Yet Another Reason to Go to the Gym: How Exercise Can Help Fight Depression
Prozac and its competitors have spawned best-selling books, racked up sales of more than $10 billion annually and reshaped the clinical treatment of depression.
But an altogether different treatment that shows tremendous promise in alleviating depression has gone largely unnoticed. That treatment is exercise. A growing body of medical literature, including at least three 2005 studies, is showing that aerobic routines as well as weight lifting are effective at combating depression. In addition to the famous "runner's high," or endorphin surge that provides a temporary mood lift following a workout, the studies show that there is a round-the-clock relief that sets in several weeks after the establishment of a regular exercise routine.
A study in the January issue of the Journal of Preventive Medicine suggested that a half-hour a day of exercise six days a week -- which is the amount the federal government recommends for all Americans -- might be ideal. Comparing two groups of depressed patients, the study found that the group that performed only 80 minutes of exercise a week received little to no mental-health benefit. But the three-hour-a-week group had a substantial reduction in symptoms. The study concluded "the response and remission rates in the (three-hours-per-week) group are comparable to other depression treatments, such as medication or cognitive behavioral therapy."
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Certainly, the need exists for additional tools to fight depression. It is a primary cause of suicide -- which is one of the top 15 causes of death -- and its burden on patients and on society is second only to that of heart disease, according to a U.S. Surgeon General's report. Between 20% and 30% of depression patients don't respond to medication after a year of taking it, says Douglas G. Jacobs, associate clinical professor of psychiatry at Harvard Medical School.
Nobody, however, is suggesting that depressed patients need only start running around the block. "I wouldn't say to anybody that exercise should be at the top of their list," says Gerald P. Koocher, president elect of the American Psychological Association. "First, get a good diagnostic evaluation. Then get your mood stabilized." And then add exercise to other treatments. Studies have shown that a combination of antidepression treatments are more effective than a single treatment.
If, as some studies have suggested, exercise is even remotely as effective as medication, then in some respects it could be an ideal treatment. It's less expensive than medication and psychotherapy. It doesn't cause sexual dysfunction or harbor potentially fatal side effects when combined with other drugs, as do some antidepressants. Exercise as a mental-health treatment has dramatically positive side effects: enhanced cardiovascular health and waist-line management.
But there are also obvious problems. Mental-health experts usually aren't fitness trainers and have no way of monitoring patient compliance with a workout regimen. Moreover, does it make sense to prescribe 30 minutes on the treadmill to a patient who can barely climb out of bed? It "is challenging enough for those who are not suffering from depression" to exercise three hours a week, says Harvard's Dr. Jacobs.
Yet depressed patients who are motivated enough to get help in many cases might be motivated enough to exercise on their own. And once they start, studies suggest many will get hooked. In surveys, people who exercise regularly cite as its main appeal its mental and emotional rewards. "The most prevalent reason that people stick with exercise is its effect on mood," says Andrea Dunn, a doctor of behavioral science whose research has focused on exercise.
But is anybody telling depressed patients about exercise? Unlike depression medication -- which has behind it the research and marketing clout of the pharmaceutical industry -- exercise has behind it little research or advertising money. Consequently, the studies supporting it are typically too small to win publication in major medical journals. Without any marketing push, the studies are getting little attention.
Interviews with psychiatrists -- medical doctors whose specialty is mental health -- suggest that some aren't even aware of the body of literature supporting exercise as a treatment for depression. When the American Psychiatric Association is asked to provide a psychiatric expert on exercise and depression, it recommends James Lake, a California psychiatrist who says he believes his specialty is too narrowly focused on medication.
"Because of collective professional values and financial interests of academic psychiatry, research priorities have almost exclusively targeted psychopharmacology," says Dr. Lake. However, Dr. Lake points out that the association recently created a committee to research and provide information about alternative therapies, including exercise.
Psychologists are much more aware of exercise as an antidepressant. Indeed, psychologists have produced the majority of the research on exercise and depression. The Web site of the American Psychological Association features an entire page describing exercise as a legitimate third leg of treatment, along with psychotherapy and medication.
Later this month, the annual meeting of the American Psychiatric Association will feature a seminar called, "Does exercise have a place in psychiatry?" One of the two presenters of that seminar isn't a psychiatrist but rather a doctor of psychology, James Annesi.
The other presenter is a 77-year-old psychiatrist who years ago deduced from his own running experience that exercise had tremendous mood-altering potential. The psychiatrist, Sheldon B. Cohen, also devised a way to get his patients exercising: He walked and ran with them during psychotherapy sessions.
治疗抑郁的新手段──锻炼
锻炼其实是一种很能纾缓抑郁症状的手段，但可惜的是大多数人都忽视了这一点。越来越多的医学文献（至少2005年的三份研究）显示，常规的有氧训练和举重锻炼都能有效地缓解抑郁症状。研究显示，运动能带来短暂的心情舒畅，而且，一旦养成经常锻炼的习惯，可以在几周里时时刻刻都能感受到抑郁症状的减轻。
Journal of Preventive Medicine在1月刊的一份研究中显示，每周锻炼6天、每天锻炼半个小时或许是最理想的锻炼强度，而这也正是联邦政府对所有美国人的建议。研究对两组抑郁症患者进行了观察，那些每周只锻炼80分钟的患者在精神状态上没有什么好转，但每周锻炼3个小时的患者群的抑郁症状就得到了显著的缓解。研究得出结论，后一个群组的症状缓解程度可以同其他治疗抑郁症的方法相媲美，如药物治疗或认知行为治疗。
当然，治疗抑郁症还需要其他的手段。U.S. Surgeon General的报告显示，抑郁症是自杀的主要原因，而自杀是15种最常见死亡原因的一种。它给患者造成的痛苦、给社会带来的负担仅次于心脏病。哈佛医学院(Harvard Medical School)的临床助理教授道格拉斯?雅各布(Douglas G. Jacobs)表示，在服药治疗1年后，药物便对20%-30%的抑郁症患者失去了疗效。
不过，没有人会建议抑郁症患者必须每天从早到晚地锻炼个不停。美国心理学学会(American Psychological Association)会长杰拉德?库切(Gerald P. Koocher)表示，“我不会对任何人说锻炼是他们生活中的首要任务。我会建议他们，首先好好地做一个诊疗，然后把心绪安定下来。”之后，用锻炼辅助其他治疗方法。有研究显示，就治疗抑郁症而言，多管齐下比单一疗法的效果要更为明显。
尽管一些研究显示锻炼在缓解抑郁症方面和药物治疗一样都没有什么明显的效果，但在某些方面它却是一个理想的治疗方式。首先，它的花费要少于药物和心理治疗。而且，它也不会导致性功能紊乱。另外，在同其他药物配合使用时也不会带来可能致命的副作用，这一点是一些抗抑郁药物所无法比拟的。相反，用锻炼来改善心理健康状况还会产生非常积极的副作用：不但可以提高心血管的健康，还能让你拥有一个苗条的身材。
但也存在著明显的问题。心理健康专家们往往不是健身教练，他们不懂得如何督促患者来执行锻炼计划。况且，你认为让一个连床都爬不起来的患者在脚踏车上锻炼30分钟可行吗？哈佛医学院的雅各布表示，让那些没有患上抑郁症的人每周锻炼3个小时都是件非常困难的事。
许多情况下，与其鼓励抑郁症患者接受帮助倒不如鼓励他们主动锻炼。研究显示，一旦他们开始锻炼，就会乐此不疲。调查显示，那些经常锻炼的人表示，锻炼的魅力主要体现在它给人带来了精神面貌和思想情绪上的积极变化。专注研究锻炼的行为科学医生安德列亚?邓恩(Andrea Dunn)表示，在询问人们为何坚持锻炼时，最常见的一个说法是它能让心情变得舒畅起来。
但是否有人告诉抑郁症患者锻炼的妙用呢？与背后有医药行业强大研发及营销支持的药物治疗不同的是，围绕锻炼这个课题的研究和宣传投入少得可伶。其结果是，那些宣传锻炼的调查往往因为势单力薄而无法在权威的医学刊物上发表。缺乏权威刊物的配合导致这些研究少人问津。从对精神病医生的采访中可以看出，一些精神病医生甚至都不知道有医学刊物支持把锻炼作为治疗抑郁症的一种方法。
相比之下，心理学家对锻炼在治疗抑郁症方面的疗效有著较为充分的认识。事实上，多数对锻炼和抑郁症的研究都是由心理学家完成的。美国心理学会(American Psychiatric Association)的网站用一整页的篇幅把锻炼认定为心理疗法和药物疗法之外的第三种得到承认的治疗手段。
