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Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder
Abstract
To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls.
Between October 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50-200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D).
After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of <8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise = 45%; home-based exercise = 40%; medication = 47%; placebo = 31% (p = .057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p = .23).
The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, ongoing symptom monitoring, attention, and other nonspecific factors.
... Resistance exercise (REx) involves activities that require sustained or intermittent exertion of forces against resistance with the intention of improving musculoskeletal function and enhancing muscular strength or endurance [16]. Both, AEx training and REx training have demonstrated antidepressant effects [20][21][22][23] and improve cardiometabolic [24,25] and brain health [26,27] yet remain underutilized in the clinical management of depression. ...
... Among the 27 studies that utilized an AEx-only intervention arm(s), thirteen (48%) sufficiently reported all FITT criteria that would enable replication of the intervention [23,50,51,53,54,56,58,60,61,63,67,69,73], and only eleven (40%) met public health recommendations for PA [21,23,50,51,56,58,60,61,65,67,72]. Of these 27 studies, 22 (81.5%) reported a positive anti-depressant effect in the AEx arm [21, 23, 50, 52-54, 56-62, 65, 67, 69-73, 75-77]. ...
... Among the 27 studies that utilized an AEx-only intervention arm(s), thirteen (48%) sufficiently reported all FITT criteria that would enable replication of the intervention [23,50,51,53,54,56,58,60,61,63,67,69,73], and only eleven (40%) met public health recommendations for PA [21,23,50,51,56,58,60,61,65,67,72]. Of these 27 studies, 22 (81.5%) reported a positive anti-depressant effect in the AEx arm [21, 23, 50, 52-54, 56-62, 65, 67, 69-73, 75-77]. ...
Globally, depression is a leading cause of disability and has remained so for decades. Antidepressant medications have suboptimal outcomes and are too frequently associated with side effects, highlighting the need for alternative treatment options. Although primarily known for its robust physical health benefits, exercise is increasingly recognized for its mental health and antidepressant benefits. Empirical evidence indicates that exercise is effective in treating individuals with depression; however, the mechanisms by which exercise exerts anti-depressant effects are not fully understood. Acute bouts of exercise have been shown to transiently modulate circulating levels of serotonin and norepinephrine, brain-derived neurotrophic factor, and a variety of immuno-inflammatory mechanisms in clinical cohorts with depression. However, exercise training has not been demonstrated to consistently modulate such mechanisms, and evidence linking these putative mechanisms and reductions in depression is lacking. The complexity of the biological underpinnings of depression coupled with the intricate molecular cascade induced by exercise are significant obstacles in the attempt to disentangle exercise's effects on depression. Notwithstanding our limited understanding of these effects, clinical evidence uniformly argues for the use of exercise to treat depression. Regrettably, exercise remains underutilized despite being an accessible, low-cost alternative/adjunctive intervention that can simultaneously reduce depression and improve overall health. To address the gaps in our understanding of the clinical and molecular effects of exercise on depression, we propose a model that leverages systems biology and multidisciplinary team science with a large-scale public health investment. Until the science matches the scale of complexity and burden posed by depression, our ability to advance knowledge and treatment will continue to be plagued by fragmented, irreproducible mechanistic findings and no guidelines for standards of care.
... The validity and reliability of the Chinese version of the MEQ-5 used in this study have been validated [18]. The circadian rhythms of the testers were classified as absolute night type (4-7), moderate night type (8)(9)(10)(11), intermediate type (12)(13)(14)(15)(16)(17), moderate early morning type (18)(19)(20)(21), and absolute early morning type (22)(23)(24)(25) by summing up the scores of five questions. ...
... Compared to past research: past studies have shown that exercise and physical activity can have beneficial effects on depression, even comparable to the effects of medication [21,22]. Exercise interventions in hospitalized adolescent depressed patients were found to reduce depressive symptoms, but no beneficial effects were found in anxiety [23]. ...
Purpose:
Since the prolonged sequestration management that was implemented in order to achieve lower infection and mortality rates, there has been a surge in depression worldwide. The correlation between the physical activity level and the detection rate of a depressed mood in college students should be of wide concern. A large number of studies have focused on the association between physical activity levels and a negative mood, but circadian rhythm differences seem to be strongly associated with both physical activity levels and mental illness. Therefore, this paper will examine the correlation between physical activity levels, circadian rhythm differences, and mental health levels in college students.
Methods:
Data were collected through a web-based cross-sectional survey. In June and December 2022, questionnaires were administered to college students from three universities in Anhui, China. In addition to socio-demographic information, measures included the International Physical Activity Questionnaire-Short Form (IPAQ-SF), Morning and Evening Questionnaire-5 Items (MEQ-5), and Symptom Check List90 (SCL-90) scales. Correlation analysis was used to understand the relationship between physical activity and circadian rhythm differences in the three aspects of college student's mental health.
Results:
The analysis of the data led to the conclusion that 28.4% of the 1241 college students in this survey had psychological disorders. The physical activity level of male students was higher than that of female students, but the risk of having depressive tendencies was higher in female students than in male students. There was a significant negative correlation between the physical activity level and scl-90 scores (p < 0.01), which indicates that higher physical activity levels are associated with higher mental health. Circadian rhythm differences and scl-90 scores were significantly positively correlated among college students (p < 0.01), and night-type people had a higher risk of mental illness than intermediate-type and early-morning-type people.
Conclusions:
During the period of closed administration due to COVID-19, school college students experienced large and high levels of negative emotional phenomena due to reduced physical activity and public health emergencies. This study showed significant correlations between both physical activity levels and circadian rhythmicity differences and the degree of mental health of college students.
... Furthermore, the efficiency of an exercise intervention on reducing depressive symptoms could differ according to the modalities through which it is delivered. Interventions delivered in groups and supervised by an instructor showed greater effect in reducing depression than solitary, unsupervised activity [28,112,113]. Clinicians' advice and follow-up are very important to improve compliance and maintain adherence over time. The follow-up can be done through consultation, telephone calls [114], or telemedicine and/or eHealth strategies to increase compliance with exercise programs [115]. ...
... Therefore, clinicians should be aware of the interplay between symptoms and treatment side effects. Potential mitigating strategies have to include actions to promote health literacy, notably by reminding their patients that physical activity and exercise can both improve depressive symptoms, increase energy levels, and combat fatigue in general [112]. By giving greater emphasis to the importance of exercise in a patient's quality of life, and outlining both the physical and mental benefits they can get from regularly engaging in a prescribed exercise regimen, clinicians can support the development of the patient's health literacy. ...
Depression is a major public health issue in numerous countries, with around 300 million people worldwide suffering from it. Typically, depressed patients are treated with antidepressants or psychological therapy or a combination of both. However, there are some limitations associated with these therapies and as a result, over the past decades a number of alternative or complementary therapies have been developed. Exercise is one such option that is supported by published extensive basic and clinical research data. The aim of this review was to examine the beneficial effects of exercise in depression. Physical activity and exercise have been shown to be effective in treating mild-to-moderate depression and in reducing mortality and symptoms of major depression. However, physical activity and exercise are still underused in clinical practice. This review attempts to propose a framework to help clinicians in their decision-making process, how to incorporate physical activity in their toolkit of potential therapeutic responses for depressed patients. We first summarize the interactions between depression and physical activities, with a particular focus on the potential antidepressant physiological effects of physical activity. We then identify some of the barriers blocking physical activity from being used to fight depression. Finally, we present several perspectives and ideas that can help in optimizing mitigation strategies to challenge these barriers, including actions on physical activity representations, ways to increase the accessibility of physical activity, and the potential of technology to help both clinicians and patients.
... Our study was based on four main premises: (a) BDNF polymorphism regulates the expression of BDNF protein [24], and high levels of BDNF are supposed to have a protective effect against neurodegeneration in the brain [61,62]; (b) physical activity temporarily increases BDNF expression and improves mood [63,64]; (c) early stress leads to neurological adaptations that increase the risk of depression, and BDNF polymorphism apparently moderates the occurrence of depressive symptoms in adults who have had adverse experiences in childhood [34,65,66]; and (d) the differences in effects appear to be associated with specific periods in life [23,67]. ...
... However, frequent physical activity prevents the negative consequence of depressive symptoms [63]. Additionally, the same positive effect of the reduction in depressive symptoms was found in BDNF rs6265 GA carriers. ...
Depression affects one in five persons at 18 years of age. Allele A of the brain-derived neurotrophic factor (BDNF) rs6265 is considered to be a risk factor for depression. Previous studies of the interaction between BDNF rs6265, early adversity, and/or physical activity have shown mixed results. In this study, we explored the relation between BDNF rs6265 polymorphism and childhood stress, as well as the moderating effect of physical activity in relation to depressive symptoms using binary logistic regressions and process models 1, 2 and 3 applied to data obtained at three times (waves 1, 2 and 3) from the Survey of Adolescent Life in Västmanland cohort study (SALVe). Results revealed that both childhood stress and physical activity had a moderation effect; physical activity in wave 1 with an R2 change = 0.006, p = 0.013, and the Johnson–Neyman regions of significance (RoS) below 1.259, p = 0.05 for 11.97%; childhood stress in wave 2 with the R2 change = 0.008, p = 0 002, and RoS below 1.561 with 26.71% and >4.515 with 18.20%; and a three-way interaction in wave 1 in genotype AA carriers. These results suggest that allele A is susceptible to physical activity (positive environment) and childhood stress (negative environment).
... Furthermore, the combined effect of VD supplements with PA helps chronic kidney disease (CKD) patients to improve muscle strength [37]. Other observations have included a positive linear association of PA with 25(OH)D levels in White subjects, with favorable synergistic effects on atherosclerotic cardiovascular disease in White and Black subjects [38], relief of depressive symptoms [39], and overall better quality of life [40]. ...
The relation between knowledge and awareness of vitamin D (VD) and physical activity in adults has not been well studied. The present cross-sectional study aims to demonstrate this relation among adults living in Saudi Arabia. A total of 774 adults participated and were stratified based on self-reports of whether they were physically active (PA group, N = 562) or not (non-PA, N = 212). The prevalence of VD awareness and its health effects were significantly higher in the PA group compared with their counterparts (97 vs. 93.4%; p = 0.02 and 92.3 vs. 81.6%; p < 0.001, respectively). Sunlight was the preferred overall source of VD among the PA group (91.1%) followed by food, supplements, and fortified foods. Sardine, salmon, oily fish (63.7%) and eggs (54.6%) were reported as good dietary sources. Other positive attitudes, represented by taking supplement or multivitamins (51.2%), high sun exposure (33.1%), and daily duration of exposure to sunlight (15–30 min; 53.4%) were higher in the PA than the non-PA group (p values < 0.05). The body parts exposed to the sun among the PA group were arms (67.1%), hands (64.1%), face and hands (62.5%), legs (58.5%), and face (53.2%), while sunscreen cream (47.2%) was their preferred sun-protection method. High levels of knowledge and positive attitudes were reported by the PA group compared with the non-PA group in regard to walking outdoors for sun exposure (80.6 vs. 62.7%; p < 0.001). Information about good dietary sources, the role of VD in human health, associated diseases, positive attitudes to sun exposure, and the use of supplements or multivitamins were among the determinants of VD knowledge and awareness. In conclusion, VD knowledge and awareness are positively associated with self-reported physical activity in adults. Further objective classifications of PA may strengthen the results of the present investigation.
... A study of the effect of physical exercise on people over the age of 60 (Antunes, Stella, Santos, Bueno & Mello, 2005) showed that patients in the experimental group (who were practicing physical activities) had a significant improvement in all the psychological parameters that were being monitored. Some authors (Blumenthal, Babyak & Moore., 1999;Barbour & Blumenthal, 2005) concluded that the elderly depressed patients experienced the same effects in reducing depression after a sixteen-week exercise program as in the treatment with antidepressants, but also emphasize a number of methodological limitations.In another study Blumenthal (Blumenthal et al., 2007), showed that the therapeutic effects of physical exercise are nearly the same as those in antidepressant therapy. A study conducted on a sample of 16,483 students found that there was a significant correlation between exercise and low depression (Stepoe, Wardle & Filler, 1997). ...
The aim of this research was to determine the postural status of first league female basketball players. The sample of participants consisted of 12 elite senior basketball players who had been involved in a training program for more than eight years. To evaluate the postural status of the spinal column in the frontal and sagittal plane, as well as to evaluate the postural status of the legs and feet in the frontal plane, a special measuring instrument was used (Formetric 4D System, Diers, Germany). To determine the differences in the prevalence of deformities and normal posture, the Chi square test was used. The results indicated that the prevalence of physical deformities of the spinal column are found in the following percentages: kyphosis (66.7%), lordosis (100%) and scoliosis (91.7%) while the prevalence of the percentage of leg and arch deformity was: knock‐knees (8,3%), bowlegs (91.7%) and flat feet (58.3%). Based on the obtained information on their postural status, we can conclude that frequent control and monitoring of postural status among elite female athletes is necessary. In addition, the constant strengthening of both sides of the body is needed, especially in the case of sports where the specific nature of the technical elements is tied to the dominant side of the body.
... A study of the effect of physical exercise on people over the age of 60 (Antunes, Stella, Santos, Bueno & Mello, 2005) showed that patients in the experimental group (who were practicing physical activities) had a significant improvement in all the psychological parameters that were being monitored. Some authors (Blumenthal, Babyak & Moore., 1999;Barbour & Blumenthal, 2005) concluded that the elderly depressed patients experienced the same effects in reducing depression after a sixteen-week exercise program as in the treatment with antidepressants, but also emphasize a number of methodological limitations.In another study Blumenthal (Blumenthal et al., 2007), showed that the therapeutic effects of physical exercise are nearly the same as those in antidepressant therapy. A study conducted on a sample of 16,483 students found that there was a significant correlation between exercise and low depression (Stepoe, Wardle & Filler, 1997). ...
Visual impairment, i.e. the lack of visual control can lead to postural disorders of the spine. Taking part in sports has positive effects on the development of motor skills, so it can be assumed that it also has positive effects on reducing the presence of postural disorders among athletes with visual impairment. With regard to this, the aim of this paper was to determinethe difference in the presence of postural disorders and body deformities between athletes with visual impairment and non‐athletes from the same population. The sample of participants consists of 21 athletes and 20 non‐athletes with visual impairment. For the assessment of
postural disorders, a device called “Spinal Mouse“ was used, with which 8 variables were determined. 52.39% of the athletes had some form of postural disorder, most of whom had bad scoliotic body posture combined with kyphosis and lordosis. 55% of the non‐athletes had some form of postural disorder, where kyphosis was
the most frequent one – 30%. There was no statistically significant difference in the presence of postural disorders of the spine between the two groups. Based on the obtained results, in this group of the participants it can be concluded that taking part in sports does not lead to a reduction in the presence of postural disorders among athletes with visual impairment compared to non‐athletes from the same population.
... Son yıllarda yapılan çalışmalara göre akıl sağlığı ve egzersiz arasında bir korelasyon olduğu görülmüştür (Stein, 2009;Dishman, 2006). Klinik araştırmalar egzersiz ile farklı ruhsal hastalıklar, Alzheimer hastalığı ve Parkinson hastalığı olumlu bir ilişki olduğunu, sadece hastalığı değil, hastaların yaşam kalitesini de etkilediğini göstermiştir (Blumenthal, 2007;Hirsch, 2003 ...
İÇİNDEKİLER
Bölüm 1. Sorularla Kardio tenis / Doç. Dr. Hüseyin GÜMÜŞ
Bölüm 2. Kardio Tenis ve Beslenme/ Doç. Dr. İrfan YILDIRIM
Bölüm 3. Kardio Teniste Masaj Uygulamaları / Doç. Dr. Mustafa Can KOÇ
Bölüm 4. Kardio Tenis ve Sağlık/ Dr. Öğretim Üyesi Yasin ERSÖZ
... Regular physical activity has also long been strongly associated with better mood and preventing and treating depression [10][11][12][13]. In fact, exercise is comparable to antidepressant medications for relieving depression [14]. Some of the mechanisms by which physical activity can be mood enhancing include boost in endorphins and other neurotransmitters, regulation of the hypothalamic-pituitary-adrenal axis, increased neurogenesis psychological distraction, and improved self-efficacy [15][16][17]. ...
Positive psychology in combination with a healthy lifestyle has the potential to enhance health and well-being at a level beyond that achieved by healthy lifestyle habits alone—a state of health termed positive health by Martin Seligman, the founder of the positive psychology field. This chapter covers how positive psychology interventions and positive emotions with healthy physical habits play a vital role in health. The mechanism is twofold: 1. positive emotions as powerful drivers of behavior change and 2. direct physiologic benefits of positive emotions. Health professionals need to consider how to integrate this science and practice of positive psychology into their patient assessments and recommendations. An overview will be provided about the scientific studies that show the reinforcing, reciprocal relationship between positive psychology activities and physical healthy lifestyles. Strategies to apply in clinical practices outside of behavioral health and research recommendations are reviewed. Future research is needed to transform these research-informed approaches into evidence-based practice and address a major research gap on how different cultures and populations form positive psychology interventions.
... 증가하는 스트레스와 우울증 은 국가의 주요 사회문제로 예방과 개선에 관심이 높아 지고 있다. 규칙적인 운동으로 인한 체력의 향상은 자아 존중감과 자기 효능감 등 긍정적 정서를 증가시키고 우 울과 불안 등의 부정적 정서를 감소시킨다 [11,12]. 대학생들의 ...
... MDD can induce a drastic change in interests, mood, and pleasure, as well as changes in cognitive and vegetative behaviors. [1][2][3] MDD is the fourth biggest global cause of life-years adjusted for disability out of all medical illnesses significantly linked to disability, major death for patients, and suffering for patients with their family members. [4][5][6] According to an estimation, up to 50% of the 0.8 million suicides every year worldwide occurred during a depressed episode. 1 Compared to the mass population, individuals with MDD are prone to a 20-fold higher risk of death due to suicide. ...
Background and aims:
Major depressive disorder (MDD) is the fourth biggest health-related concern that dramatically impacts individuals' mental and physical health. Alteration of serum proinflammatory cytokine levels may take part in the development and progression of MDD. We aimed to explore and compare the role of interleukin-12 (IL-12) in MDD patients and healthy controls (HCs) and its involvement with the disease severity.
Methods:
The present study included 85 patients and 87 age-sex matched HCs. A qualified psychiatrist utilized the diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) criteria to diagnose patients and evaluate HCs. We applied the Ham-D rating scale to measure the severity of depression. Serum IL-12 levels were measured using ELISA kits.
Results:
We observed a notable increase in the serum levels of IL-12 in MDD patients compared to HCs (164.27 ± 10.18 pg/ml and 82.55 ± 4.40 pg/ml; p < 0.001). Moreover, we noticed a positive correlation between serum IL-12 levels and Ham-D scores in MDD patients (r = 0.363; p = 0.001). Receiver operating characteristic analysis showed a good predictive performance (AUC = 0.871; p < 0.001) at the cut-off point of 53.46 pg/ml for serum IL-12.
Conclusion:
The current study findings support that IL-12 levels are involved with the pathogenesis and inflammatory process in MDD. At the same time, this involvement may make this cytokine eligible for the risk evaluation of MDD. However, we recommend further interventional studies to explore more accurate associations between IL-12 and depressive disorder.
... Finally, although the DSES in this study had no correlation with a measure of pathology, including symptoms of mood disorders, it could be noted that daily spiritual experiences are often included in interventions to alleviate mood disorders such as depression and anxiety (Mofidi et al., 2006;Underwood, 2011). Follow up research on such interventions showed the positive effect of DSE on mood disorders (Mofidi et al., 2006;Han & Richardson, 2010), and on physical conditions (Koenig, George, & Titus, 2004;Blumenthal et al., 2007;Fombuena et al., 2016). This study, to validate the DSES for use with a group of black South African students, found that the scale was valid for use within this context. ...
This study aimed to validate the English version of the Daily Spiritual Experience Scale (DSES) in a group of N = 324 black South African students. Validation studies are important in Global South contexts, because they facilitate the broadening in understanding of psychological and psychometric phenomena, in general, and more specifically, validating psychometric instruments allows for a better understanding of psychosocial and existential phenomena in specific groups of people. Validation of the DSES was done by investigating its internal consistency, reliability, factorial validity, and convergent and divergent validity. The DSES had reliability of 0.85, a unidimensional factor structure, and showed convergent validity by significantly correlating with the Mental Health Continuum (MHC), and divergent validity by significantly correlating with the Patient Health Questionnaire (PHQ). The unidimensional, 16-item DSES is valid for use in a South African black student context as a domain general measure of spiritual experience.
... In addition, it has been shown that the incorporation of strength training exclusively or combined with aerobic training decreases the prevalence of depression [14,42]. Regarding frequency, there are no exact guidelines for the treatment of depression through exercise, since volume, intensity and frequency are parameters that will influence training as well as the chosen training modality [42][43][44][45]. ...
Introduction:
Depression is a concerning mental health disorder. It is the first cause of inability worldwide, which entails high economic costs for the public system. Current evidence suggests that physical activity is an effective tool for the prevention and treatment of depressive symptoms.
Objective:
To examine the relationship between the cases of depressive symptoms and depression presented by the adult Spanish population and the days per week of physical activity and strength training that they perform.
Design:
It is a cross-sectional study with data from the European Health Survey of Spain 2020 (EESE 2020), consisting of 10,024 males and 11,126 females, between 18 and 84 years, which conformed the sample of 21,150 participants.
Results:
Depressive symptoms and depression were related to days of PA per week, PA frequency per week and strength training days per week (p < 0.001), depressive symptoms and depression were found to have higher prevalence in the inactive groups than in the active groups (p < 0.05); this phenomenon was found in both sexes and age groups.
Conclusions:
The prevalence of depressive symptoms and depression were associated with physical activity in the general population, by sex and by age group too. The prevalence of both were higher in the inactive population than in the active population of all ages and sexes. Future studies are required to confirm the relationship between PA and depression prevalence, in order to establish the scope of the effect of PA on depressive symptoms and depression.
... Por outro lado, (Blumenthal, et al., 2007) realizando um estudo randomizado e controlado com 202 adultos deprimidos encontraram que, após a prática regular de exercícios aeróbios regulares, 45 % dos pacientes obtiveram a remissão com exercícios em grupo, 40 % com exercícios em casa, 47 % com uso do medicamento sertralina e 31 % com placebo. ...
Esta pesquisa teve por objetivo investigar, através de uma revisão integrativa da literatura, a prática de atividade física por universitários para diminuir sintomas de depressão. A pesquisa foi realizada no ano de 2016 e conta com interesse histórico. Foram utilizadas cinco bases de dados: MedLine (PubMed), Scopus, PsyINFO, BVS e Scielo. Com os descritores: “depress* AND student* (OR colleg*) AND physic* AND activit* (OR exercise*)”. Encontradas 622 investigações científicas, sendo 109 (17,52%) na base de dados MedLine (PubMed), 251 (40,35%) na Scopus, 23 (3,7%) na PsyInfo, 228 (36,65%) na BVS e 11 (1,7%) na Scielo. Após análise e remoção as 46 investigações restantes foram agrupadas em cinco categorias e discutidas. Nossos resultados indicaram que pouco se pesquisa sobre os obstáculos para a prática de atividades físicas em universitários com indicativo de depressão. Contudo, a associação entre prática de atividade/exercício físico e saúde mental positiva em universitários é muito investigada e muitos autores descrevem correlação negativa entre essas variáveis. Neste contexto, nossos resultados apontam para o benefício de diferentes tipos de atividades corporais com diferentes programas de treinamento, desde que realizadas sob orientação adequada, principalmente quando realizadas de forma intensa. Cabe lembrar que nenhuma investigação presente nesta revisão utilizou metodologia qualitativa descritiva o que aponta para carência de informações sobre aspectos particulares em relação a estes sujeitos e às universidades onde realizam seus estudos. Espera-se que nossos resultados possam auxiliar profissionais de saúde, em especial os da educação física, na prescrição de atividade/exercício físico dentro das universidades como tratamento complementar ao psicoterapêutico e/ou medicamentoso da depressão.
... A total of 30 studies directly examined the efficacy on depressive symptoms of AE vs. control condition [34,36,58,59,61,64,67,69,71,72,[74][75][76][77]85 ...
Background
The efficacy of exercise interventions in the treatment of mental health disorders is well known, but research is lacking on the most efficient exercise type for specific mental health disorders.
Objective
The present study aimed to compare and rank the effectiveness of various exercise types in the treatment of mental health disorders.
Methods
The PubMed, Web of Science, PsycINFO, SPORTDiscus, CINAHL databases, and the Cochrane Central Register of Controlled Trials as well as Google Scholar were searched up to December 2021. We performed pairwise and network meta-analyses as well as meta-regression analyses for mental health disorders in general and each type of mental health disorder, with alterations in symptom severity as the primary outcome.
Results
A total of 6456 participants from 117 randomized controlled trials were surveyed. The multimodal exercise (71%) had the highest probability of being the most efficient exercise for relieving depressive symptoms. While resistance exercise (60%) was more likely to be the most effective treatment for anxiety disorder, patients with post-traumatic stress disorder (PTSD) benefited more from mind–body exercise (52%). Furthermore, resistance exercise (31%) and multimodal exercise (37%) had more beneficial effects in the treatment of the positive and negative symptoms of schizophrenia, respectively. The length of intervention and exercise frequency independently moderated the effects of mind–body exercise on depressive (coefficient = 0.14, p = .03) and negative schizophrenia (coefficient = 0.96, p = .04) symptoms.
Conclusion
Multimodal exercise ranked best for treating depressive and negative schizophrenic symptoms, while resistance exercise seemed to be more beneficial for those with anxiety-related and positive schizophrenic symptoms. Mind–body exercise was recommended as the most promising exercise type in the treatment of PTSD. However, the findings should be treated with caution due to potential risk of bias in at least one dimension of assessment and low-to-moderate certainty of evidence.
Trial Registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42022310237).
... For the specific category of daily life changes, decreased physical activity was associated with depression in our study. It is known that reduced physical activity can cause depression studies [25][26][27] and sufficient physical activity has a protective effect against depression 28,29 . Also, our study showed that increased consumption of www.nature.com/scientificreports/ ...
The coronavirus (COVID-19) pandemic has led to substantial daily life changes for people worldwide. We investigated the association between daily life restrictions and depression during the COVID-19 pandemic based on the Korea Community Health Survey. Daily life restrictions were evaluated using a questionnaire to population into three restriction categories: no/slightly, moderately, and severely. Depression was assessed by the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Chi-square tests and Fisher’s exact tests were used to compare the demographic characteristics of individuals with and without depression. Logistic regression was used to assess the association between the severity of daily life restrictions and the prevalence of depression. The prevalence of depression was 2.4% in the total population: 5.7% in the severely restricted group and 2.7% in the moderately restricted group. After adjusting for age, sex, educational level, income, marital status, and employment status, the severely restricted group was more likely to have depression than was the no change/slightly restricted group (OR = 2.40, 95% CI 2.16–2.67, p < 0.001). Employers with severely restricted daily life exhibited a higher OR for depression compared to the no/slightly restricted group (OR = 3.24, 95% CI 2.37–4.45, p < 0.001). It is necessary to consider the mental health of vulnerable affected by the COVID-19 pandemic.
... Moreover, it is necessary to examine a special group of people with sleep disorders, such as patients with MDD instead of the healthy (Kredlow et al., 2015) or adolescents (Lang et al., 2016) population. The literature has shown that even very modest amounts of exercise can reduce depressive symptoms (Blumenthal et al., 2007;Hallgren et al., 2016). ...
Patients with major depressive disorders (MDD) who exercise report better quality of sleep, but there is a need for more conclusive evidence. This systematic review sought to gather data only from randomized controlled trials (RCTs) that looked at how physical activity affects the quality of sleep in patients with MDD. Three e-databases (Web of Sciences, Scopus, and PubMed) were searched for relevant RCTs in January 2021. Ten RCTs (768 participants) with a total of 24 articles were deemed eligible, including RCTs with clinically diagnosed MDD. Across the studies, physical activity was found to improve sleep quality among people with MDD. However, the limitations of this systematic review include the few available trials, the small number of samples with clinically diagnosed MDD patients, and the wide range of exercise modalities. The physical activity enhanced sleep quality in people with MDD, especially in RCTs with 150 min per week moderate intensity interventions. Although more RCTs are required to examine the effects of physical activity among people with MDD, these findings are clinically useful.
... In a series of randomised controlled trials, aerobic exercise has been shown to be as effective as antidepressant medication (e.g. Serotonin Reuptake Inhibitors [SSRIs] such as sertraline) in reducing depressive symptoms in adults with MDD (Blumenthal et al. 1999;Blumenthal et al. 2007) and in individuals with coronary disease and MDD or elevated depressive symptoms (Blumenthal et al. 2012). However, the presence of depression and co-morbid anxiety may Box 1. Clinical advice and tips for lifestyle-based mental health care. ...
Objectives
The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings.
Methods
Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria.
Results
Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework.
Conclusions
Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.
... Potential overlap between mental health and physical activity in genetic variance Physical activity is known to promote resilience to various psychiatric conditions, alleviating symptoms of depression, anxiety, and negative mood [37,38]. This buffering effect may be rooted in the shared genetic variance between mental health and physical activity. ...
Abstract Physical activity is correlated with, and effectively treats various forms of psychopathology. However, whether biological correlates of physical activity and psychopathology are shared remains unclear. Here, we examined the extent to which the neural and genetic architecture of physical activity and mental health are shared. Using data from the UK Biobank (N = 6389), we applied canonical correlation analysis to estimate associations between the amplitude and connectivity strength of subnetworks of three major neurocognitive networks (default mode, DMN; salience, SN; central executive networks, CEN) with accelerometer-derived measures of physical activity and self-reported mental health measures (primarily of depression, anxiety disorders, neuroticism, subjective well-being, and risk-taking behaviors). We estimated the genetic correlation between mental health and physical activity measures, as well as putative causal relationships by applying linkage disequilibrium score regression, genomic structural equational modeling, and latent causal variable analysis to genome-wide association summary statistics (GWAS N = 91,105–500,199). Physical activity and mental health were associated with connectivity strength and amplitude of the DMN, SN, and CEN (r’s ≥ 0.12, p’s
... Certaines pathologies non psychiatriques ayant pour origine le dysfonctionnement d'un organe périphérique, peuvent également favoriser l'apparition de TDM. Ainsi, les affections chroniques comme les maladies cardiovasculaires, le diabète ou des affections pulmonaires sont des comorbidités de la dépression, et un lien bidirectionnel entre la dépression et ces pathologies a été démontré (Bogner et al., 2007;Ducat et al., 2014;Whooley et al., 2008). ...
Les troubles majeurs dépressifs concernent plus de 300 millions de personnes à travers le monde. Si des composés pharmacologiques permettent de traiter la dépression, les substances commercialisées pour cette indication présentent certaines limites thérapeutiques. Notamment, on observe pour tous ces composés, un faible taux de réponse, un taux élevé de rechute et/ou un long délai d'action. En effet, la plupart des antidépresseurs nécessitent un traitement au long cours, avant que les premiers signes thérapeutiques ne soient observables, ce qui constitue un inconvénient clinique majeur. Au niveau mécanistique, ceci s'explique par le fait que l'administration chronique d'antidépresseur entraîne des modifications cérébrales qui nécessitent plusieurs semaines, voire plusieurs mois, pour se mettre en place. Dans ce contexte, il apparaît pertinent d'identifier de nouvelles solutions permettant une action plus rapide et plus durable sur les symptômes dépressifs. Pour ce faire, les approches non pharmacologiques suscitent un intérêt croissant puisqu'elles visent les causes des symptômes comportementaux, apparaissant ainsi comme des alternatives aux traitements pharmacologiques. En effet, on sait aujourd'hui que le style de vie est un facteur de déclenchement de la dépression majeure, et les effets protecteurs d'une alimentation saine, d'une vie sociale riche et de l'exercice physique sur la santé mentale ont été décrits. Au cours de ce travail de thèse, nous avons examiné si et comment ces éléments environnementaux contribuent à traiter le trouble dépressif lorsqu'ils sont proposés seuls ou combinés à un antidépresseur classique. A l'aide de souris modèle de dépression, nous avons montré que le séjour en environnement enrichi réduit le délai d'action de la venlafaxine. Ensuite nous avons déterminé que l'effet bénéfique de cette combinaison est associé à la désorganisation rapide de la plasticité des interneurones GABAergiques de l'hippocampe, impliquant la matrice extracellulaire qui entoure ces neurones, ainsi que des effets sur la neurogenèse hippocampique adulte. Nous avons également observé que l'arrêt des stimulations environnementales aggrave le phénotype pseudo-de´pressif chez les animaux, alors que l'exercice physique combiné avec un traitement antidépresseur induit des effets bénéfiques précoces mais partiels sur le comportement. Dans l'ensemble, nos travaux montrent un effet bénéfique des stratégies thérapeutiques non pharmacologiques et identifient les interneurones GABAergiques à parvalbumine comme une cible pertinente sur laquelle agir pour réduire le délai d'action des antidépresseurs actuellement disponibles sur le marché.
... Apart from the preventive effect, a growing body of literature suggests that exercise is an effective strategy for treating depression, reducing depressive symptoms, and improving quality of life [14][15][16]. Previous research suggests that exercise training can induce similar effects as psychological or pharmacological treatments [17][18][19][20]. However, the number of studies reporting these comparisons is still small [17]. ...
Depression is a major cause of disability among populations worldwide. Apart from primary symptoms, depressed patients often have a higher cardiovascular risk profile. Multimodal therapy concepts, including exercise, have emerged as promising approaches that not only improve depressive symptoms but also have a positive impact on cardiovascular risk profile. However, controversies have arisen concerning the influence of baseline severity on the effects of therapy concepts for this demographic. This study assessed whether pretreatment severity moderates psychological and physiological treatment outcomes of a multimodal therapy. A total of 16 patients diagnosed with mild depression (MD) and 14 patients diagnosed with severe depression (SD) took part in a 3-month outpatient multimodal treatment therapy. Before and after the treatment, depression score (Beck Depression Inventory (BDI)), peripheral systolic (pSBP) and diastolic (pDBP) blood pressure, central systolic (cSBP) and diastolic (cDBP) blood pressure, pulse wave velocity (PWV), heart rate (HR), and parasympathetic parameters of heart rate variability (RMSSD) were assessed. Significant time effects were detected for BDI (−20.0 ± 11.6, p > 0.001, η2 = 0.871), pSBP (−4.7 ± 6.8 mmHg, p < 0.001, η2 = 0.322), pDBP (−3.5 ± 6.9 mmHg, p = 0.01, η2 = 0.209), cSBP (−4.8 ± 6.5 mmHg, p < 0.001, η2 = 0.355), cDBP (−3.6 ± 6.8 mmHg, p = 0.008, η2 = 0.226), PWV (−0.13 ± 0.23 m/s, p = 0.008, η2 = 0.229), HR (4.3 ± 8.8 min−1, p = 0.015, η2 = 0.193), RMSSD (−12.2 ± 23.9 ms, p = 0.017, η2 = 0.251), and and SDNN (10.5 ± 17.8 ms, p = 0.005, η2 = 0.330). Significant time × group interaction could be revealed for BDI (p < 0.001, η2 = 0.543), with patients suffering from SD showing stronger reductions. Pretreatment severity of depression has an impact on the effectiveness of a multimodal therapy regarding psychological but not physiological outcomes.
... The relationship between physical activity and well-being may have both a physiological and a psychological explanation; indeed, physical exercise seems to have a positive impact on the neurotransmitter system, regulating primary monoamines like dopamine, noradrenaline and serotonin (Dishman, 1997). It also seems to have a positive relationship with mental resilience (Childs & De Wit, 2014), selfefficacy and self-esteem (Blumenthal et al., 2007). ...
College students have poorer mental health than their peers. Their poorer health conditions seem to be caused by the greater number of stressors to which they are exposed, which can increase the risk of the onset of mental disorders. The pandemic has been an additional stressor that may have further compromised the mental health of college students and changed their lifestyles with important consequences for their well-being. Although research has recognized the impact of COVID-19 on college students, only longitudinal studies can improve knowledge on this topic. This review summarizes the data from 17 longitudinal studies examining changes in mental health and lifestyle among college students during the COVID-19 pandemic, in order to improve understanding of the effects of the outbreak on this population. Following PRISMA statements, the following databases were searched PubMed, EBSCO, SCOPUS and Web of Science. The overall sample included 20,108 students. The results show an increase in anxiety, mood disorders, alcohol use, sedentary behavior, and Internet use and a decrease in physical activity. Female students and sexual and gender minority youth reported poorer mental health conditions. Further research is needed to clarify the impact of the COVID-19 pandemic on vulnerable subgroups of college students.
Supplementary information:
The online version contains supplementary material available at 10.1007/s40894-022-00192-7.
... The 202 study participants were randomly divided into four groups as follows: group 1: physical exercises under supervision; group 2: physical exercises that are carried out at home; group 3: drug treatment with antidepressants; group 4: placebo. The study shows that the effects of exercise brought about the same benefits as the use of antidepressants [31]. The data of 14,706 students were analysed to find associations between physical activity, mental health, stress, and sociability. ...
Background:
Statistics show that the number of received psychosocial counselling sessions remains at a constantly high level or has even increased since the COVID-19 pandemic situation in 2020. The objective of this work is to identify factors associated with students' mental health to improve prevention and promotion in mental health at universities.
Methods:
The analyses were based on a cross-sectional data set collected by an online survey among 1,842 students from a German University of Applied Sciences in 2014. Descriptive statistics as well as nine different multiple linear regression models were calculated with IBM® SPSS® Statistics software. Mental health indicators used were mental health-related quality of life (mental HRQOL), depression, and anxiety, which were analysed in a gender-specific manner.
Results:
The analyses showed that the mean of the mental HRQOL score of the SF-36 for the student sample (46.68) was lower than the values for German (48.76) or American (51.34) norm samples. A key finding was the differences in mental health indicators between male and female students. Women reported worse mental health status in comparison to men. Female gender (ß of -.09; p < 0.01), age (ß of -1.05; p < 0.01), underweight (ß of -.09; p < 0.05), smoking (ß of -.10; p < 0.05) and drug consumption (ß of -.15; p < 0.001) were negatively associated with mental health indicators. In our sample, a moderate consumption of alcohol within the female population (ß of .12; p < 0.01) and physical activity within the male sample (ß of .09; p < 0.05) were positively associated with mental health indicators.
Conclusion:
The gender-specific differences of students' mental health and its associations could be an important result for counselling services at universities to adjust methods according to gender. Contrary to the general societal perception, students have lower mental health than a norm sample even before the pandemic. Due to the additional mental stress caused by the pandemic, it can be assumed that mental health problems have increased even more. Universities should therefore pay more attention to the mental health of their students.
Background:
Primary care patients and clinicians may prefer alternative options to second-generation antidepressants for major depressive disorder (MDD).
Purpose:
To compare the benefits and harms of nonpharmacologic treatments with second-generation antidepressants as first-step interventions for acute MDD, and to compare second-step treatment strategies for patients who did not achieve remission after an initial attempt with antidepressants.
Data sources:
English-language studies from several electronic databases from 1 January 1990 to 8 August 2022, trial registries, gray literature databases, and reference lists to identify unpublished research.
Study selection:
2 investigators independently selected randomized trials of at least 6 weeks' duration.
Data extraction:
Reviewers abstracted data about study design and conduct, participants, interventions, and outcomes. They dually rated the risk of bias of studies and the certainty of evidence for outcomes of interest.
Data synthesis:
65 randomized trials met the inclusion criteria; eligible data from nonrandomized studies were not found. Meta-analyses and network meta-analyses indicated similar benefits of most nonpharmacologic treatments and antidepressants as first-step treatments. Antidepressants had higher risks for discontinuation because of adverse events than most other treatments. For second-step therapies, different switching and augmentation strategies provided similar symptomatic relief. The certainty of evidence for most comparisons is low; findings should be interpreted cautiously.
Limitations:
Many studies had methodological limitations or dosing inequalities; publication bias might have affected some comparisons. In some cases, conclusions could not be drawn because of insufficient evidence.
Conclusion:
Although benefits seem to be similar among first- and second-step MDD treatments, the certainty of evidence is low for most comparisons. Clinicians and patients should focus on options with the most reliable evidence and take adverse event profiles and patient preferences into consideration.
Primary funding source:
American College of Physicians. (PROSPERO: CRD42020204703).
Körperpsychotherapie etabliert sich zunehmend und ist keine neue Entdeckung. Bereits vor über 120 Jahren war bekannt, dass über den Körper die Psyche erreicht werden kann und damit die verbale Psychotherapie effektiver und gegebenenfalls erst möglich wurde. Wissenschaftliche Untersuchungen sprechen dafür, dass Körperpsychotherapie heute als fünfte Säule der allgemein anerkannten psychotherapeutischen Verfahren (PA, TP, VT, ST) angesehen werden kann. Sie hat sich aus der atemtherapeutischen und der Bewegung der Gymnastik sowie der Verwendung in der Psychoanalyse entwickelt. Sie ist weitestgehend in die tiefenpsychologische und verhaltenstherapeutische Psychotherapie integriert und kann zu den humanistischen Verfahren gezählt werden. Anwendung findet die Körperpsychotherapie beispielsweise in der Psychosomatischen Medizin sowie auf verschiedenen Gebieten der Psychotherapie. Laut den hier vorgelegten Befunden erreicht die Arbeit am Körper nonverbal Verarbeitetes, das sich tief in das implizite Körpergedächtnis eingegraben hat, lange bevor ein junger Mensch das Sprechen erlernte. Eine Möglichkeit, dies konzeptuell einzuordnen und therapeutisch nutzbar zu machen, ist das Modell der „verkörperten Selbstwahrnehmung“ nach Fogel, das Teile des Körperschemas beinhaltet. In der Bindungsbeziehung nicht adäquates Eingehen auf die kindlichen Bedürfnisse hat weitreichende Folgen auf das weitere Leben. In Untersuchungen konnte gezeigt werden, wie sich Störungen in der Entwicklung eines Kindes in Form von Körperschemastörungen und Körperdissoziationen, in Emotionsregulations- und als Entwicklungstraumastörung manifestieren können. Diese sind weit verbreitet und Teil einer Gesellschaft, die auf Leistung und Effizienz ausgerichtet ist und in Zusammenhang mit chronischem Stress stehen. Evolutionsgeschichtlich begründete Überlebensmuster werden durch chronischen Stress aktiviert und sind Ursache zahlreicher Erkrankungen. Hierfür liefert Porges mit seiner Polyvagal-Theorie einen neuen neurobiologischen Erklärungsansatz. Durch eine Imbalance stressauslösender und entspannender Faktoren zugunsten des Stresses werden körpereigene Selbstheilungskräfte der Selbstregulation verhindert und die Resilienzfähigkeit eingeschränkt. Selbstregulation und Resilienz sind vorhanden, wenn das Ruhe- und Bindungssystem dominiert im Gegensatz zur Kampf-, Flucht- und Erstarrungsreaktion. In seiner Hypothese zeigt Porges auf, wie das autonome Nervensystem Verhaltensweisen beeinflusst und wie diesen begegnet werden kann. Durch den sympathischen Zweig wird die An- und Verspannungsreaktion auf körperlicher Seite mit den auch auf der psychischen Seite verbundenen Reaktionen vermittelt. Diesem kann durch die parasympathisch vermittelte Oxytocin-Freisetzung begegnet werden. Durch eine Balance dieser beiden Waagschalen kann körperliche und seelische Gesundheit sowie Resilienzfähigkeit gefördert werden. Die Körperpsychotherapie bietet auch aus meiner Sicht eine noch unterschätzte Möglichkeit, die Balance wieder herzustellen. Eine Methode, die positive durch Oxytocin vermittelte heilsame Reaktionen in Gang zu setzt, stellt die berührende Körperarbeit dar wie sie beispielsweise nach der Rosen-Methode praktiziert wird. Körperpsychotherapie im Allgemeinen kann in der Behandlung von Depressionen, Angst- und psychosomatischen Störungen hilfreich sein. Sie ist empirisch in einer umfassenden Theorie begründet und fundiert auf neurobiologischen und neurowissenschaftlichen Erkenntnissen. Aus Sicht der Autorin handelt es sich bei der Körperpsychotherapie angesichts der vorliegenden Befunde und theoretischen Wirkkonzepte um einen therapeutischen Ansatz, der wesentlich dazu beitragen kann, die Behandlung psychischer Störungen kosteneffizienter und wirksamer zu gestalten. Um differenzierter zwischen theoretischem Potential und tatsächlich nachweisbaren Effekten körperpsychotherapeutischer Methoden unterscheiden zu können, ist es aus meiner Sicht dringend zu empfehlen, körperpsychotherapeutische Arbeitsansätze exakter zu erforschen. Beispielsweise wäre es lang- oder mittelfristig auch wünschenswert, Forschungsdaten für eine präzisere Indikationsstellung zur Verfügung zu haben. Dabei wäre beispielweise zu klären, welche Verfahren für welche Störungsbilder, in welchem Behandlungssetting und für welche Behandlungsdauer in Frage kommen. Auch fehlen hinsichtlich der Kontraindikationen belastbare Forschungsdaten zu den oben benannten Empfehlungen diverser Vertreter der Körperpsychotherapie. Aufgrund des hohen Erklärungspotentials für das individuelle Erleben psychisch beeinträchtigter Personen, das beispielsweise die Polyvagal-Theorie nach Porges oder die verkörperte Selbstwahrnehmung nach Fogel bieten, erscheint mir auch die Forderung nach einer Berücksichtigung körperpsychotherapeutischer Theorien und Methoden in der Ausbildung von Ärzten und Psychologen nachvollziehbar und sinnvoll. Aufgrund der in dieser Arbeit zusammengetragenen Ergebnisse halte ich es für dringend empfehlenswert, die Körperpsychotherapie als eigenständiges Behandlungselement in die fachgerechte Versorgung psychisch Erkrankter aufzunehmen, sofern keine der erwähnten Kontraindikationen dem widersprechen.
Background:
Post-stroke depression (PSD) occurs in approximately one-third of chronic stroke survivors. Although pharmacotherapy reduces depressive symptoms, side effects are common and stroke survivors have increased likelihood of multimorbidity and subsequent polypharmacy. Thus, alternative non-pharmacological treatments are needed. Combining two non-pharmacological anti-depressant treatments, aerobic exercise (AEx) and repetitive transcranial magnetic stimulation (rTMS), has been demonstrated to be feasible and well-tolerated in chronic stroke survivors.
Objectives:
The purpose of this trial was to determine the feasibility of conducting a multi-arm combinatorial trial of rTMS and AEx and to provide an estimate of effect size of rTMS+AEx on PSD symptoms.
Methods:
Twenty-four participants were allocated to one of four treatment arms AEx, rTMS, rTMS+AEx, or non-depressed Control receiving AEx. All participants received a total of 24 treatment sessions. Participant adherence was the primary outcome measure for feasibility and within group effect sizes in Patient Health Questionnaire-9 (PHQ-9) score was the primary outcome for preliminary efficacy.
Results:
Mean adherence rates to the exercise intervention for AEx, rTMS+AEx, and Control subjects were 83%, 98%, and 95%, respectively. Mean adherence rates for rTMS and rTMS+AEx subjects were 97% and 99%, respectively. The rTMS and rTMS+AEx treatment groups demonstrated clinically significant reductions of 10.5 and 6.2 points in PHQ-9 scores, respectively.
Conclusion:
Performing a multi-arm combinatorial trial examining the effect of rTMS+AEx on PSD appears feasible. All treatment arms demonstrated strong adherence to their respective interventions and were well received. rTMS and the combination of AEx with rTMS may be alternative treatments for PSD.
The co-occurrence of mental and physical illness (i.e., comorbidity) incrementally worsens health compared with mental illness alone, chronic disease alone, and with any combination of chronic diseases without mental illness. The presence of a comorbid physical illness adds an additional burden to managing mental illness, contributing to greater severity of illness, functional limitation, and increasing the number and array of health care services necessary to manage the comorbid conditions. The purpose of this chapter is two-fold. First, we provide the reader with a more in-depth picture of the role that medical comorbidities play among the different Hispanic subgroups with mental health disorders. We focus on six comorbid conditions that have had a significant impact on the mental health of Hispanics. Second, we provide treatment recommendations from a psychiatric and psychological perspective on how to treat Hispanics given these comorbidities.KeywordsHispanicComorbiditiesCardiovascular diseaseStrokeCardiometabolic riskCOVIDHIVTobaccoHealth promotion
Background: Exercise interventions are efficacious in reducing disorder-specific symptoms in various mental disorders. However, little is known about long-term transdiagnostic efficacy of exercise across heterogenous mental disorders and the potential mechanisms underlying treatment effects.
Methods: Physically inactive outpatients, with depressive disorders, anxiety disorders, insomnia or attention deficit hyperactivity disorder were randomized to a standardized 12-week exercise intervention, combining moderate exercise with behavior change techniques (BCTs) (n = 38), or a passive control group (n = 36). Primary outcome was global symptom severity (Symptom Checklist-90, SCL-90-R) and secondary outcomes were self-reported exercise (Physical Activity, Exercise, and Sport Questionnaire), exercise-specific affect regulation (Physical Activity-related Health Competence Questionnaire) and depression (SCL-90-R) assessed at baseline (T1), post-treatment (T2) and one year after post-treatment (T3). Intention-to-treat analyses were conducted using linear mixed models and structural equations modeling.
Results: From T1 to T3, the intervention group significantly improved on global symptom severity (d = −0.43, p = .031), depression among a depressed subsample (d = −0.62, p = .014), exercise (d = 0.45, p = .011) and exercise-specific affect regulation (d = 0.44, p = .028) relative to the control group. The intervention group was more likely to reveal clinically significant changes from T1 to T3 (p = .033). Increases in exercise-specific affect regulation mediated intervention effects on global symptom severity (ß = −0.28, p = .037) and clinically significant changes (ß = −0.24, p = .042).
Conclusions: The exercise intervention showed long-term efficacy among a diagnostically heterogeneous outpatient sample and led to long-lasting exercise behavior change. Long-term increases in exercise-specific affect regulation within exercise interventions seem to be essential for long-lasting symptom reduction.
Objectives:
To estimate the prevalence of depression symptoms and quality of life (QoL) and examined the influence of factors in the empty nest elderly.
Methods:
This was a cross-sectional study, which was conducted from February 2022 to May 2022. We recruited a convenience sample of no empty-nest elderly and empty-nest elderly (≥60 years) living in Chengdu. QoL was assessed using WHOQOL-BREF, Geriatric Depression Scale (GDS-15) was used to assess depression symptoms. Multivariable logistic regression was used to analyze data between independent variables with depression symptoms.
Results:
Two thousand twenty-six participants were included in this study, 39.0% (660/1,082) experienced depression symptoms among empty-nest elderly. Age (aOR, 1.02; 95% CI, 1.00-1.04; P = 0.046), chronic disease≥2 (aOR, 3.29; 95% CI, 2.50-4.33; P < 0.001) were associated with increased risk of depression symptoms, and physical activity (aOR, 0.59; 95% CI, 0.40-0.87; P = 0.008), physical health (aOR, 0.93; 95% CI, 0.88-0.99; P = 0.026), psychological health (aOR, 0.93; 95% CI, 0.87-0.98; P = 0.013), and total score (aOR, 0.97; 95% CI, 0.96-0.99; P < 0.001) were associated with decreased risk of depression symptoms among empty-nest elderly.
Conclusions:
Depression symptoms are common mental health problems among empty-nest elderly. We found that age, chronic disease ≥2 and physical activity were important factors that have an impact on depressive symptoms. Empty-nest elderly would have lowered QoL score.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
The current study examined moderators of the relationship between depressive symptoms and global neurocognition in a large non-clinical community-dwelling sample spanning adulthood. Participants comprised 5,430 individuals between the ages of 18-99 years drawn from the Virginia Cognitive Aging Project. Depressive symptoms were measured via the Center for Epidemiologic Studies-Depression scale and neurocognition was operationalized as a composite variable comprising episodic memory, spatial visualization, processing speed, and reasoning tasks. Moderator variables included physical activity, cognitive activity, education, emotional stability, and openness. Hierarchical regressions were used to examine the influence of depressive symptoms and the moderators on neurocognition. Depressive symptoms significantly predicted neurocognition. Cognitive activity, years of education, and emotional stability moderated the depression-neurocognition relationship by buffering the impact of depressive symptoms on neurocognition. Cognitive activity engagement and level of education may function as a protective influence on those with higher levels of depressive symptoms, while emotional stability may be protective for individuals with lower levels of depressive symptoms. No differences in moderation were found across three age groups representing younger, middle, and older adults. Post-hoc analyses showed years of education and openness as moderators in a subsample excluding individuals with potentially clinically meaningful levels of depressive symptoms.
Background
Depression is associated with physical inactivity, low cardiorespiratory fitness (CRF), and poor physical health compared with the general population. Various protocols are employed to determine CRF studies of people experiencing depression, but standardized methods are absent from the literature. Thus, the aim of the present review is to systematically examine the protocols reported to determine CRF in patients with major depressive disorder (MDD).
Methods
Replicating a previously published search strategy, the present review sourced relevant studies from PubMed, PsycInfo, Embase, CINAHL, MEDLINE, Psychology and Behavioural Sciences Collection, and SPORTDiscus from August 2015 to February 2021. Details of CRF testing protocols were extracted into a preprepared form for analysis.
Results
Twenty-three studies met the inclusion criteria, including those from a previous review of CRF in people with MDD. Twelve included studies employed maximal testing protocols, while 11 studies reported using submaximal testing protocols. Cycle ergometry was the most used protocol, followed by treadmill and walk tests. Notably, complete descriptions of the test protocols to facilitate test replication were frequently absent.
Conclusions
Cycle ergometry is commonly used to assess CRF in people with MDD, but protocol details are lacking, making replication difficult. Efforts to standardize protocol descriptions are warranted.
Objective
To assess the comparative effectiveness of exercise, antidepressants and their combination for alleviating depressive symptoms in adults with non-severe depression.
Design
Systematic review and network meta-analysis.
Data sources
Embase, MEDLINE, PsycINFO, Cochrane Library, Web of Science, Scopus and SportDiscus.
Eligibility criteria
Randomised controlled trials (1990–present) that examined the effectiveness of an exercise, antidepressant or combination intervention against either treatment alone or a control/placebo condition in adults with non-severe depression.
Study selection and analysis
Risk of bias, indirectness and the overall confidence in the network were assessed by two independent investigators. A frequentist network meta-analysis was performed to examine postintervention differences in depressive symptom severity between groups. Intervention drop-out was assessed as a measure of treatment acceptability.
Results
Twenty-one randomised controlled trials (n=2551) with 25 comparisons were included in the network. There were no differences in treatment effectiveness among the three main interventions (exercise vs antidepressants: standardised mean differences, SMD, −0.12; 95% CI −0.33 to 0.10, combination versus exercise: SMD, 0.00; 95% CI −0.33 to 0.33, combination vs antidepressants: SMD, −0.12; 95% CI −0.40 to 0.16), although all treatments were more beneficial than controls. Exercise interventions had higher drop-out rates than antidepressant interventions (risk ratio 1.31; 95% CI 1.09 to 1.57). Heterogeneity in the network was moderate (τ ² =0.03; I ² =46%).
Conclusions
The results suggest no difference between exercise and pharmacological interventions in reducing depressive symptoms in adults with non-severe depression. These findings support the adoption of exercise as an alternative or adjuvant treatment for non-severe depression in adults.
Systematic review registration
PROSPERO CRD4202122656.
El estudio determinó los efectos del ejercicio físico y la terapia cognitivo-conductual (TCC) sobre la depresión. Las bases de
datos consultadas fueron: Google Scholar, Redalyc, Scielo, Science Direct Collection, PsycINFO, EBSCOhost y ProQuest Central. La revisión
sistemática se llevó a cabo del 14 de agosto de 2018 al 10 de agosto del 2021. Se utilizaron como criterios de elegibilidad los siguientes:
a) ensayos aleatorizados con diseño entre grupo (grupo control y grupo experimental), b) ejercicio físico, TCC o su combinación como
variables independientes, c) reporte de puntajes de depresión clínica tanto especificada como no especificada, medidos por instrumentos
psicométricos válidos, d) año de publicación superior a 1980 e) participantes de ambos sexos mayores de 18 años. Ciento tres estudios
formaron parte de los resultados (126 tamaños de efecto), para un total de 9488 participantes. Además, como intervención, 36 estudios
se caracterizaron por usar TCC, 62 ejercicio y 5 emplearon la combinación de ambos. La depresión se redujo de manera global, con un
tamaño de efecto alto (d = -.87, n = 126, 95%CI = -.98, -. 75, Z = -14.53, p <.001, Q = 922.18, gl = 125, I2 = 86.45, p < .001). El ejercicio físico
por sí solo tuvo un tamaño de efecto alto (d = -.80, n = 73, 95%CI = -.95, -.64, Z = -10.23, p <.001), la TCC tuvo un tamaño de efecto alto
(d = -1.03, n = 46, 95%CI = -1.24, -.83, Z = -9.98, p <.001) y el ejercicio en combinación con la TCC uno moderado (d = -. 57, n = 7, 95%CI
= -1.04, -.10, Z = -2.40, p = .016). En conclusión, el ejercicio, la TCC y su combinación reducen la depresión de forma moderada a alta en
adultos mayores de 18 años.
In some regions, such as North America, sports psychiatry strongly focuses on competitive sports and treating psychiatric disorders in elite athletes. In other regions, such as German-speaking countries, sports psychiatry has developed in two ways: competitive sports on the one hand, and physical activity, exercise and sport in the case of mental illnesses on the other. Both topics are also addressed by the Sport and Exercise Psychiatry Special Interest Group (SEPSIG) of the Royal College of Psychiatrists and in the World Psychiatric Association (WBA), Section Sport and Exercise. As shown in this issue by Claussen and colleagues, sports psychiatry professionals today identify several other fields of activities that they consider relevant for this young discipline.
Over the past two decades, there has been a steady increase in awareness that physical activity, exercise and sport can play an essential role in preventing and treating mental illness. The number of methodically sound studies has increased significantly. In recent years, knowledge has also been pooled in the form of systematic reviews and meta-analyses. In the meantime, a solid basis of scientific evidence exists, from which conclusions for practice can be derived. As a result, several international professional societies now recommend physical activity, exercise and sport in treating mental disorders as standard therapy. It can also be seen that many psychiatric institutions have moved to follow these recommendations. This is a positive development, as physical activity, exercise and sport in psychiatric care not only positively affect symptom severity but can also counteract increased morbidity and mortality in psychiatric patients.
Context
Extracts of Hypericum perforatum (St John's
wort) are widely used for the treatment of depression of varying severity.
Their efficacy in major depressive disorder, however, has not been conclusively
demonstrated.Objective
To test the efficacy and safety of a well-characterized H perforatum extract (LI-160) in major depressive disorder.Design and Setting
Double-blind, randomized, placebo-controlled trial conducted in 12 academic
and community psychiatric research clinics in the United States.Participants
Adult outpatients (n = 340) recruited between December 1998 and June
2000 with major depression and a baseline total score on the Hamilton Depression
Scale (HAM-D) of at least 20.Interventions
Patients were randomly assigned to receive H perforatum, placebo, or sertraline (as an active comparator) for 8 weeks. Based
on clinical response, the daily dose of H perforatum
could range from 900 to 1500 mg and that of sertraline from 50 to 100 mg.
Responders at week 8 could continue blinded treatment for another 18 weeks.Main Outcome Measures
Change in the HAM-D total score from baseline to 8 weeks; rates of full
response, determined by the HAM-D and Clinical Global Impressions (CGI) scores.Results
On the 2 primary outcome measures, neither sertraline nor H perforatum was significantly different from placebo. The random regression
parameter estimate for mean (SE) change in HAM-D total score from baseline
to week 8 (with a greater decline indicating more improvement) was –9.20
(0.67) (95% confidence interval [CI], –10.51 to –7.89) for placebo
vs –8.68 (0.68) (95% CI, –10.01 to –7.35) for H perforatum (P = .59) and –10.53 (0.72)
(95% CI, –11.94 to –9.12) for sertraline (P = .18). Full response occurred in 31.9% of the placebo-treated patients
vs 23.9% of the H perforatum–treated patients
(P = .21) and 24.8% of sertraline-treated patients
(P = .26). Sertraline was better than placebo on
the CGI improvement scale (P = .02), which was a
secondary measure in this study. Adverse-effect profiles for H perforatum and sertraline differed relative to placebo.Conclusion
This study fails to support the efficacy of H perforatum in moderately severe major depression. The result may be due to low
assay sensitivity of the trial, but the complete absence of trends suggestive
of efficacy for H perforatum is noteworthy.
Figures in this Article
Hypericum perforatum (St John's wort) is widely
used to treat depression, sometimes in an attempt to avoid adverse effects
associated with prescription antidepressants. One meta-analysis in 1996 concluded
that hypericum is superior to placebo for treatment of mild to moderate depression.1 Subsequent studies have found hypericum to be comparable
to active controls, such as amitriptyline,2
imipramine,3- 5
and fluoxetine,6 and superior to placebo.4,7 Some studies suggest that it may be
an effective treatment for moderately severe depression.3- 4
Others have been unable to differentiate hypericum from placebo.8- 9
Important issues have been raised regarding existing studies, including
limited information about use in clinically defined major depression, lack
of placebo-controlled trials that have included a selective serotonin reuptake
inhibitor arm, and absence of controlled data for continuation treatment.
Concern has been raised about adverse interactions of hypericum with certain
drugs.10- 11 Most hypericum in
the United States is consumed without physician consultation. Even though
many patients prefer to avoid the use of medications with adverse effects,
there is a risk that people with clinically significant depression may self-medicate
with hypericum rather than receive effective medication or psychotherapy.
This placebo-controlled study was designed to expand on previous trials
by studying outpatients with well-defined major depression of moderate severity
and included a 4-month continuation phase and sertraline as an active comparator
to calibrate the trial's validity. The main hypothesis tested whether hypericum
would be superior to placebo after 8 weeks of treatment.
Associations between exercise and mental well-being have been documented repeatedly over the last two decades. More recently, there has been application of exercise interventions to clinical populations diagnosed with depression, anxiety, and eating disorders with evidence of substantial benefit. Nonetheless, attention to the efficacy of exercise interventions in clinical settings has been notably absent in the psychosocial treatment literature, as have been calls for the integration of these methods within the clinical practice of psychologists. In this article, we provide a quantitative and qualitative review of these efficacy studies in clinical samples and discuss the potential mechanism of action of exercise interventions, with attention to both biological and psychosocial processes. The meta-analysis of 11 treatment outcome studies of individuals with depression yielded a very large combined effect size for the advantage of exercise over control conditions: g = 1.39 (95% CI: .89–1.88), corresponding to a d = 1.42 (95% CI: .92–1.93). Based on these findings, we encourage clinicians to consider the role of adjunctive exercise interventions in their clinical practice and we discuss issues concerning this integration.
Two clinical trials have been conducted in a sample of depressed patients to determine whether the addition of an aerobic exercise programme to their usual treatment improved outcome after 12 weeks. In the first trial, an aerobic exercise group had a superior outcome compared with a control group in terms of trait anxiety and a standard psychiatric interview. A second trial was then conducted to compare an aerobic exercise programme with low intensity exercise. Both groups showed improvement but there were no significant differences between the groups. In neither trial was there any correlation between the extent of change in the subjects' physical fitness due to aerobic exercise and the extent of the improvement of psychiatric scores.
We have retrospectively analyzed the results of the pooled data from three 6-week placebo controlled double blind phase III clinical trials, initially designed to assess the efficacy of newer antidepressants, in order to study the relationship of early onset improvement with later outcome in 145 depressed outpatients receiving placebo (n = 98) or imipramine (n = 47). The early onset response was seen in a subgroup of subjects receiving either imipramine or placebo and appeared to be independent of treatment assignment. Furthermore, the early onset response predicted outcome for the duration of the trial and was not selective as defined by specific changes in subscales measuring insomnia, anxiety or endogenous features. Exclusion of early onset responders resulted in the augmentation of the difference in outcome with drug and placebo. We recommend that future placebo controlled trials assessing therapeutic efficacy of active treatments in depressed outpatients take into account the early onset response in the analysis of results.
The cardiovascular and behavioral adaptations associated with a 4-month program of aerobic exercise training were examined in 101 older men and women (mean age = 67 years). Subjects were randomly assigned to an Aerobic Exercise group, a Yoga and Flexibility control group, or a Waiting List control group. Prior to and following the 4-month program, subjects underwent comprehensive physiological and psychological evaluations. Physiological measures included measurement of blood pressure, lipids, bone density, and cardiorespiratory fitness including direct measurements of peak oxygen consumption (VO2) and anaerobic threshold. Psychological measures included measures of mood, psychiatric symptoms, and neuropsychological functioning. This study demonstrated that 4 months of aerobic exercise training produced an overall 11.6% improvement in peak VO2 and a 13% increase in anaerobic threshold. In contrast, the Yoga and Waiting List control groups experienced no change in cardiorespiratory fitness. Other favorable physiological changes observed among aerobic exercise participants included lower cholesterol levels, diastolic blood pressure levels, and for subjects at risk for bone fracture, a trend toward an increase in bone mineral content. Although few significant psychological changes could be attributed to aerobic exercise training, participants in the two active treatment groups perceived themselves as improving on a number of psychological and behavioral dimensions.
Patients were randomly allocated to a training group and a control group by block randomisation with respect to sex. For nine weeks the training group underwent a programme of systematic aerobic exercise consisting of one hour of training with an instructor three times a week at 50-70% of maximum aerobic capacity. The control group attended occupational therapy while the training group exercised, but otherwise the programme of treatment for the two groups was as similar as possible. The reduction in depression scores and the increase in maximum oxygen uptake were significantly larger in the training group.
A series of arguments are presented that emphasize the importance of comparatively evaluating psychotherapies with appropriate pharmacotherapy and pill placebo. The lack of a pill-placebo arm has rendered moot those studies that compared pharmacotherapy directly with psychotherapy because of the lack of an internal sample defining calibration with regard to medication responsivity. The National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program is critically discussed because this program incorporated the recommended design features but still led to substantial controversy. The inclusion of a pill-placebo arm in future therapeutic studies is most desirable. NIMH should initiate a funded program specifically for multisite, pill-placebo-controlled studies of psychotherapy, pharmacotherapy, and their combination, jointly sponsored and supervised by skilled psychopharmacologists and psychotherapists.
Previous observational and interventional studies have suggested that regular physical exercise may be associated with reduced symptoms of depression. However, the extent to which exercise training may reduce depressive symptoms in older patients with major depressive disorder (MDD) has not been systematically evaluated.
To assess the effectiveness of an aerobic exercise program compared with standard medication (ie, antidepressants) for treatment of MDD in older patients, we conducted a 16-week randomized controlled trial.
One hundred fifty-six men and women with MDD (age, > or = 50 years) were assigned randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride), or combined exercise and medication. Subjects underwent comprehensive evaluations of depression, including the presence and severity of MDD using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) scores before and after treatment. Secondary outcome measures included aerobic capacity, life satisfaction, self-esteem, anxiety, and dysfunctional cognitions.
After 16 weeks of treatment, the groups did not differ statistically on HAM-D or BDI scores (P = .67); adjustment for baseline levels of depression yielded an essentially identical result. Growth curve models revealed that all groups exhibited statistically and clinically significant reductions on HAM-D and BDI scores. However, patients receiving medication alone exhibited the fastest initial response; among patients receiving combination therapy, those with less severe depressive symptoms initially showed a more rapid response than those with initially more severe depressive symptoms.
An exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons. Although antidepressants may facilitate a more rapid initial therapeutic response than exercise, after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD.
Despite the documented benefits of participating in rehabilitation programs, access to cardiac rehabilitation is limited for a large number of people with coronary artery disease (CAD). There is potential to increase participation in exercise training if home-based exercise were a viable option.
We conducted a retrospective database review of 1,042 patients who took part in exercise rehabilitation following coronary artery bypass graft surgery (CABGS) between 1992 and 1998. Of these, 713 patients took part in supervised exercise, and 329 were in an unsupervised, home-based group. All exercise protocols were based upon American College of Sports Medicine guidelines, and patients in both groups received exercise prescriptions that were similar in intensity, frequency, and duration.
There were no differences between groups at baseline. Following 6 months of exercise training, there were substantial improvements in peak VO2, peak workload, and peak MET levels in both the supervised and unsupervised groups (P < 0.0001). Patients in the supervised group had significant improvements in both LDL and HDL-cholesterol, whereas the home-based group showed improvement in HDL-cholesterol only. When analyzed by sex, men performed better than women for all measures of exercise capacity; however, women in both groups showed approximate 20% improvements (P < 0.05) in exercise capacity as well as improvements in HDL-cholesterol.
Stable post CABGS patients who receive a detailed exercise prescription to follow at home do as well as those in supervised rehabilitation.
Pharmacological treatment of depression in geriatric patients is often difficult. Although unsupervised exercise has been shown to benefit younger depressed patients, there is no evidence that unsupervised exercise can be used as a maintenance treatment for depression in elderly patients. Our aim was to test the feasibility and efficacy of unsupervised exercise as a long-term treatment for clinical depression in elderly patients.
We studied 32 subjects (71.3 +/- 1.2 years of age, mean +/- SE) in a 20-week, randomized, controlled trial, with follow-up at 26 months. Subjects were community-dwelling patients with major or minor depression or dysthymia. Exercisers engaged in 10 weeks of supervised weight-lifting exercise followed by 10 weeks of unsupervised exercise. Controls attended lectures for 10 weeks. No contact was made with either group after 20 weeks until final follow-up. Blinded assessment was made with the Beck Depression Inventory (BDI), the Philadelphia Geriatric Morale Scale, and Ewart's Self Efficacy Scale at 20 weeks and with the BDI and physical activity questionnaire at 26 months.
Patients randomized to the exercise condition completed 18 +/- 2 sessions of unsupervised exercise during Weeks 10 to 20. The BDI was significantly reduced at both 20 weeks and 26 months of follow-up in exercisers compared with controls (p <.05-.001). At the 26-month follow-up, 33% of the exercisers were still regularly weight lifting, versus 0% of controls (p <.05).
Unsupervised weight-lifting exercise maintains its antidepressant effectiveness at 20 weeks in depressed elderly patients. Long-term changes in exercise behavior are possible in some patients even without supervision.
The methods used to evaluate the efficacy of antidepressants differ from treatment for depression in routine clinical practice. The rigorous inclusion/exclusion criteria used to select subjects for participation in efficacy studies potentially limit the generalizability of these trials' results. It is unknown how much impact these criteria have on the representativeness of subjects in efficacy trials. This study estimated the proportion of depressed patients treated in routine clinical practice who would meet standard inclusion/exclusion criteria for an efficacy trial.
A total of 803 individuals, aged 16--65 years, who were seen at intake at an outpatient practice underwent a thorough diagnostic evaluation, including the administration of semistructured diagnostic interviews; 346 patients had current major depression. Common inclusion/exclusion criteria used in efficacy studies of antidepressants were applied to the depressed patients to determine how many would have qualified for an efficacy trial.
Approximately one-sixth of the 346 depressed patients would have been excluded from an efficacy trial because they had a bipolar or psychotic subtype of depression. The presence of a comorbid anxiety or substance use disorder, insufficient severity of depressive symptoms, or current suicidal ideation would have excluded 86.0% (N=252) of the remaining 293 outpatients with nonpsychotic unipolar major depressive disorder from an antidepressant efficacy trial.
Subjects treated in antidepressant trials represent a minority of patients treated for major depression in routine clinical practice. These results show that antidepressant efficacy trials tend to evaluate a subset of depressed individuals with a specific clinical profile.
Objective.
—To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy, sedentary older adults.Design.
—Year-long randomized, controlled trial comparing (1) higher-intensity group-based exercise training; (2) higher-intensity home-based exercise training; (3) lower-intensity home-based exercise training; or (4) assessment-only control.Setting.
—General community located in northern California.Participants.
—One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease. One out of nine persons contacted through a community random-digit-dial telephone survey and citywide promotion were randomized.Interventions.
—For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise training, five 30-minute endurance training sessions per week were prescribed at 60% to 73% of peak treadmill heart rate.Main Outcome Measures.
—Treadmill exercise test performance, exercise participation rates, and heart disease risk factors.Results.
—Compared with controls, subjects in all three exercise training conditions showed significant improvements in treadmill exercise test performance at 6 and 12 months (P<.03). Lower-intensity exercise training achieved changes comparable with those of higher-intensity exercise training. Twelve-month exercise adherence rates were better for the two home-based exercise training conditions relative to the group-based exercise training condition (P<.0005). There were no significant training-induced changes in lipid levels, weight, or blood pressure.Conclusions.
—We conclude that (1) this community-based exercise training program improved fitness but not heart disease risk factors among sedentary, healthy older adults; (2) home-based exercise was as effective as group exercise in producing these changes; (3) lower-intensity exercise training was as effective as higher-intensity exercise training in the home setting; and (4) the exercise programs were relatively safe.(JAMA. 1991;266:1535-1542)
Context Major depressive disorder (MDD) occurs in 15% to 23% of patients with
acute coronary syndromes and constitutes an independent risk factor for morbidity
and mortality. However, no published evidence exists that antidepressant drugs
are safe or efficacious in patients with unstable ischemic heart disease.Objective To evaluate the safety and efficacy of sertraline treatment of MDD in
patients hospitalized for acute myocardial infarction (MI) or unstable angina
and free of other life-threatening medical conditions.Design and Setting Randomized, double-blind, placebo-controlled trial conducted in 40 outpatient
cardiology centers and psychiatry clinics in the United States, Europe, Canada,
and Australia. Enrollment began in April 1997 and follow-up ended in April
2001.Patients A total of 369 patients with MDD (64% male; mean age, 57.1 years; mean
17-item Hamilton Depression [HAM-D] score, 19.6; MI, 74%; unstable angina,
26%).Intervention After a 2-week single-blind placebo run-in, patients were randomly assigned
to receive sertraline in flexible dosages of 50 to 200 mg/d (n = 186) or placebo
(n = 183) for 24 weeks.Main Outcome Measures The primary (safety) outcome measure was change from baseline in left
ventricular ejection fraction (LVEF); secondary measures included surrogate
cardiac measures and cardiovascular adverse events, as well as scores on the
HAM-D scale and Clinical Global Impression Improvement scale (CGI-I) in the
total randomized sample, in a group with any prior history of MDD, and in
a more severe MDD subgroup defined a priori by a HAM-D score of at least 18
and history of 2 or more prior episodes of MDD.Results Sertraline had no significant effect on mean (SD) LVEF (sertraline:
baseline, 54% [10%]; week 16, 54% [11%]; placebo: baseline, 52% [13%]; week
16, 53% [13%]), treatment-emergent increase in ventricular premature complex
(VPC) runs (sertraline: 13.1%; placebo: 12.9%), QTc interval greater than
450 milliseconds at end point (sertraline: 12%; placebo: 13%), or other cardiac
measures. All comparisons were statistically nonsignificant (P≥.05). The incidence of severe cardiovascular adverse events was
14.5% with sertraline and 22.4% with placebo. In the total randomized sample,
the CGI-I (P = .049), but not the HAM-D (P = .14), favored sertraline. The CGI-I responder rates for sertraline
were significantly higher than for placebo in the total sample (67% vs 53%; P = .01), in the group with at least 1 prior episode of
depression (72% vs 51%; P = .003), and in the more
severe MDD group (78% vs 45%; P = .001). In the latter
2 groups, both CGI-I and HAM-D measures were significantly better in those
assigned to sertraline.Conclusion Our results suggest that sertraline is a safe and effective treatment
for recurrent depression in patients with recent MI or unstable angina and
without other life-threatening medical conditions.
The effect of exercise on negative affect has been examined in hundreds of studies. However, the effect of exercise on diagnosed clinical depression has received far less attention. Furthermore, poor methodological techniques predominate and results have been conflicting. A meta-analysis was conducted to investigate the effect of exercise on clinical depression and depression resulting from mental illness. The 37 chosen studies (since 1996) examined the effect of a chronic exercise paradigm (independent variable) on depression (dependent variable). Each study's variables were coded: design, subjects, exercise, and dependent measure characteristics that could moderate the effect of exercise on depression. Moderator variables were analyzed using ANOVA. Results showed an overall mean effect of –.72. Therefore, individuals who exercised were –.72 of a standard deviation less depressed than individuals who did not exercise. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Replicates and extends the present authors' (1979, 1984) previous research comparing the effects of running and various kinds of psychotherapy in the treatment of clinical depression, using improved procedures to increase compliance with all treatment conditions. 74 Ss (mean age 30 yrs) completed an assessment battery that included the Social Adjustment Self-Report Scale and the Cornell Medical Index–Health Scale and were randomly assigned to 1 of 3 treatment conditions: running therapy, meditation-relaxation therapy, or group therapy. Data analysis focused on selected variables from the assessment battery that reflected depression, general psychological distress, and symptom changes hypothesized to be specific to each of the 3 treatments. Findings reveal that the majority of Ss assigned to running started treatment, but many dropped out within the 1st 6 sessions. Ss who were assigned to the group or meditation conditions were more likely to drop out immediately (i.e., fail to start). Ss in each condition who completed treatment showed improvement in depression at termination and at 9-mo follow-up. The specific improvement in depression was accompanied by more general improvement in other areas such as global symptoms, interpersonal and somatic distress, anxiety, and tension. Comparisons among treatments suggested that the 3 treatments were generally of equal effectiveness. (53 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Six-month physical activity and fitness changes in Project Active, a randomized trial. Med. Sci. Sports Exerc., Vol. 30, No. 7, pp. 1076-1083, 1998.
Purpose: Project Active is a randomized clinical trial (N = 235) comparing a lifestyle physical activity program with a structured exercise program in changing physical activity (total energy expenditure [kcal·kg-1·d-1]) and cardiorespiratory fitness (V˙O2peak in mL·kg-1·min-1).
Methods: Sedentary but healthy adults (N = 235) aged 35-60 years received 6 months of intensive intervention.
Results: Analysis of covariance (ANCOVA), adjusting for baseline measure, age, gender, body mass index (BMI), cohort, and ethnicity, showed that at 6 months both lifestyle and structured groups significantly increased energy expenditure over baseline (P < 0.001). The mean increases ± SE, 1.53 ± 0.19 kcal·kg-1·d-1 for the lifestyle group and 1.34 ± 0.20 kcal·kg-1 d-1 for the structured group, were not significantly different between groups (P = 0.49). For cardiorespiratory fitness, both groups had significant increases from baseline (P < 0.001). Mean increases ± SE were 1.58 ± 0.33 mL·kg-1·min-1 and 3.64 ± 0.33 mL·kg-1·min-1 for the lifestyle and structured groups, respectively. This was significantly greater in the structured group (P < 0.001). We also studied changes in intensity of physical activity. Both groups significantly increased moderate intensity activity from baseline, but the increase was significantly greater in the lifestyle group than the structured group (P = 0.02). In contrast, the structured group increased its hard activity more than the lifestyle group, but the difference was not significantly different (P = 0.18). Very hard activity significantly increased (P < 0.01) for both groups by 0.25 kcal·kg-1·d-1.
Conclusion: Both intervention approaches are effective for increasing physical activity and fitness over a 6-month period in initially sedentary men and women.
This study determined the efficacy of antidepressant medication for the treatment of depression in the "old-old."
This randomized 8-week medication trial compared citalopram, 10-40 mg/day, to placebo in the treatment of patients 75 and older with unipolar depression.
A total of 174 patients who were 58% women with a mean age of 79.6 years (SD=4.4) and a mean baseline Hamilton Depression Rating Scale score of 24.3 (SD=4.1) were randomly assigned to treatment at 15 sites. There was a main effect for site but not for treatment condition. The remission rate, defined as a final Hamilton depression scale score <10, was 35% for the citalopram and 33% for the placebo groups. However, patients with severe depression (baseline Hamilton depression scale score >24) tended to have a higher remission rate with medication than with placebo (35% versus 19%).
In the oldest group of community-dwelling patients to be studied to date, medication was not more effective than placebo for the treatment of depression. However, given the considerable psychosocial support received by all patients, the placebo condition represents more than the ingestion of an inactive pill. Across sites, there was considerable range in response to medication, 18% to 82%, and to placebo, 16% to 80%.
--To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy, sedentary older adults.
--Year-long randomized, controlled trial comparing (1) higher-intensity group-based exercise training; (2) higher-intensity home-based exercise training; (3) lower-intensity home-based exercise training; or (4) assessment-only control.
--General community located in northern California.
--One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease. One out of nine persons contacted through a community random-digit-dial telephone survey and citywide promotion were randomized.
--For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise training, five 30-minute endurance training sessions per week were prescribed at 60% to 73% of peak treadmill heart rate.
--Treadmill exercise test performance, exercise participation rates, and heart disease risk factors.
--Compared with controls, subjects in all three exercise training conditions showed significant improvements in treadmill exercise test performance at 6 and 12 months (P less than .03). Lower-intensity exercise training achieved changes comparable with those of higher-intensity exercise training. Twelve-month exercise adherence rates were better for the two home-based exercise training conditions relative to the group-based exercise training condition (P less than .0005). There were no significant training-induced changes in lipid levels, weight, or blood pressure.
--We conclude that (1) this community-based exercise training program improved fitness but not heart disease risk factors among sedentary, healthy older adults; (2) home-based exercise was as effective as group exercise in producing these changes; (3) lower-intensity exercise training was as effective as higher-intensity exercise training in the home setting; and (4) the exercise programs were relatively safe.
Thirty community-dwelling, moderately depressed elderly were randomly assigned to 1 of 3 interventions: experimenter-accompanied exercise in the form of walking, a social contact control condition, and a wait-list control. Exercise and social contact both resulted in significant reductions in both the total and the psychological subscale of the Beck Depression Inventory (BDI). The exercise condition, however, unlike the control conditions, resulted in decreased somatic symptoms of the BDI. These results indicate that, at least in the short term, exercise has a broader effect compared with control conditions in reducing depressive symptoms in the moderately depressed elderly.
Major depressives often have abnormalities in the secretion patterns of their anterior pituitary hormones and target endocrine gland hormones. There are changes in both basal hormone secretion and the responses of these hormones to perturbation tests. Considerable work has been done attempting to develop a clinical application for some of these changes as biological state markers of endogenous depression. Prominent among the changes is an overactivity of the hypothalamo-pituitary-adrenocortical (HPA) axis. The dexamethasone suppression test (DST), as a reflection of HPA axis activity, has been the most thoroughly investigated "biological test" in psychiatry to date. Considerably fewer studies have addressed more fundamental issues of HPA axis regulation in depression, such as the relationship between pre-DST cortisol hypersecretion and DST outcome. The next most widely investigated endocrine axis in depression has been the hypothalamo-pituitary-thyroid (HPT) axis. Most studies have dealt with the TSH response to exogenously administered thyrotropin releasing hormone. While blunted TSH responses have been found in depressives compared with normal controls, the frequency of blunted responses in other types of psychiatric patients has made this test marginally useful for differential diagnosis. The reported changes in other hormone axes, for example the blunted growth hormone response to several challenges noted in depressed patients, have not been investigated sufficiently thoroughly to support their general clinical use at present.(ABSTRACT TRUNCATED AT 250 WORDS)
An experiment was conducted to determine whether aerobic exercise training or relaxation training would be effective for reducing the deleterious effects of life stress on physical and psychologic health. Over 1000 college students were surveyed, and 55 of those who reported experiencing a high number of negative life events over the preceding year were assigned to an aerobic exercise training condition, a relaxation training condition, or a no-treatment control condition. Physical and psychologic health were assessed with self-report measures before, halfway through, immediately following, and 8 weeks after the 11-week training (and control) period. Heart rate data collected during a treadmill test indicated that the aerobic exercise training was effective for improving cardiovascular fitness. Psychologic measures indicated that the exercise training condition was more effective than the other two conditions for reducing depression during the first 5 weeks of training. No differences were found among the conditions on self-report measures of physical health. These findings suggest that aerobic exercise training may be useful for reducing the severity and duration of depressive reactions following stressful life change.
The effects of the intensity of exercise training on cardiorespiratory variables were investigated in a consecutive series of men with recent (median 8 weeks) acute myocardial infarction. Forty-five patients were randomly assigned either to a high- (65 to 75% maximum oxygen consumption rate [VO2max]) or to a low-intensity (less than 45% VO2max) exercise group. Patients engaged in medically supervised aerobic training 3 sessions a week for 12 weeks. With training, mean VO2max significantly increased by 11% (2.09 to 2.31 liters/min) within the high group and by 14% (1.93 to 2.21 liters/min) within the low group. Differences between groups were not statistically significant. Both groups also had comparable changes in heart rate, blood pressure and double-product at submaximal and maximal workloads. Analysis of blood lipids revealed that both groups experienced a significant increase in high density lipoprotein cholesterol. There were no significant changes in total serum cholesterol or triglycerides. These findings suggest that within an unselected population of patients after acute myocardial infarction referred for cardiac rehabilitation, low- and high-intensity exercise training produces relatively similar changes in cardiorespiratory variables during the initial 3 months of exercise training.
The Hamilton Depression Rating Scale (HDRS) is the most widely used scale for patient selection and follow-up in research studies of treatments of depression. Despite extensive study of the reliability and validity of the total scale score, the psychometric characteristics of the individual items have not been well studied. In the only reliability study to report agreement on individual items using a test-retest interview method, most of the items had only fair or poor agreement. Because this is due in part to variability in the way the information is obtained to make the various rating distinctions, the Structured Interview Guide for the HDRS (SIGH-D) was developed to standardize the manner of administration of the scale. A test-retest reliability study conducted on a series of psychiatric inpatients demonstrated that the use of the SIGH-D results in a substantially improved level of agreement for most of the HDRS items.
A review of the literature suggests that exercise may have antidepressant effects and, like other treatments for depression such as electroconvulsive therapy (ECT), antidepressant medication, and REM sleep deprivation, may enhance aminergic synaptic transmission in the central nervous system. In addition, the effects of exercise and other antidepressants on sleep are similar. Therefore, it is suggested that exercise is an antidepressant that enhances aminergic synaptic transmission in the central nervous system. Many more psychological and physiological studies must be performed in order to verify and quantify this relationship. Present statements that single out norepinephrine, dopamine, or serotonin as the crucial amine may be premature and oversimplified. Future physiological studies must take into consideration the advantages and disadvantages of human and animal subjects. Future psychological studies should be attentive to possible differences in psychological benefits between normal and depressed subjects and should not neglect the possible role of cognitive factors such as subjects' attitudes towards exercising or the feelings of accomplishment that may result from increased physical fitness. There is also a need to measure antidepressant effects in long-term exercise programs and in studies employing various forms of exercise.
Thirty-four normal male subjects were tested to determine the relationships between physical fitness condition (Ismail criterion), levels of self-reported depression (MMPI) and anxiety (Welsh criterion), and the urinary concentrations of 3-methoxy-4-hydroxyphenylglycol (MHPG), normetanephrine (NM), and metanephrine (M). Urinary samples were collected after sleep and during occupational activities to ascertain the effects of different psychosocial stimuli on the relationships among the variables. Univariately, urinary MHPG did not relate to physical fitness and was moderately related to depression (p less than or equal to 0.10) during the occupational period. Multivariate canonical correlational results revealed a significant (p less than or equal to 0.04) relationship between the biochemical and personality sets of variables during the occupational settings. MHPG was the most sensitive catecholamine metabolite for reflecting depressive conditions. The results suggest a biochemical reactivity syndrome involving MHPG that may relate to depressive personality characteristics.
During the last decade, there has been an increasing use of a placebo run-in period prior to randomization to active treatments, or placebo in randomized controlled trials aimed at establishing acute phase antidepressant drug efficacy in patients with major depression. This procedure is thought to reduce response rates to placebo treatment after randomization, thereby increasing the drug-placebo difference. Metaanalyses of 101 studies reveal that a placebo run-in does not (1) lower the placebo response rate, (2) increase the drug-placebo difference, or (3) affect the drug response rate post-randomization in either inpatients or outpatients for any antidepressant drug group. If there is a post-randomization placebo treatment cell, drug response rates are unchanged or are slightly lower than if there is no placebo treatment cell for outpatients. These results suggest that a pill placebo run-in provides no advantage in acute phase efficacy trials.
The placebo response rate in depression consistently falls between 30 and 40%. Among more severely depressed patients antidepressants offer a clear advantage over placebo; among less severely depressed patients and those with a relatively short episode duration the placebo response rate is close to 50% and often indistinguishable from the response rate to antidepressants. In the treatment of depression none of the psychotherapies have consistently been shown to offer an advantage over pill placebo. This is not entirely surprising given the fact that the common, and arguably the therapeutic, features of the psychotherapies (expectation of improvement, support, mobilization of hope) are provided with pill placebo treatment.
The placebo response in depression has been viewed as a nuisance rather than as a therapeutic and research opportunity. I propose that the initial treatment for selected depressed patients should be four to six weeks of placebo. Patients so treated should be informed that the placebo pill contains no drug but that this treatment can be helpful.
The 12-month effects of exercise training on psychological outcomes in adults ages 50-65 years were evaluated. Ss (N = 357) were randomly assigned to assessment-only control or to higher intensity group, higher intensity home, or lower intensity home exercise training. Exercisers showed reductions in perceived stress and anxiety in relation to controls (p < .04). Reductions in stress were particularly notable in smokers. Regardless of program assignment, greater exercise participation was significantly related to less anxiety and fewer depressive symptoms, independent of changes in fitness or body weight (p < .05). It was concluded that neither a group format nor vigorous activity was essential in attaining psychological benefits from exercise training in healthy adults.
Synopsis
This paper draws attention to an important adverse outcome in depression, the occurrence of residual symptoms after partial remission. Among patients with definite major depression followed every 3 months to remission and thereafter, residual symptoms reaching 8 or more on the Hamilton Depression Scale 17-item total were present in 32% (19) of the 60 who remitted below major depression by 15 months. The pattern was of mild but typical depressive symptoms. Residual symptoms were more common in subjects with more severe initial illness, but were not related to any other predictors, including longer prior illness, dysthymia, or lower dose of drug treatment during the illness episode. There were weak associations with personality that might have been consequences of symptom presence. Residual symptoms were very strong predictors of subsequent early relapse, which occurred in 76% (13/17) of those with residual symptoms and 25% (10/40) of those without.
We examined the effects of chronic activity wheel running on brain monoamines and latency to escape foot shock after prior exposure to uncontrollable, inescapable foot shock. Individually housed young (approximately 50 day) female Sprague-Dawley rats were randomly assigned to standard cages (sedentary) or cages with activity wheels. After 9-12 weeks, animals were matched in pairs on body mass. Activity wheel animals were also matched on running distance. An animal from each matched pair was randomly assigned to controllable or uncontrollable inescapable foot shock followed the next day by a foot shock escape test in a shuttle box. Brain concentrations of norepinephrine (NE), dopamine (DA), dihydroxyphenylacetic acid (DOPAC), 5-hydroxytryptamine (5-HT), and 5-hydroxyindole acetic acid (5-HIAA) were assayed in the locus coeruleus (LC), dorsal raphe (DR), central amygdala (AC), hippocampus (CA1), arcuate nucleus, paraventricular nucleus (PVN), and midbrain central gray. After prior exposure to uncontrollable foot shock, escape latency was reduced by 34% for wheel runners compared with sedentary controls. The shortened escape latency for wheel runners was associated with 61% higher NE concentrations in LC and 44% higher NE concentrations in DR compared with sedentary controls. Sedentary controls, compared with wheel runners, had 31% higher 5-HIAA concentrations in CA1 and 30% higher 5-HIAA concentrations in AC after uncontrollable foot shock and had 28% higher 5-HT and 33% higher 5-HIAA concentrations in AC averaged across both foot shock conditions. There were no group differences in monoamines in the central gray or in plasma prolactin or ACTH concentrations, despite 52% higher DA concentrations in the arcuate nucleus after uncontrollable foot shock and 50% higher DOPAC/DA and 17% higher 5-HIAA/5-HT concentrations in the PVN averaged across both foot shock conditions for sedentary compared with activity wheel animals. The present results extend understanding of the escape-deficit by indicating an attenuating role for circadian physical activity. The altered monoamine levels suggest brain regions for more direct probes of neural activity after wheel running and foot shock.