter; so the more vigorous, the better.
The benefits are also greater if you participate in exercise with other people as opposed to going at it alone.
There’s no point trying to pursue yoga or weight training if you really hate it.
In fact, pushing yourself to do something you get no sense of satisfaction from can actually have a negative effect, says Rhiannon White, senior lecturer at the University of Western Sydney, who was not involved in the review.
She’s been studying the link between physical activity and mental health for 10 years and says it can be unhelpful to be overly prescriptive about what exercise people with depression should do.
“If we say ‘this is the best type’ and someone doesn’t feel competent doing it or can’t access that activity due to cost then exercise doesn’t feel like an option to them,” Dr White says.
“It’s good to know what types are more beneficial but then we need to guide people to find the one that gives them the biggest sense of accomplishment … that might not be resistance training, it might be a walk to the park with their dog or a friend.”
Context matters, she says, and even the time of day you exercise can alter the mental health benefits you receive.
Experts believe there are a few reasons.
When someone is depressed they can get stuck in a cycle of isolation — they withdraw socially and then find it hard to re-integrate — but exercising with others can break that cycle.
Depression can also make you feel hopeless, making it difficult to get out of bed and do the things that are important to you. This can create a loop of guilt, but exercise can break this by providing a sense of accomplishment, Dr Noetel says.
That’s why resistance training can be so effective as it’s based on the number of repetitions and it’s easy to set small goals and see progress.
There’s also a lot to be said for novel experiences. If you are learning something new, there’s a greater sense of satisfaction when you master it.
Dr Noetel suggests this could be the reason why yoga is more effective for men.
“If I think of my dad, he would not have done a downward dog in his whole lifetime … so it’s about learning something new, it’s the cognitive aspect.”
On top of that, when we exercise we get a surge of neurotransmitters like dopamine (ever had runners high?) which could be why more vigorous exercise has stronger effects.
Those experiencing depression might meet the criteria for a chronic disease management (CDM) plan, which could get them up to five subsidised sessions under Medicare with an exercise physiologist.
Accredited exercise physiologists often design programs for people with anxiety, depression and post-traumatic stress disorder.
“They could support you as you start exercising and although five appointments isn’t a lot, it’s a start and starting is often the biggest hurdle,” Dr Noetel says.
CDM plans can be arranged by a GP but Dr Noetel says not many doctors use them to refer people to exercise physiologists, perhaps because the field is relatively new.
Dr White says unfortunately many GPs don’t go further than giving their patient a nudge to get moving, which isn’t much help.
Both experts say it’s important exercise isn’t considered an “add-on” treatment and research shows patients do a lot better when they are given a structured exercise program, rather than just encouragement.
Depression is often characterised by days where leaving the house is an impossibility, so getting to a gym or a group class won’t be realistic.
Dr White says this is why it might be more helpful to have a support person, like a family member or friend, who can be on standby to come around and accompany you on a walk around the block on bad days.
She says online exercise videos might be preferable when symptoms are worse, as they can be done at home.
“It might not be the best exercise you’ll ever do but it’s the small steps that build a bit of confidence.”
She suggests keeping in mind three factors that determine whether we feel motivated to exercise:
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