ExerciseandPsychotherapy: Better than Antidepressants
Michael Conner, Psy.D.
Almostany strenuous exercise for 30 minutes three to five times a week canreduce oreliminate symptoms of depression. This can include activities likestrenuouswalking, hiking, rowing, biking, running or weight lifting. Combiningexerciseand psychotherapy is more effective than combining antidepressants withpsychotherapy. Only 15 to 25% of depressed people improve somewhattakingantidepressants. Research repeatedly confirms that 40 to 50% ofdepressedpatients get better because of the passage of time, fortunate events orchangesthey make in their lives. Psychotherapy can empower people to makechanges andincorporate exercise into their lives.
Too often weaccept theoutdated assertion that medication and psychotherapy are the "proven"treatmentmodes for depression. Psychotherapy and exercise can reduce oreliminatesymptoms of depression in almost anyone. There are good studies thatdemonstrate this and my work with patients confirms it.
Exerciseis an important and positive addition to psychotherapy. Books, articlesandguidelines for combining exercise and psychotherapy in treatment havebeendeveloped. I'm so convinced of this that I installed an exercise gym inmyoffice for patients. I also have simple exercise equipment patients cantakehome with them. The combined results and interaction effects areimmediate andpowerful. I can hardly imagine using antidepressants as the firsttreatment fordepression.
Accordingto the U.S. Health Department, more and more people are depressed. Thereasonsare stress, the consequences of stress, and a culture that promotes thepursuitof stimulation and pleasure as distraction or escape from emotionalproblems.Instead of more healthy activities, people are pursuing stimulation andpleasure through food, alcohol, television and video games whilesitting on thecouch.
Whydo patients in the U.S. take antidepressants without trying morehealthy andproven approaches first? There are two reasons:
First,antidepressantsare big business. Americans spend more than 86 billion dollars a yearonantidepressants alone. Pharmaceutical companies spend nearly 10 billiondollarseach year on marketing and promotion. Antidepressants are among themostcommonly prescribed and most profitable drugs in America. Very littlemoney isspent in the U.S. to promote awareness of healthier alternatives.
Second,people in the U.S. seem to believe drug marketing. Research results arewidelymisinterpreted and oversimplified in U.S. newspapers, magazines and ontelevision. The problem has become so wide spread that many health careandmental health professionals misunderstand the research as well.
Journalists,media personalities and advertisements incorrectly report thatantidepressantscan help up to 65% of people diagnosed with depression. But when youread theresearch, and account for placebo effects, you realize that 40 to 50%ofdepressed people would get better without an antidepressant. Only 15 to25%improve somewhat on drugs. Research repeatedly confirms that 40 to 50%ofdepressed patients get better because of the passage of time, changesthey makein their lives, and fortunate events. And if you read all the studiesonantidepressants you discover that nearly 6 out of 10 studies show thatantidepressants don't work at all. The failed studies are neverpublicized andare often kept secret. There is very little difference in how "antidepressing"one antidepressant is over another. In fact, the "new generation" ofantidepressants (like Prozac) are not more effective than the old ones.Themain difference is a patient's ability to tolerate unpleasant and evenembarrassing side effects. The newest medications are just moreexpensive withdifferent risks and side-effects.
Thereare some important realities that are fully supported by research andpublications.
How Do MostPeopleRecover From Depression?
Mostpeople get better because of the passage of time, fortunate events, orpositivechanges in their life style. Medications can prevent people from makingchangesin their life. In Europe, many people who stay on antidepressants for10 yearsare generally worse off than those who found and chose healthyalternatives.Psychotherapy and exercise can help create a better life.
Professionalsoften refer to psychotherapy as a "talking cure". In fact it is apsychologicaland behavioral science. It is about our awareness as well as what wethink,feel and do.
Exercisecan benefit people of all ages. Almost any strenuous exercise canreduce or eliminatesymptoms of depression. This can include activities like walking,hiking,rowing, biking, running or weight lifting. Exercise on a daily basisthatinvolves social interaction is best. The effect of exercise ispositive, bothimmediately and long term.
Researchersat the University of Texas Southwest Medical Center found thatreduction ofdepressive symptoms after individuals exercised for 30 minutes, threeto fivetimes per week over 12 weeks. High-intensity activity produced a 47percentreduction. Low-intensity activity resulted in a 30 percent reduction.Stretching activity revealed only a 29 percent reduction
ADuke University study compared the benefits of aerobic exercise,medication anda combination of the two. After 10 weeks of treatment, patients in allthreegroups were significantly less depressed, and two-thirds no longer metthediagnostic criteria for depression. And when researchers followed upwith thetest subjects six months after the study was completed, they foundpatients inthe exercise group were more likely to be partially or fully recoveredthanthose who were in the medication or medication plus exercise groups.
Dependingon the study, the effectiveness of psychotherapy and antidepressantscan bevery misleading. Short term studies make antidepressants look moreeffectivethan they are in reality. A 12 week study by the National Institute ofMentalHealth (NIMH) concluded that antidepressants are more effective thanpsychotherapy and that psychotherapy combined with antidepressants isbest inthe treatment of depression. However, another NIMH study ofantidepressantsdemonstrates that a 16 week trial of psychotherapy is more effective inthelong run to one year of antidepressants. Patients who have 16 weeks ofpsychotherapy will have about the same relapse rate a year later aspeople whotake an antidepressant the whole time.
Thefollowing will be true for the majority of people
Exercisecan be included in a psychotherapy treatment plan and used as abehavioralhealth "action method". A psychologist might talk with a patient whilethey areexercising. When combining psychotherapy during exercise, a therapistmightwork with a patient on their prior experience with exercise, their fearofequipment, anxiety when exercising in public, fear of injury, or theirdiscomfort using and gaining awareness of their own body.
Resistanceto exercise can be addressed using techniques such as historicalre-synthesis,perceptual shifting, countering, stress inoculation, validation andoperantconditioning. Realistic expectations and beliefs about the benefits canbereinforced in vivo and through documentation of gains over time. Apsychologistmay eventually prescribe exercise between appointments. Patients aremorelikely to continue exercise as a life style when therapeutic exerciseisincluded and reinforced as part of a treatment plan.
Psychotherapyis more than just talking about problems. It is about supporting ahealthylifestyle where people are engaged in meaningful, stimulating andrewardingactivities. The biggest challenge for a person who has been depressedis tostart exercising and to keep exercising once they feel better. Patientshavedifficulty starting exercise. Motivation is usually low because theyaredepressed and exercise requires an investment of energy that is oftenlow tobegin with. Depressed people often have realistic and unrealistic fearsthatneed to be examined. People who are depressed often have a pessimisticattitude. They are often reluctant to change their lifestyle to includesomething unfamiliar that requires a long term commitment and efforts.
Researchand experience reveals that merely recommending new behavior topatients is notadequate to initiate and maintain a change. This appears to be whyphysiciansand psychologists who merely recommend exercise find that very fewpatientsactually follow their advice and remained committed.
Psychologistsare uniquely qualified to help patients change their behavior and lifestyle.However, research indicates that the willingness of a psychologist torecommendand use exercise in a treatment plan is probably related to their ownexperience and commitment to exercise.
Peoplewho have not seen a health care professional in a long time, and thosewithhealth problems, should have a medical check-up before entering a newexerciseprogram. This is especially important for people who have high bloodpressure,are overweight, smoke, are diabetic or have family history of heartdisease.People with skeletal or muscle problems should consult with a physicaltherapist.People are more likelyto continue exercise if their activity involves positive socialexperience, scheduledtimes for exercise and when they measure progress and pay attention toall thebenefits. Exercise and psychotherapy can eliminate depression andcreate joy.
Michael Conner isa psychologist who practices in Bend Oregon.
965 NE Wiest Way, No. 2
Bend, Oregon 97701541388-5660