Exercise vs Antidepressants: Which is More Effective for Mental Health Issues?

More people than ever are struggling to manage their mental health. According to a 2020 study, 1 in 10 adults and 1 in 5 adolescents in America have been clinically depressed over the past year. The stats on anxiety aren’t any better; from 2008 to 2018, rates of anxiety nearly doubled among young adults.  

In recent decades, the first-line treatment for anxiety and depression has been medications such as selective serotonin re-uptake inhibitors (SSRI's). In fact, antidepressant prescription has increased by 65% over the past 15 years, according by the American Psychological Association. 

These medications, while helpful for many, are not a magic bullet, and are not without side-effects such as weight gain. 

An increasing body of research, in light of this problem, is beginning to illuminate the role of simple lifestyle interventions, such as exercise, in managing mental health conditions.  

A recent study, which we will explore in detail today, went so far as to directly compare the effects of antidepressant medication versus running therapy on mental health in a sample of patients with depression and/or anxiety.  

The results might surprise you. 

Mental Health Outcomes

The researchers recruited 141 people with depression and/or anxiety to participate in the trial. 96 participants underwent group running therapy (two to three times per week for 45 minutes), and the other 45 participants received a common antidepressant medication (either escitalopram or sertraline). 

When they tallied their results after 16 weeks, the researchers found that remission rates were similar among the two groups; at the study's conclusion, 45% of people in the antidepressant group and 43% in the running group no longer had a depression or anxiety disorder.  

Physical Health Outcomes

While the two interventions had nearly identical effects on mental health, the study did find significant differences in physical health outcomes between the two groups. Predictably, on every physical health marker (such as weight, waist circumference, blood pressure, and heart rate), the running group had superior outcomes. 

But it wasn’t just that exercise boosted physical health, while antidepressants had no effect. According to the data, antidepressants were a net negative on physical health. Consistent with prior research, the study found that participants on antidepressants gained an average of about 6.6 pounds during the study, and showed a significant increase in waist circumference, a measure that is correlated with metabolic disease. They also showed borderline significant increases in blood pressure and triglycerides. The reason for these side-effects isn’t clear, but presumably centers around the drug’s ability to change either metabolism or appetite. 

Limitations and Caveats 

This study had one key limitation, which is important to mention: a majority of participants were given a choice as to which treatment group to enter. Most people had a preference for the running intervention, so it’s possible that expectations, or a higher baseline level of motivation among participants willing to exercise, could have skewed the results. 

It's also worth noting the difference in adherence between the two interventions. 82% for the antidepressant group, but only 52% of the running therapy group made it through the whole study without dropping out. So, while exercise was just as effective, it was harder to stick to over time. This makes intuitive sense, of course, but is a particularly important point to acknowledge in light of the baseline lack of energy and motivation that is characteristic of depression. 

Practically speaking, if you’re trying to start exercising for the mental (or physical) health benefits, we highly recommend leveraging the power of community and accountability, in the form of a group class, a coach, or a training partner. This will make the habit more likely to stick. 

The Bottom Line 

As more and more research mounts, exercise is emerging as a legitimate treatment for mental health issues. Unlike antidepressants, its only side-effect is to produce better physical health outcomes, across the board. 

This doesn’t mean, however, that exercise is a panacea, or that antidepressants are useless. Every individual's mental health journey is unique, and what works for some may not work for others. The two treatments aren’t mutually exclusive, either. For many, antidepressants provide the initial spark of energy that lets them engage in healthy habits like exercise in the first place.  

Despite the nuances in this area that still need to be explored, one thing is overwhelmingly clear: exercise is more than just a tool to lose weight, build muscle, and improve our physical health; it's a powerful ally in our pursuit of mental wellness. 

References  

https://www.apa.org/monitor/2017/11/numbers  

https://pubmed.ncbi.nlm.nih.gov/36828150/  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441973/  

https://www.sciencedirect.com/science/article/pii/S0165032723002239?via%3Dihub