Exercise is an effective alternative in the management of non-severe depression

1. In this systematic review and meta-analysis, there was no difference between exercise and antidepressant treatment in patients with non-severe depression.

2. Interestingly, there was a stronger dropout rate in studies including exercise as a treatment modality, compared to antidepressant interventions.

Evidence Rating Level: 1 (Excellent)

Antidepressants are integral in the treatment of depression; however, the high costs, fear of addiction, and adverse effects may limit real world usage. Though many guidelines have promoted the use of exercise as a treatment modality, it’s effectiveness has been minimally studied in comparison to antidepressants. As a result, the objective of the present systematic review and network meta-analysis was to compare the effectiveness of exercise and antidepressants versus either treatment alone, as well as their synergistic effects.

Of 23,209 identified records, 21 studies were included in the analysis (n=2551 participants) from January 1990 to January 2022. Studies were included if they investigated the efficacy of exercise and/or antidepressants against treatment alone or a control/placebo on symptom severity in patients with non-severe depression. The primary outcome was depressive symptoms severity based on a depression scale. Risk of bias was assessed using the Cochrane risk of bias assessment tool. Statistical analysis was performed using a frequentist network meta-analysis using the Hartung-Knapp-Sidik-Jonkman method.

Results demonstrated that all treatments had similar benefit on depressive symptoms amongst patients with non-severe depression, when compared to controls. Comparing each of the treatment modalities amongst one another, exercise interventions interestingly had greater drop-out rates compared to those on antidepressant interventions. However, collectively, no treatment was superior to the other. Despite these results, this study was limited due to the overall low number of studies, thereby precluding the ability to evaluate sources of publication and heterogeneity bias. Nonetheless, this study was significant in suggesting that there was no difference in effectiveness between exercise and anti-depressants which may guide future treatment modalities in patients with non-severe depression.

Click to read the study in British Journal of Sports Medicine 

Image: PD

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