Posted on Oct 10, 2023, 3 p.m.
In the first peer-reviewed experimental trial with humans to directly compare the effects of treatments on both mental and physical health, exercise was demonstrated to have clear benefits, but antidepressants caused slight physical worsening.
Professor Brenda Penninx, of Vrije University presented this study at the ECNP conference in Barcelona after publishing the work in the Journal of Affective Disorders (1).
“We wanted to compare how exercise or antidepressants affect your general health, not just your mental health," said Professor Penninx.
This study involved 141 patients with depression and/or anxiety who were offered a choice of treatments: group-based running therapy for 16 weeks or SSRI antidepressants for 16 weeks. 96 participants chose the group-based running therapy and 45 opted for the medication. According to the researchers, those in the group that chose the antidepressant were observed to be slightly more depressed than those in the group that opted for exercise.
“This study gave anxious and depressed people a real-life choice, medication or exercise. Interestingly, the majority opted for exercise, which led to the numbers in the running group being larger than in the medication group,’ said Professor Penninx.
Those who chose medication had to adhere to their prescribed antidepressant treatment dosage, but it generally did not have any direct impact on their daily behaviors. Whereas those in the exercise group were directly addressing the sedentary lifestyle that is most often found in those with depressive and anxiety disorders as running therapy encourages people to go outside and set personal goals while improving their fitness and participating in group activities.
Those in the medication group took SSRI Escitalopram antidepressants for 16 weeks, while those in the exercise group aimed for 2-3 closely supervised 45-minute group sessions per week for 16 weeks. Those in the antidepressant group had a higher rate of adherence with 82% sticking to the protocol, and only 52% of those in the running therapy group adhered to the protocol despite the initial preference for exercise over medication.
At the end of the 16 weeks, close to 44% of both groups showed an improvement in depression and anxiety. But those in the running group also experienced improvements in their weight, waist circumference, blood pressure, and heart function, while those in the antidepressant group showed a tendency towards a slight decline in these metabolic markers.
“Both interventions helped with the depression to around the same extent. Antidepressants generally had worse impact on body weight, heart rate variability and blood pressure, whereas running therapy led to improved effect on general fitness and heart rate for instance. We are currently looking in more detail for effects on biological aging and processes of inflammation,” said Professor Penninx. “It is important to say that there is room for both therapies in care for depression. The study shows that lots of people like the idea of exercising, but it can be difficult to carry this through, even though the benefits are significant. We found that most people are compliant in taking antidepressants, whereas around half of the running group adhered to the two-times-a-week exercise therapy. Telling patients to go run is not enough. Changing physical activity behaviour will require adequate supervision and encouragement as we did by implementing exercise therapy in a mental health care institution.”
“Antidepressants are generally safe and effective. They work for most people. We know that not treating depression at all leads to worse outcomes; so antidepressants are generally a good choice. Nevertheless, we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them. Our results suggest that implementing exercise therapy is something we should take much more seriously, as it could be a good – and maybe even better – choice for some of our patients.,” adds Professor Penninx.
“In addition, let’s also face potential side effects our treatments can have. Doctors should be aware of the dysregulation in nervous system activity that certain antidepressants can cause, especially in patients who already have heart problems. This also provides an argument to seriously consider tapering and discontinuing antidepressants when depressed or anxious episodes have remitted. In the end, patients are only truly helped when we are improving their mental health without unnecessarily worsening their physical health”.
This article was adapted from a commentary recently published in the journal European Neuropsychopharmacology (2).
As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before changing your wellness routine. This article is not intended to provide a medical diagnosis, recommendation, treatment, or endorsement.
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References/Sources/Materials provided by:
- Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders, Josine E. Verhoeven et al Journal of Affective Disorders 329 (2023) 19–29
- Awareness of cardiac autonomic dysregulation by antidepressants, Brenda WJH Penninx, European Neuropsychopharmacology (in press)