About 320 million people have depression worldwide. Two in 10 will have the disease in their lifetime. And its costs associated with lost productivity exceed $920 billion. Financial (lower wages) and social (domestic violence, family demands) disparities make women the most affected. According to Vigitel (2021), 14.7% of them suffer from depression, compared to 7.3% of men.
The so-called second-generation antidepressants — a broad class of drugs that modulate the concentration of neurotransmitters, such as serotonin — are considered the front line in combating the disease.
It so happens that these drugs have a small therapeutic effect, particularly in cases of moderate-intensity depression — a condition that results in milder symptoms and, therefore, causes little harm to social and professional activities.
In addition to the low effectiveness, the justified concern about possible adverse events, addiction and social stigma dampens the acceptance of antidepressants.
It is in this scenario that lifestyle interventions —focused on improving the quality of diet and sleep, and the practice of physical activity— arise as tools to alleviate the symptoms of the disease.
With regard to physical exercise, in particular, treatment guidelines for depression are still vacillating. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), for example, considers a lack of evidence to recommend exercise as a treatment for the disease. The European Psychiatric Association disagrees with this in recognizing data that support the use of this tool in the management of mild to moderate conditions.
To quell the controversy, scientists in Hong Kong reviewed studies that evaluated the effectiveness of exercise, antidepressants, and their combination on symptoms of depression of non-severe intensity.
Twenty-one studies were analyzed, involving 2,551 patients. The joint analysis of the data allowed the authors to conclude that (1) exercise and antidepressants are effective in reducing symptoms, compared to control (no intervention); (2) combined treatment with exercise and antidepressants is not superior to either alone; and, perhaps the main finding, (3) exercise and medications provide similar therapeutic benefits.
Concerning the differences between interventions, the dropout rate appears to be lower with antidepressants than with exercise (40% vs. 58%). And the reverse is true for the rate of adverse events: 22% vs. 9% in disfavor of drugs. In the final score, technical tie.
These findings definitely place exercise in the therapeutic arsenal for mild to moderate depression. And on a par with antidepressant drugs.
A not inconsiderable advantage of exercise interventions is that, in addition to promoting mental health benefits, they improve cardiovascular, pulmonary, metabolic, immunological, muscular, bone health, etc.
As there is still no drug capable of exerting such effects simultaneously — and there probably never will be — people with depression, on medication or not, need to exercise.
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