An article soon to be published in the Journal of Affective Disorders finds that while running therapy and antidepressants have similar effects on depressive symptoms, running therapy is much better for participants’ physical health.
The study split participants into two groups, one that was given antidepressants and another that took part in supervised 45-minute jogging sessions. Where participants that were given antidepressant treatment experienced deterioration of physical health, those given exercise therapy as treatment saw improvements. The authors write:
“While the interventions had comparable effects on mental health, running therapy outperformed antidepressants on physical health, due to both larger improvements in the running therapy group as well as larger deterioration in the antidepressant group.”
The current research set out to compare the effects of antidepressants and exercise as treatments for participants with depression and anxiety disorders. To accomplish this goal, the authors split 141 participants between 18 and 70 years of age into two groups, one that received the antidepressant escitalopram and one that received running therapy. Some participants in the antidepressant group were prescribed a second antidepressant (sertraline) if the first was ineffective. Participants in the running group were encouraged to run for 45 minutes 2 or 3 days per week.
The participants could select which group they were assigned to or could opt to be assigned randomly to a group. As a result of participant preference, 45 participants joined the antidepressant group and 96 the running therapy group. Participants were given baseline assessments before their interventions and 16 weeks after starting either antidepressants or exercise. The assessments included mental health (diagnosis and symptom severity) and physical health (heart rate, heart rate variability, weight, lung function, waist circumference, blood pressure, etc.). Participants were excluded from the current work based on seven exclusion criteria:
- Use of antidepressants in the last two weeks
- Use of other psychotropics (excluding benzodiazepines)
- Regular exercise
- Mental health diagnoses other than depression or anxiety disorders
- Suicide risk
- Physicians advising against either of the interventions (for example, people with severe heart problems)
82.2% of participants in the antidepressant group and 52.1% in the running group adhered to the treatment protocol. In the running therapy group,14 participants (15%) never started treatment, and 16 (17%) participated in 9 sessions or less.
While the antidepressant group saw a slightly quicker improvement in mental health symptoms, remission rates were not significantly different at the 16-week mark. 43.3% of the running therapy group and 44.8% of the antidepressant group saw a remission of their symptoms at the conclusion of the study. The authors note that remission did not mean an absence of symptoms and that even those participants “still had considerable depressive and anxiety symptomatology.”
Regarding physical health, the running therapy group saw significant improvements, with a decrease in heart rate, blood pressure, and waist circumference and an increase in lung function. Conversely, the antidepressant group saw a deterioration of their physical health with increased weight (3kg on average), blood pressure, triglycerides, and a decrease in heart rate variability.
The authors mention two limitations to the current work. First, relatively few participants were willing to be assigned a treatment group randomly (15%), which made the randomly assigned group too small for separate analyses. Second, the participants largely preferred the running therapy group, making the antidepressant group much smaller. The authors conclude:
“We showed that while antidepressant medication and running therapy did not statistically significantly differ on mental health outcomes … antidepressant users showed a decrease in heart rate variability and increases in waist circumference, blood pressure, and triglyceride levels, suggestive of an increased incidence of metabolic syndrome, and higher cardiovascular risk. The running group showed a decrease in both metabolic syndrome components and heart rate, which indicated, in turn, protective effects on cardiovascular incidents. Overall, this study showed the importance of exercise in the depressed and anxious population and cautions against antidepressant use in physically unhealthy patients.”
Recent research has shown that exercise treats mild to moderate depression as well as antidepressants. One review found that the effects of exercise on depression are likely underestimated due to publication bias. Exercise appears to be protective against depression as well, with as little as 15 minutes of exercise 3 times a week linked to less depressive symptoms in older adults. Research has also found that people who did the equivalent of 2.5 hours of brisk walking per week had a 25% reduced risk of depression.
Research has found that antidepressants are no better than a placebo for 85% of people. Another piece of research found that antidepressants are “largely ineffective and potentially harmful.” Similar research has shown that antidepressants are ineffective for children and adolescents.
Verhoeven, J. E., Han, L. K. M., Lever-van Milligen, B. A., Hu, M. X., Révész, D., Hoogendoorn, A. W., Batelaan, N. M., van Schaik, D. J. F., van Balkom, A. J. L. M., van Oppen, P., & Penninx, B. W. J. H. (2023). Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.02.064 (Link)
Richard, thank you for this informative article. I’ve read your essay as well as the original article which is available free and in full here: https://www.sciencedirect.com/science/article/pii/S0165032723002239?via%3Dihub.
The finding that running therapy is as effective as antidepressants at reducing depression/anxiety in a 16-week study is notable and consistent with previous research. For me, the most significant finding is that antidepressants actively worsened the physical health of people who took them in numerous ways. After 4 months of taking an antidepressant, the average participant gained a whopping 3.3 kg, which is 7.3 pounds. Heart rate variability, blood pressure, and inflammation significantly worsened. In contrast, all physical health measures were either unchanged or significantly better in the running therapy group.
The authors concluded their article by stating, “Overall, this study showed the importance of exercise in the depressed and anxious population and caution of antidepressant use in physically unhealthy patients. Exercise therapy is therefore a valuable option in mental health care with respect to both mental and physical health and should be considered standard practice for those with depression and/or anxiety disorders.”
True. But they left out the other equally obvious conclusion based on their findings: an intervention that actively worsens participants’ physical health should not be used when an equally effective alternative exists that does not cause such harm.
First do no harm. Right?
That’s exactly my reaction! If you have two options, one of which is completely safe and without notable adverse effects, while the other has all sorts of possible damage AND stops working as soon as you stop it, and both are “equally effective,” clearly, the first is FAR preferable! But the researchers never seem to say this. Maybe they’re not “allowed” to!
I also agree, Brett.
Steve, the psych “professionals” can’t make money off of prescribing exercise, like they do off of prescribing the anticholinergic drugs.
But I will say I find it rather amazing how many times we must tell the psych “professionals” that exercise is good for you. Yet I know we do need to do this, since my psychiatrist tried to get me to stop exercising.
I love running and can attest to the positive effect on mood and mental health, especially once you’ve trained to the level where you start having runner’s high, which I find hugely beneficial.
I think there are a few issues with this research though. It says that the jogging sessions were supervised (the link to the paper says ‘group-based’). That means there’s a social aspect to it which the antidepressant group didn’t have (assuming they were left to themselves and just swallowed the pills). I think that’s a big confounder because social interactions are known to affect depression.
Secondly, in terms implementing it in real life I think the training protocol is unsound. Since participants doing regular exercise were excluded, all of these people were unfit. For physically inactive people, going from nothing to running for 45 mins 2-3 times per week is way too much. If you try to run way past your fitness level for long periods of time this is experienced as stressful and overly exhausting. Maybe that’s why only half of the participants adhered to the running therapy, despite the mental health benefits.
Also, I don’t think you should be running that much if you’re overweight because it could damage your knees. I guess that might come under point 6. Physicians advising against the intervention. In practice a lot of people are overweight and might be better off doing brisk walking.
Obviously exercise is advisable and effective, but it should be done in a realistic way so that people will actually be able to stick to it and derive the long term benefits.
You make some excellent points. I wish the authors would have used a walking rather than running condition. Almost anyone can walk but if I were depressed and physically unfit, I’d imagine running at least twice a week for 45 minutes would seem like too much. I’m not sure how broadly applicable the implications of this study are. Is the benefit attributable to being in a group, aerobic exercise specifically, exercise in general, or an unknown combination of these?
And Steve, my thoughts exactly, I would guess they are not allowed to state the obvious. I’m also guessing this unwritten rule is so clear the authors didn’t even try. This would almost certainly result in the paper being rejected from that particular journal.
Therapy is an conveninet escape from sth which is very hard to bare. It is a form of nihilism, the reality of the depression is when you actually can’t move and you are not happy – and this is not theological sin, this is psychological necessity. Those psychologically shallow are empty and that is why they are privileged in materialism, and they are using transcendence against those who are controlled by things they do not understand, and do not have control over it. Grow up to understand the reality of psychological issues. Grow up, followers of easy recipes, and easy escapes. Psychiatry preserves Wall Street, mammon and moloch. Not the psyche. Psyche is not an empircial problem to be solved by barbaric intellectuals. Psyche it is not a toy for medicine of whatever kind.
James Hillman, “Re-Visioning Psychology”.
Speaking as someone who took antidepressants for 24 years, here. It’s not much of a comparison to say running works as well. I would hope it works much better.