Exercise or medication: Which is best for depression?

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When treating depression or anxiety, running may be just as effective as antidepressants, according to new research. But experts say the solution may not be so straightforward for every person.

Because of the prevalence of depression and anxiety and the consequences on health, researchers from Amsterdam looked at the best way to mitigate these effects, and whether antidepressants or lifestyle intervention would have different effects on mental health as well as certain aspects of physical health.

The research is the first “to compare effects of antidepressants with running exercises for anxiety, depression and overall health,” according to a news release for a study presented October 6 at the European College of Neuropsychopharmacology’s annual conference. The study published earlier this year in the Journal of Affective Disorders.

“Antidepressants are generally safe and effective. They work for most people,” said study coauthor Brenda Penninx, a professor of psychiatric epidemiology at Vrije University in Amsterdam, the Netherlands, in a news release. “We know that not treating depression at all leads to worse outcomes, so antidepressants are generally a good choice. Nevertheless, we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them.”

The researchers studied the effects of running therapy versus taking an antidepressant medication — in this case, escitalopram — on these health factors among 141 patients with depression, anxiety disorder or both. During a 16-week trial, members of the antidepressant group took their medication, while those in the running group aimed for two to three, supervised 45-minute group running sessions per week.

After the trial period, about 44% of both groups experienced improvement in depression or anxiety symptoms — showing the medication and running were equally effective, the study found. The running group also saw improvements in weight, waist size, blood pressure and heart health, while the medication group slightly deteriorated in these measures.

“We have long viewed exercise as an adjunct support to more formal treatments like psychotherapy or medication,” said Karmel Choi, a clinical psychologist and assistant professor of psychology at Harvard Medical School in Boston, via email. Choi wasn’t involved in the research.

“Here, we see that in some cases,” Choi said, “exercise may prove as helpful as an antidepressant, with fewer side effects and more physical health benefits.”

Whether general exercise or medication is best for the treatment of depression or anxiety, however, remains an open question that depends on multiple factors, she added.

Which treatment option works best partly depends on personal perceptions or preferences, including a person’s motivation to exercise or concern about potential side effects of a medication, experts said.

Generally, “there is no reason to ask patients to choose only one of these interventions when there is no interaction between them,” said Felipe Barreto Schuch, adjunct professor of psychiatry and mental health at the Federal University of Santa Maria in Brazil, via email. Schuch wasn’t involved in the study.

“There are no extra risks in taking the pills and exercising. They are not mutually exclusive,” Schuch added. “Naturally, someone with depression can take both without any (harm).”

There are also research-based challenges in answering the question of what treatment option is best. For example, depression varies in severity, but most studies “tend to focus on milder forms of depression because they are more common and safer to study,” said Ben Singh, a research fellow in allied health at the University of South Australia, who wasn’t involved in the study.

As a result, not much is known about treating severe depression with exercise, said Parco Siu, associate professor of kinesiology at the University of Hong Kong, who also wasn’t involved in the research.

For people with severe depression, exercise alone typically isn’t enough.

“Severe depression typically involves intense symptoms, such as profound sadness, persistent hopelessness, suicidal thoughts or an inability to carry out daily tasks,” Singh said. “Severe depression often necessitates a combination of treatments and close medical supervision.”

Schuch and a team of researchers found in a 2015 study that for people who were severely depressed and hospitalized, exercise in addition to medication was a viable option. “However, the hospital setting has much more resources and support for the patients, which may facilitate acceptance and adherence to exercise,” he added. “In the community, adherence to exercise by severely depressed patients can be more challenging.”

One common limitation in studies comparing exercise and medication interventions for depression is uncertainty in whether the instructed doses of exercise and antidepressants are biologically comparable, and whether participants met, fell short of, or exceeded the dose of medicine or the amount of exercise, Schuch said.

Some experts also wonder which exercise is best for patients who benefit most from such physical activity, Schuch said. Nevertheless, some evidence has shown no differences between aerobic and anaerobic exercises — so while certain people may benefit from running, as the recent research found, others may prefer weightlifting.

Additionally, the recent research “was not a randomized trial,” Choi said. “Participants were allowed to choose their treatment, and most tended to choose the exercise program. This means we don’t know for sure if effects were due to the treatment itself — medication or exercise — or other factors like people’s health-related interests and motivation.”

The group that chose antidepressants for the 16-week trial were more depressed than those who opted for running, according to the study.

While exercise and medication are both viable options, it’s important to note that “none will work for all patients,” Schuch said. “Response rates are near 50% for antidepressants and for exercise.”

The scientific consensus highlights the importance of personalized treatment plans, experts said.

“The key is to have an open discussion with a healthcare provider who can assess your specific situation and help you make an informed decision tailored to your needs,” Singh said via email.

If you’re thinking of trying to alleviate depression with fitness, know “the time it takes for someone to experience relief from depression through exercise can vary widely,” Choi said. “Some individuals may start to notice improvements within a few weeks of consistently engaging in regular exercise. However, others might require several months of dedicated effort.”

For this reason, consistency is key, she added, as “sticking to a routine over time is more likely to yield positive effects.”

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