Exercise or Medication: How to Deal With Depression

One of the most important and effective treatments for depression is exercise. Knowing that exercise will help combat depression and actually getting out there to exercise are two completely different things.

The depressed person is often called “lazy”. The truth of the matter is, the depressed person lacks the drive to do just about anything. Sometimes, getting out of bed is often an insurmountable challenge.

It’s definitely a catch-22. You have depression and you know that exercise will help but the symptoms of your depression (lack of motivation, fatigue, inability to make decisions, etc.) prevent you from exercising. It’s a constant battle between what you should do and what you can do.

Here is why you must find a way infuse an exercise plan in your daily life.

Dealing With Depression: Exercise vs. Medication

James Blumenthal is a neuroscientist at Duke University who specializes in depression. In one of his most famous experiments, published in the Journal of Biobehavioral Medicine, Blumenthal gathered 156 adults who had mild or moderate cases of depression.

The patients were split into three groups.

Group 1 was treated with sertraline, an antidepressant drug. You probably know sertraline by it’s trade names Zoloft and Lustral. In 2011, over 37 million sertraline prescriptions were written to treat a wide range of issues, including major depressive disorder, obsessive–compulsive disorder, panic and social anxiety.

Group 2 used a combination of exercise and medication. They were prescribed the same dosage of sertraline as Group 1. Additionally, Group 2 exercised three times each week for 45 minutes. They followed the same exercise program that is described for Group 3 below.

Group 3 used an exercise only treatment. Three times per week, they performed 45 minutes of exercise. This included 10 minutes of warm up, 30 minutes of walking or jogging at a pace that would maintain a heart rate that was 80% to 90% of their maximum, and then 5 minutes of cool down.

Here’s what happened…

Each patient received treatment for 16 weeks (4 months) under the supervision of the researchers and professional staff. At the end of the treatment period, the researchers were surprised to find that all three treatments delivered essentially equal results.

Treating depression with exercise was just as effective as medication, and vice versa. Furthermore, combining the two treatments yielded the same success rate as doing either one individually.

But then the researchers decided to track the long–term progress of each patient and this is where the study gets really interesting…

Exercise and Depression: The Long–Term Impact

After 16 weeks of treatment, there were 83 patients (spread evenly across all three groups) that were declared in remission and free from depression.

The researchers decided to let these patients spend the next six months without receiving any treatment from professionals. The patients were welcome to continue their treatment on their own or to try something new entirely.

When the researchers followed up with the patients six months later, here’s what they found…

• In the medication only group, 38% of patients relapsed into depression.
• In the exercise and medication group, 31% of patients relapsed into depression.
• In the exercise only group, only 8% of patients relapsed into depression.

You can see the results of the study in the graph below. Notice that over 85% of patients in the exercise only group remained depression free after 6 months on their own.

What made the difference?

Why Exercise Outperformed Medication

Dr. Blumenthal and his colleagues described the differences between exercise and medication like this…

One of the positive psychological benefits of systematic exercise is the development of a sense of personal mastery and positive self–regard, which we believe is likely to play some role in the depression–reducing effects of exercise.

In other words, exercise confirms your new identity to yourself. It changes the type of person that you believe that you are and proves that you can become better. (I’ve previously said that the self–confidence that comes with exercise is one of the biggest benefits of weight training.)

This philosophy directly aligns with our community’s focus on identity-based habits. It doesn't matter if you’re battling depression, working to lose weight, or trying to create work that matters. Your identity — the type of person that you believe that you are — is what dictates how far you’ll go in any endeavor.

When it comes to beating depression over the long–term, this is what makes exercise more powerful than medication. It’s not that medication doesn't work — it does. But exercise does something that medication doesn’t. It proves a new identity to yourself. Each time you finish a workout, you reap the benefits of an increased sense of self–confidence. The cumulative impact of these “small wins” is enormous.

In the words of the researchers, patients who only used medication had the following internal thoughts…

Instead of incorporating the belief “I was dedicated and worked hard with the exercise program; it wasn't easy, but I beat this depression,” patients might incorporate the belief that “I took an antidepressant and got better.”

It seems small, but this subtle shift in empowerment and self–confidence is huge. It’s your identity that carries you to success.

• If you believe that you’re the type of person who doesn’t miss workouts, then you’re going to get in great shape.
• If you believe that you’re the type of person who overcomes uncertainty, then you’ll succeed when you face a challenge.
• If you believe that you’re the type of person who puts others first, then you’ll live a life of service.

But no matter what, it’s your identity that carries you to long–term success. And this is where medication falls short. It treats your symptoms, but doesn’t rebuild your identity.

Cut Your Risk of Depression by Half

As the researchers sorted through the data, they discovered that for every 50 minutes of exercise added each week, the rate of depression fell by half. In other words, if you’re not exercising right now, then adding just 1–hour of walking per week will cut your risk of depression by 50%.

The same holds true if you’re already an exerciser. Let’s say that right now you exercise for 5 hours each week. Bumping it up to 6 hours will cut your personal risk of depression by half.

I’m sure there is an upper limit to this at some point, but the evidence is clear: exercise often and it’s more likely that you’ll enjoy the rest of your life.

Are there Types of Exercises That Are Better for Depression?

It appears that any form of exercise can help depression. Some examples of moderate exercise include:

• Biking
• Dancing
• Gardening
• Golf (walking instead of using the cart)
• Housework, especially sweeping, mopping, or vacuuming
• Jogging at a moderate pace
• Low-impact aerobics
• Playing tennis
• Swimming
• Walking
• Yard work, especially mowing or raking
• Yoga

Because strong social support is important for those with depression, joining a group exercise class may be beneficial. Or you can exercise with a close friend or your partner. In doing so, you will benefit from the physical activity and emotional comfort, knowing that others are supportive of you.

Should I Talk to my Doctor Before Exercising?

For most people, it is OK to start an exercise program without checking with a health care provider. However, if you have not exercised in a while, are over age 50, or have a medical condition such as diabetes or heart disease, contact your health care provider before starting an exercise program.

How Can I Decide What Types of Exercise to Do?

Before you begin an exercise program for depression, here are some questions you should consider:

• What physical activities do I enjoy?
• Do I prefer group or individual activities?
• What programs best fit my schedule?
• Do I have physical conditions that limit my choice of exercise?
• What goals do I have in mind? (For example: weight loss, strengthening muscles, improving flexibility, or mood enhancement)

How Often Should I Exercise to Ease Depression?

Try to exercise at least 20 to 30 minutes, three times a week. Studies indicate that exercising four or five times a week is even better. Take it easy if you are just beginning. Start exercising for 20 minutes. Then you can build up to 30 minutes.

What Are Some Tips for Getting Started Exercising?

When you first start your exercise program, you should plan a routine that is easy to follow and maintain. When you start feeling comfortable with your routine, then you can start varying your exercise times and activities.

Here are some tips to help you get started:

• Choose an activity you enjoy. Exercising should be fun.
• Put your exercise routine into your schedule. If you need reminding, put it on your calendar.
• Variety is the spice of life. Make sure you vary your exercises so that you don't get bored. Check your local gymnasium or community center for an assortment of exercise programs.
• Don't let exercise programs break the bank. Unless you are going to be using them regularly, avoid buying health club memberships or expensive equipment.
• Stick with it. If you exercise regularly, it will soon become part of your lifestyle and will help reduce your depression.