When it comes to beating depression and anxiety, antidepressants have become the common go to, but new research from the Netherlands has challenged our preference for pills over exercise, revealing that running could be just as, if not more effective.
According to the study, published in the Journal of Affective Disorders, both running, and antidepressants showed similar benefits for mental health – but a 16-week course of running over the same period scores higher in terms of physical health improvement, whereas antidepressants led to a slightly worse physical condition.
The study involved 141 patients with depression and/or anxiety who were offered a choice of two treatments – a course of the SSRI Escitalopram for 16 weeks or participating in group-based running therapy for the same period.
While 45 chose antidepressants, 96 participated in running, and the team noted that the members of the group which chose antidepressants were slightly more depressed than the members of the group which chose to take running.
The running group aimed for two to three closely supervised 45-minute group sessions per week and adherence to the protocol was lower in the running group (52%) than in the antidepressant group (82%), despite the initial preference for running over antidepressants.
At the end of the trial, around 44% % in both groups showed an improvement in depression and anxiety, however the running group also showed improvements in weight, waist circumference, blood pressure, and heart function, whereas the antidepressant group showed a tendency towards a slight deterioration in these metabolic markers.
Lead author, Professor Brenda Penninx, from Vrije University, Amsterdam, explained that despite the well-known benefits of exercise, this was the first trial to directly compare effects of treatments on mental and physical health.
“This study gave anxious and depressed people a real-life choice, medication, or exercise. Interestingly, the majority opted for exercise, which led to the numbers in the running group being larger than in the medication group,” she said.
“Both interventions helped with the depression to around the same extent. Antidepressants generally had worse impact on bodyweight, heart rate variability and blood pressure, whereas running therapy led to improved effect on general fitness and heartrate for instance… we showed that persons on antidepressants gained on average 3kg over the 16 weeks and benefited from a significant difference in waist circumference change, with an increase of 1.5cm.
“Treatment with antidepressants required patients to adhere to their prescribed medication intake but this generally does not directly impact on daily behaviours.
“In contrast, exercise directly addresses the sedentary lifestyle often found in patients with depressive and anxiety disorders by encouraging persons to go outside, set personal goals, improve their fitness, and participate in a group activity.”
The researchers highlighted that significantly, clinicians need to remember that ‘there is room for both therapies in care for depression.’
“Antidepressants are generally safe and effective. They work for most people. We know that not treating depression at all leads to worse outcomes; so, antidepressants are generally a good choice,” Professor Pennix pointed out.
“Nevertheless, we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them. Our results suggest that implementing exercise therapy is something we should take much more seriously, as it could be a good – and maybe even better – choice for some of our patients.
“Doctors should be aware of the dysregulation in nervous system activity that certain antidepressants can cause, especially in patients who already have heart problems.”
Another important clinical finding was the difference in treatment adherence to the interventions, and particularly the compliance in the running therapy group of 52 % (despite the high patient preference for this intervention).
“It should be noted that in this trial 14 participants (15 %) did not start with the running therapy intervention at all, showing that it is important (but also challenging) to stimulate adherence from the start,” the authors said.