Exercise enhances depression treatment

Exercise increases the levels of neurotransmitters that affect mood: dopamine, serotonin and norepinephrine --  the same brain chemicals controlled by antidepressants.
The body of evidence supporting exercise as a treatment for depression and other mood disorders continues to grow.

Many psychiatrists and psychologists urge their patients to get more exercise and make other lifestyle changes.

But perhaps no one takes this idea further than Washington therapist Jane Cibel, a licensed clinical social worker and certified personal trainer who conducts traditional talk therapy while clients walk on a treadmill or crank out dumbbell curls.

Active therapy

In an hour-long therapy session, patients get their weekly counseling session along with a high-heart-rate, sweat-inducing workout.

Cibel, 40, works from a large room in the basement of her home here. One side is a handsome office, complete with comfortable couches, a fireplace, a desk and a wall full of heady books. The other side of the room has a treadmill, a multi-station weight machine, a rack of dumbbells, a Bosu balance ball and a small trampoline.

Mixing the two disciplines offers several benefits, Cibel said: First, by putting clients on a treadmill during therapy, they begin to see, via their physical accomplishments, that they are capable of "self-bettering behavior." In addition, people talk more freely when they're moving.

Finally, Cibel seeks to exploit the generalized positive feelings that occur as a result of exercise to help rewire the brain. Exercise is known to increase levels of dopamine, serotonin and norepinephrine, neurotransmitters that affect mood. These are the same brain chemicals whose levels are controlled by such antidepressant medications as Prozac, Paxil and Zoloft.

Positive thoughts triggered by exercise-driven higher levels of brain chemicals can help reinforce positive emotions and behaviors, she said.

"You can restructure your brain with exercise," Cibel said.

The neural connection

The theory behind this is known as "neural Darwinism," a concept advanced by 1972 Nobel Prize winner Gerald Edelman, who asserted that people become optimistic or pessimistic based on habits of mind reinforced by specific neural connections.

"Your brain is made of cell clusters, and the thoughts you attend to dictate the connections between clusters," explained Cibel, who has a Ph.D. in social work from the University of Maryland along with certifications in personal training and sports nutrition from the International Fitness Professionals Association.

"So, if you have a lot of negative thoughts, those (pessimistic) connections are strengthened." The converse also is true, she said. Positive thoughts, including those derived from the exercise experience, reinforce the positive neural connections.

A typical client will warm up on a treadmill at around 55 to 70 percent of maximum heart rate, do some upper- and lower-body strength training (on machines or with dumbbells), maybe some core training and balance exercises, then more treadmill.

She provides towels, but her office doesn't have a shower. She said she will soon move to quarters where clients may shower and change if they wish.

Working out to feel good

Daniel I. Galper, senior research associate at the University of Texas South-western Medical Center in Dallas, has performed a meta-analysis of 1,000 studies on the effects of exercise on mood.

His observations about practical applications of these effects:

  • Thirty minutes of moderate-intensity exercise at least five days a week -- which happens to be the Centers for Disease Control and Prevention's recommendation for all adults, regardless of their mood or psychological state -- "should be enough to have an effect" for most people with depression, Galper said.
  • In a reversal of the usual outcome, where those who are fitter benefit more than others from an increase in exercise, "very unfit people will get more of a response from less exercise" than will more-fit people, Galper said. Why? Someone who's out of shape has to work harder just to walk, for example, for 15 minutes; that extra effort will activate more physical and cognitive hardware.
  • A single session of exercise can boost energy level and mood for two to four hours. Broader, lasting effects on mood may require 10 weeks of workouts. "Sixteen weeks or longer showed the best effect," Galper said, "but even irregular or intermittent exercisers will see some mental health benefit."
  • Other things being equal, and assuming a person can develop sufficient strength and cardiovascular capacity, intense workouts provide more benefits than less-strenuous ones.

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