Running Therapy May Be as Effective as Medication for Depression
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Regular exercise can have a profound positive impact on your mental health. In fact, a recent study concluded that running therapy had effects on depression and anxiety similar to antidepressants.
Scientific work presented at the October 2023 European College of Neuropsychopharmacology (ECNP) Congress in Barcelona found that an exercise program also led to more favorable physical outcomes — although the results indicated that sticking with regular activity was a challenge.
“Antidepressants work for most people — we know that not treating depression at all leads to worse outcomes; so antidepressants are generally a good choice,” says the lead study author, Brenda Penninx, PhD, a professor of psychiatric epidemiology at Vrije University in Amsterdam. “This study, however, showed that running therapy can reduce depressive symptoms, at least in some depressed persons. The effects on mental health outcomes were rather comparable to that seen in the group that used antidepressants.”
Dr. Penninx stresses that an exercise program might not replace medications, but rather be offered as an additional treatment option to be given in a well-coached and supervised way by trained staff.
A Comparison of Running vs. Medication for Depression
For the research, scientists followed 141 people with depression, anxiety, or both. Participants were able to choose if they wanted to pursue treatment only with medication (and no running) or with running therapy (and no medication).
Over the course of 16 weeks, 45 people were treated with a selective serotonin reuptake inhibitor, or SSRI, and 96 followed a running program.
Participants in the drug group received escitalopram (Lexapro and Cipralex) at an initial dosage of 10 milligrams (mg) per day. Medication management was provided by a psychiatrist who could decide if dosage needed to be increased. If the escitalopram was found to be ineffective or poorly tolerated, patients were then switched to a second SSRI, sertraline (Zoloft).
Running therapy consisted of supervised 45-minute outdoor running sessions, with a target of two to three sessions a week, which aligns with the public health recommendations from the Centers for Disease Control and Prevention (CDC).
Similar Results for Mental but Not Physical Health
At the end of the trial, about 44 percent in each group showed a remission in their symptoms of depression and anxiety, but the authors noted that symptoms were still “considerable.”
When it came to physical health, however, changes were more favorable among the runners, who saw a decrease in heart rate, blood pressure, and waist circumference and an increase in lung function. On the other hand, the antidepressant group experienced signs of physical decline, with weight, blood pressure, and triglycerides increasing, and heart rate variability decreasing (a sign of less resiliency), according to Cleveland Clinic.
The research team highlighted that exercise directly addresses the sedentary lifestyle often found in patients with depressive and anxiety disorders by encouraging people to go outside, set personal goals, improve their fitness and participate in a group activity.
Sticking with an exercise program, however, can be a challenge. Only 52 percent in the running group adhered to the protocol, while 82 percent in the drug group were able to keep up with their medication regimen.
“It’s more difficult to change one’s behavior than to take a drug,” says Eric Ruhe, MD, a psychiatrist with Amsterdam University Medical Centers specializing in the treatment of depressive disorders.
Dr. Ruhe, who was not involved in the research, advises that an antidepressant should be accompanied by increased physical activity, and would like to see future research look at the outcomes of the use of antidepressants and running together.
Encouraging Lifestyle Changes
The study authors recognize that motivating people to keep up with exercise is not an easy task. Ruhe points out that a change of lifestyle pattern and beginning to run regularly can be especially difficult for depressed individuals, whose mental health severely interferes with motivational drives.
To be effective, running therapy has to go beyond just telling a person to “go run” — it’s essential to supervise and coach people adequately, according to Penninx.
She adds that running might not be for everyone, and depressed individuals may get similar benefits from other activities they prefer, such as bicycling, swimming, or a sport like soccer or tennis. Pursuing physical activity with other people can also help with motivation.
Study results presented at the ECNP (which were initially published in the Journal of Affective Disorders in May 2023) build on previous research demonstrating the mental health benefits of exercise. An analysis of 21 randomized trials concerning exercise and depression published in the British Journal of Sports Medicine in September 2022 found no difference between exercise and pharmacological interventions in reducing depressive symptoms in adults with nonsevere depression. For someone with severe depression, exercise alone may not be enough.
Because this study was relatively limited in size and not completely randomized (participants chose their therapy), Penninx would like to pursue a larger scale, multi-site study with stricter randomization and evaluate the combination of running therapy and antidepressant medication.
“There is no ‘miracle treatment’ for depression that works for everyone,” says Penninx. “If we have more choices in our treatment arsenal, there is choice for patients, and treatments can also be combined in order to reach the best outcome.”
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