New Trial Should Lead to Better Understanding of Why Exercise is an Effective Treatment for Depression
bobwhelan
DURHAM, N.C. - The Duke University Medical Center researchers who
found evidence that exercise can be an effective treatment for major
depression are
embarking on a larger trial they believe will answer some of the
remaining questions posed by their earlier results.
The new trial, which is being funded by a $3 million grant from the
National Institute of Mental Health, is designed to further refine
which depressed patients can benefit
from exercise and determine why exercise appears to be effective.
Additionally, the study will measure the effect of exercise on a
phenomenon known as vascular depression, a form of depression that
appears linked to actual
abnormalities in blood vessels of the brain, and not brain chemical
imbalances.
The previous Duke studies, led by psychologist James Blumenthal, found
that exercise was just as effective as the most common anti-depressive
medication in reducing
the symptoms of major depression.
"This new trial is intended to answer some of the 'whys' posed by
those original studies," Blumenthal explained. "We are very interested
in evaluating behavioral,
non-pharmacologic approaches to treating depression. Because up to
one-third of depressed patients may not respond to drug therapy, and
those who do take drugs may
complain of side effects, it is important to find other approaches."
Over the next five years, the researchers plan to enroll 216
volunteers, half of whom will be assigned randomly to the drug arm of
the trial and half to the exercise arm.
The drug to be used is sertraline (trade name Zoloft), a member of a
class of commonly used anti-depressants known as selective serotonin
reuptake inhibitors, and the
same drug used in the earlier trials.
Unlike the earlier trials, the new trial will have a placebo, or
ineffective sugar pill, arm. Also unlike the earlier trials, the
exercise arm will be divided as well - half of the
patients will do their exercises in the supportive atmosphere of the
Duke Center for Living (CFL), while the other half will perform the
same exercise regimens at home.
Moderate exercise will be performed three times a week in both
settings.
"One of the questions raised by previous studies was whether the
supportive atmosphere of exercising in a group, with other similar
patients and trainers, had any effect
on relieving the depression," Blumenthal said. "At the completion of
this trial, we should be better able to determine how much of the
benefit was derived from exercise
and how much, if any, came from the supportive atmosphere."
A new focus in this trial examines vascular depression, a form of the
disorder that is not yet widely recognized, but is being actively
studied by investigators at Duke and
Cornell. "Vascular depression is a recently identified clinical type
of depression," said Dr. Murali Doraiswamy, Duke psychiatrist and
co-investigator of the trial. "We
know, for example, that depression occurs at high rates in older
patients who have other vascular diseases, such as heart disease,
diabetes or stroke.
"We also know in the setting of these kinds of diseases that patients
have compromised cerebrovascular function, apparently caused by tiny
little strokes deep in the
brain," he said. "There is a growing consensus that these changes may
actually be mediating the high rates of depression in these patients."
Doraiswamy said that while depression is clearly associated with
imbalances of key chemicals in the brain, there are likely many
different causes behind these brain
chemical changes. Duke studies have shown that up to one-third of the
cases of depression in patients over the age of 65 may be due to this
vascular form of the
disease.
"We do not yet know the most optimal strategy to treat depression in
such patients," Doraiswamy said. "Some data suggest that people with
vascular lesions often do not
respond as well to antidepressants.
"With this trial, we hope to determine if exercise improves blood flow
in the brain and has a positive effect on relieving the depression,"
Doraiswamy continued.
"Exercise would be a very attractive option for these patients. Since
we know that exercise helps to control risk factors in cardiovascular
disease, it seems logical to
assume that it could be an ideal treatment for patients with vascular
depression."
The treatment will last for four months, and patients will be followed
up six months and one year later.
In order to be eligible for the trial, participants must be over the
age of 54, sedentary and suffer from clinically diagnosed major
depression. Symptoms include depressed
mood or loss of interest or pleasure, combined with at least four of
the following: sleep disturbances, weight loss, changes in appetite,
psychomotor agitation, feelings of
worthlessness or excessive guilt, impaired cognition or concentration,
and recurrent thoughts of death.
bobwhelan
"Studies have found that after 3 months of antidepressant
treatment between 50% and 65% of the people who take them
will be much improved (see references). This compares
with 25 - 30% of people given an inactive "dummy" pill,
or placebo."
Contrarian
> DURHAM, N.C. - The Duke University Medical Center researchers who
> found evidence that exercise can be an effective treatment for major
> half of the patients will do their exercises in the supportive
> atmosphere of the Duke Center for Living (CFL), while the other
> Moderate exercise will be performed three times a week in both
> settings.
I wonder what "moderate exercise" means. I remember when a good
hour bike ride helped a little, but not much more. Nowadays
I don't ride the bike in the city. Walking an hour isn't doing
much right now.
Signature
> x-no-archive: yes
>
> Exercise that produces no goods or services wastes the world's calorie
>supply.
This may be one of the stupidist statements I've seen in quite a while.
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