-Caveat Lector-

FOR RELEASE: 24 OCTOBER 1999 AT 16:00 ET US
Duke University Medical Center
http://www.eurekalert.org/releases/dumc-exe102299.html

Duke study: Exercise may be just as effective as medication for treating
major
depression

DURHAM, N.C.--A brisk 30-minute walk or jog around the track three times a
week
may be just as effective in relieving the symptoms of major depression as
the
standard treatment of anti-depressant medications, according to the results
of
a Duke University Medical Center study.

The researchers studied 156 elderly patients diagnosed with major depressive
disorder (MDD) and assigned them to three groups: exercise, medication, or a
combination of medication and exercise. To the surprise of the researchers,
after 16 weeks all three groups showed statistically significant and similar
improvement in measurements of depression.

"One of the conclusions we can draw from this is that exercise may be just
as
effective as medication and may be a better alternative for certain
patients,"
said the lead researcher, Duke psychologist James Blumenthal, who published
the
results of his team's study in the Oct. 25 issue of The Archives of Internal
Medicine. The research is supported by a number of grants from the National
Institutes of Health.

"While we don't know why exercise confers such a benefit, this study shows
that
exercise should be considered as a credible form of treatment for these
patients," Blumenthal said in an interview. "Almost one-third of depressed
patients in general do not respond to medications, and for others, the
medications can cause unwanted side effects. Exercise should be considered a
viable option."

While the researchers studied middle-aged and elderly people, Blumenthal
said
the results probably hold true for the general population. "Because the
elderly
tend to have additional medical problems that might make regular exercise
difficult, this is the most difficult group to test the exercise
hypothesis."

Symptoms of MDD, as defined by the psychiatric reference book Diagnostic and
Statistical Manual IV (DSM-IV), include depressed mood or loss of interest
or
pleasure combined with at least four of the following: sleep disturbances,
weight loss, changes in appetite, psychomotor agitation, feelings of
worthlessness or excessive guilt, impaired cognition or concentration and
recurrent thoughts of death.

Based on the DSM-IV definition of depression, 60.4 percent of the patients
who
only exercised were no longer depressed after 16 weeks, compared with 65.5
percent for the medication group and 68.8 percent of the combination group.
When a second commonly used measure of depression, the Hamilton Rating Scale
for Depression, was added, 47.2 percent of exercise group were no longer
considered depressed, compared to 56 percent of medication group and 47
percent
of combination.

In both cases, according to Blumenthal, the differences between the groups
were
not statistically significant.

Researchers did note that patients who took the anti-depressants saw their
symptoms relieved sooner, but by 16 weeks the group differences had
disappeared. Blumenthal said it was possible that the structured and
supportive
atmosphere of the exercise program also could have an effect in improving
the
symptoms of the exercise group, but he doesn't attribute the majority of the
benefit to social support. Studies have shown that improved levels of
physical
fitness are related to improved symptoms of depression, he said.
Nevertheless,
early next year, Blumenthal plans to begin a new study to gauge the effect
of
exercising in a less-supportive atmosphere, and he also plans to include a
placebo group. Blumenthal suggested that exercise may be beneficial because
patients are actually taking an active role in trying to get better.

"Simply taking a pill is very passive," he said. "Patients who exercised may
have felt a greater sense of mastery over their condition and gained a
greater
sense of accomplishment. They felt more self-confident and had better
self-esteem because they were able to do it themselves, and attributed their
improvement to their ability to exercise.

"These findings could change the way some depressed patients are treated,
especially those who are not interested in taking anti-depressants,"
Blumenthal
said. "While these medications have been proven to be effective, many people
want to avoid the side effects or are looking for a more ?natural' way of
feeling better."

The anti-depressant used in the study was sertraline (trade name Zoloft),
which
is a member of a class of commonly used anti-depressants known as selective
serotonin reuptake inhibitors.

Blumenthal cautions that the study did not include patients who were acutely
suicidal or had what is termed psychotic depression. Also, because patients
were recruited by advertisements, these patients were motivated to get
better
and interested in exercise.

The research team included, from Duke, Michael Babyak, Kathleen Moore, Steve
Herman, Parinda Khatri, Dr. Robert Waugh, Melissa Napolitano, Dr. Leslie
Forman, Dr. Murali Doraiswamy and Dr. Ranga Krishnan. Others included Edward
Craighead, University of Colorado at Boulder, and Mark Applebaum, University
of
California at San Diego.




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