Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder
Abstract
Objective
To
assess whether patients receiving aerobic exercise training performed
either at home or in a supervised group setting achieve reductions in
depression comparable to standard antidepressant medication (sertraline)
and greater reductions in depression compared to placebo controls.
Methods
Between
October 2000 and November 2005, we performed a prospective, randomized
controlled trial (SMILE study) with allocation concealment and blinded
outcome assessment in a tertiary care teaching hospital. A total of 202
adults (153 women; 49 men) diagnosed with major depression were assigned
randomly to one of four conditions: supervised exercise in a group
setting; home-based exercise; antidepressant medication (sertraline,
50–200 mg daily); or placebo pill for 16 weeks. Patients underwent the
structured clinical interview for depression and completed the Hamilton
Depression Rating Scale (HAM-D).
Results
After
4 months of treatment, 41% of the participants achieved remission,
defined as no longer meeting the criteria for major depressive disorder
(MDD) and a HAM-D score of <8. Patients receiving active treatments
tended to have higher remission rates than the placebo controls:
supervised exercise = 45%; home-based exercise = 40%; medication = 47%;
placebo = 31% (p = .057). All treatment groups had lower HAM-D
scores after treatment; scores for the active treatment groups were not
significantly different from the placebo group (p = .23).
Conclusions
The
efficacy of exercise in patients seems generally comparable with
patients receiving antidepressant medication and both tend to be better
than the placebo in patients with MDD. Placebo response rates were high,
suggesting that a considerable portion of the therapeutic response is
determined by patient expectations, ongoing symptom monitoring,
attention, and other nonspecific factors.
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