2023-08-12 05:00:31
Psychotropic drugs and psychotherapy – these are the drugs of choice for depression. These two treatment options indicate loudly “Depression Report Austria” in acute therapy “a similarly moderate potency”. Sport and exercise is only listed as a supporting supplement. The meta-analysisrecently published in the British Journal of Sports Medicine, found that physical activity alone can reduce the symptoms of depression.
The research team at Ben Singh from the University of South Australia in Adelaide describes sport and exercise in the study as one of the mainstays in the treatment of depression. 97 reviews including 1,039 studies with a total of 128,119 participants were used for the analysis. Physical activity reduced symptoms of depression by an average of 43 percent, anxiety by 42 percent and general stress symptoms by 66 percent.
According to the research team, the results of the study could have far-reaching implications: If sport and exercise are just as effective as psychotherapy and medication, they could also be used as the first choice for people with depression and anxiety, according to the study authors.
“Decide on a case-by-case basis”
“Therapy with sports and exercise will probably only work well for certain subtypes – just like it is with medication,” says the author Rupert Lanzenberger, Professor in the Department of Clinical Neurosciences at MedUni Vienna. Because depression is a very heterogeneous disease: “There are different subtypes or – from a biological point of view – even different diseases. The degree of severity also varies greatly and age-group-specific types also play a major role.”
In many different forms of depression, psychotherapy is “probably sufficient,” said Lanzenberger in an interview with science.ORF.at. Classic antidepressants work “quite well” in about a third of cases. However, a combination of therapies is often required. Only the treating psychiatrist can decide which therapy to aim for in each individual case. Depending on the type of depression, however, one usually “does not start with the heaviest guns.”
Inflammatory factors are suppressed
In any case, the change in lifestyle is certainly “an important point,” says Lanzenberger. Because sport and exercise to a certain extent change the metabolism – and this reduces the likelihood of neuroinflammatory processes. These in turn play an important role in a certain subtype of depression.
“These inflammatory factors, which are also released directly in the brain, are partially suppressed in their effectiveness through sport, reduced, made less likely.” And this can be used therapeutically, according to the psychiatrist: “For those subtypes of depression in which neuroinflammation plays a role plays, sport will work.”
Strength training works differently than yoga
According to the meta-analysis from Australia, exercising four to five days a week is optimal. Higher intensity workouts were associated with greater reductions in symptoms. However, the effect decreased with increasing duration of the individual units. This could be because people find it easier to maintain shorter activities, the research team suspects.
lorenzophotoprojects – stock.ado Any form of exercise is beneficial for mental health, study finds
Another result of the study: All forms of exercise have their benefits, but different modes of action were found depending on the type of sport. For example, strength training reduced the symptoms of depression the most, and forms of exercise such as yoga and Pilates those of anxiety. A finding that could help healthcare professionals suggest the ideal form of physical activity, according to the research team.
rejection and frustration
However, the prescription of sports and exercise units in particular could prove to be a weak point in therapy. The study authors also found that some patient groups refuse to be prescribed physical activity. For example, they expressed frustration at being told to “just exercise” to improve their mental health.
Ensuring that patients have a variety of options and involving them in making therapy decisions is “probably a better approach than simply replacing psychiatric drugs and psychotherapy with the prescription of yoga,” the research team said.
Motivation vs. drive inhibition
“The problem is often the motivation,” says Lanzenberger. Various forms of depression are associated with anhedonia, the inability to experience joy and pleasure. “Usually and by most people, sport can be experienced as rewarding and then of course you really enjoy doing sport. However, if reward stimuli can no longer be perceived accordingly, then the motivation to go out and do sports is significantly reduced.”
Another major problem is the inhibition of drive: “Many patients cannot really accept sports and exercise therapy – especially if they are really lacking in drive. This not only applies to sport, but to all activities that you might want to do.”
In the case of severe forms of depression, the tip: “Please do sport” is certainly not enough. First, a basis must be created to significantly reduce drive inhibition. This is precisely why a combination therapy is recommended for severe cases, according to the psychiatrist: psychotherapy, pharmacological therapy and additional measures such as exercise or changes in diet. “Exercise changes digestion, exercise also changes the microbiome. The connections are very diverse.”
Hardly any data on major depression
The question of whether sport also works in severe depression has turned out to be a weakness of the meta-analysis. The Australian research team was unable to answer this question because most of the participants in the studies used suffered from mild to moderate depression. There were hardly any patients with severe depression – which could also be due to the motivation to take part in a study.
The situation is also “different for young people, for example, than when someone gets severe depression at an older age,” says Lanzenberger. The big problem with meta-analyses is that “usually only certain subgroups are included and many things are thrown together that are clinically and biologically different to evaluate”. In principle, however, sport and exercise are highly recommended for depression: “Sport has a lot of effects, not just on the metabolism per se, but also on cognitive and emotional processes – including motivation.”
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