Posted by linkadge on August 13, 2008, at 20:38:06
In reply to Re: Peter Kramer debunks exercise, CBT, posted by Chris O on August 13, 2008, at 17:27:10
I don't know if 'debunks' is the right word. Ok, so poor study design and the obvious limitations of the application of exercise are issues, but that does not, in any way prove anything about exercise.
I have had severe depressive episodes off and on for many years. I get very little help from prescription antidepressants. They generally make my anxiety worse and induce intollerable apathy. If anything turns me off to exercise its a prescription of paxil and zyprexa.
Exercise is *not* something that works immediately. In mice studies, the types of biochemical changes in nerotransmitter function, brain growth factor levels, neurogenesis, cytogenesis and HPA axis functioning do not occur over night.
The notion that exercise chooses its responders is only supported by a few studies. Sure its true that some patients cannot complete the studies but that doesn't mean that it would not have had an effect if the treatment were continued.
If there is a biochemical target of antidepressant agents, then exercise modifies it.
Oftentimes, exercise produces a much more robust effect on brain growth factor levels than antidepressants do. For instance, in the following study, escitalopram alone had no effect on BDNF levels, whereas exercise alone had a significant effect. The antidepressant effect of BDNF administration is evident in many anmial studies.
I think there is no proof here that exercise does not have an effect on mood and there are many studies which suggest that it can.
I think that people don't like to exercise and they don't like to continue exercising. They want to look for proof that they are entitled to sit on their behinds. They want to believe that their depression is due to some genetic flaw that only a pill can solve.
Consider this. Even in the completely genetically inherited Huntington's disease, exercise can have a profound modifying effect on disease pregression. It elevates BDNF, it exerts neuroprotective and neurotrophic effects in the disease model.
Sure exercise may not do it for everbody, it may not produce the artificial buzz of a prescription drug (thats going to poop out for you in a few years anyway), put what if it is disease modifying in depression too? I.e. exercise could be a long haul treatment that patients are turned off to by the alternative availability of the quick AD boost?
but its a heck of a lot safer than siting on the couch and popping a pill and when combined with judicious use of medication, it will probably lead to a more favorable outcome. IMHO.
Think of it this way. If a patient presents with the a diagnosis of diabeties and is currently exercising that does not lead the physician to conclude that exercise has no effect upon the diabeties and therefore the patient should stop exercising and take their medication. On the contrary, it is likely that the exercise may have been exerting an effect that was outstripped by the disease sevarity. This doesn't mean that any good doctor would still not advise exercise.