I have been treated over the past 10 years on two occasions with medications for mild depression. I went to my doctor last week because I don't feel good and think that my depression has come back. He wants me to try exercise. Is there any evidence to support this?

Absolutely. A great deal of work has been done in recent years evaluating the impact of exercise on depression. Back in the '70s and '80s we knew that exercise increased levels of natural opiates (endorphins), but since then we have learned that exercise has multiple effects on brain chemistry. It can cause increases and help to modulate the same neurotransmitters that some of our most widely used medications affect. These include dopamine, serotonin and norepinephrine. Exercise also increases an important substance in your brain called BDNF.

Additionally, there have been studies comparing the effectiveness of antidepressants and exercise on depression. One of the first good studies was called SMILE. This study determined that about 30 minutes of aerobic exercise three times per week was as effective as sertraline (Zoloft). Six months after the beginning of the study they reported that the exercise worked better than the medication over the long term. So exercise is something to consider.

However, it's important never to stop taking antidepressants or consider treating oneself for depression without being under medical supervision. The important questions to ask your provider are:

1. Is it safe for me to exercise? (In other words, do you have underlying medical conditions that would make exercise dangerous?)

2. Would exercise be a viable option to medication at least for a trial period?

3. How much and which exercises should I do?

If you're interested in this topic, you might enjoy Spark! How Exercise Will Improve the Performance of Your Brain, by Harvard Psychiatrist John Ratey, M.D.. He also has plenty of information available online.

John R. White is Chair of the Department of Pharmacotherapy in the College of Pharmacy at WSU-Spokane and the author of two books.

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