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Tuesday, December 18, 2007

3 Times Walking 50 minutes a Week for Treatment Resistant Depression

Exercise addition is an effective strategy when treatment with antidepressants is not satisfactory enough. Three times a week 50 minutes walking is enough.
Seventeen patients with incomplete remission of depressive symptoms began a 12-week exercise program while continuing their antidepressant medication (unchanged in type or dose). The severity of the depression diminished significantly with 5.8 points on the Hamilton Depression Rating Scale and 13.9 points on the Inventory of Depressive Symptomatology-Self-Report.

This lower-cost addition strategy has also numerous other health benefits:
1. cardiovascular benefits
2. improves executive functioning in the elderly (neurocognitive functioning)
3. protection from brain insults and disease
4. reduces the risk for dementia.

With treatment resistant depression there are several strategies to follow. An important one especially with partial recovery on an antidepressant is an addition strategy. The most common addition strategies are the addition of lithium or thyroid supplementation. Disadvantages of these strategies are: side-effects increase withe number of medications used, complexity of use and monitoring.
Patients included were on an antidepressant for at least 6 weeks with adequate dosage. Age between 20-45 years and physically inactive (exercising< 3 times a week and < 20 minutes each time).

The 12-week intervention consisted of both supervised and home based exercise sessions. In the lab patients could use a treadmills or stationary cycles or a combination of both. At home participants could use a treadmill, stationery cycles, a combination of both, or overground walking. Intensity of the exercise was self selected and held constant during a session but be changed between sessions according to the preference of the patient. The exercise energy expenditure was 16 kcal/kg/wk, a public health dose. Participants were allowed to choose frequency between 3-5 times a week.

What exercise?

Participants mostly walked as form of exercise. On a treadmill or overground walking on average of 50 minutes three times a week.

Limitations of the study:
1. not randomized
2. lack of placebo group
3. small sample size
4. low completion rate (47%)
5. selected patient group young of age (39 years)

Article discussed
J Psychiatr Pract. 2006 Jul;12(4):205-13.

Exercise as an augmentation strategy for treatment of major depression.

Trivedi MH, Greer TL, Grannemann BD, Chambliss HO, Jordan AN.

University of Texas Southwestern Medical Center at Dallas, Mood Disorders
Research Program and Clinic, 6363 Forest Park, Dallas, TX 75235, USA.
PMID: 16883145
Blogging on Peer-Reviewed Research

Related posts on this blog:
5 features of pseudo treatment resistant depression
Treatment Resistant Depression and Genes


jcat said...

I've started something similar - in my case, lack of motivation to do anything, good or bad, is a key factor. So now I pay a personal trainer to meet me 4 times a week. For now we are just walking - aim is 50 - 60 mins, and current distance is almost 5 kms. Not great, but more than I was doing. I hate it. Only 8 days so far, and I will keep doing it anyway purely because it will please pdoc when he starts work again in the New Year. Guess expecting 3 years of TRD to be fixed in 12 weeks would be optimistic, so wishing for just some small improvement before then is totally unrealistic. At the moment though it mostly feels like yet another way of punishing myself...

Dr. Shock said...

Good for you, give it some time and also think of the other possible advantages.
Regards Dr Shock

bella de-kare said...

This information is highly helpful and just wanted to thank you for putting it out there and taking the time to do this. Its impossible to feel the benefits of what is good for you when in a state of numb and petrified depression but if one can learn enough when well then we are empowered to a certain degree. Really thank you! :)

Dr. Shock said...

Your more then welcome. When depressed it takes a lot of effort to get to running, walking or other forms of exercise, it may accomplish feeling a little less depressed for a while.
Noticed you started a blog, will be reading it, regards
Dr Shock