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Ask the Mental Health Expert Archives 2001-2004

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Controlling Depression

Q. Do you believe depression can be controlled by diet and exercise? There seems to be much information in regards to treatment with medications only. I believe proper diet and exercise can be an effective treatment without the use of antidepressants, since I am an example of that. I am writing a research paper on this subject.

A. I believe that some milder, non-psychotic, non-bipolar types of depression may be managed with exercise, whereas the role of diet is less clear. That said, I would never advise someone to manage clinically serious depression simply by means of exercise and diet, without a thorough professional evaluation.

First of all, depression means different things to different people. Maybe you've felt a little "down in the dumps" for a few years because things aren't great in your personal or professional life--on the other hand, maybe you've had chronic, severe depression accompanied by insomnia, loss of appetite, weight loss, intense guilt, and thoughts about ending your life. Aerobic exercise and dietary changes might be helpful in the first case, but might only delay appropriate professional treatment in the second. Also, depression may be due to underlying medical problems, such as low thyroid function. Exercise alone isn't going to do you much good if that's the case.

For really serious depression, most people need either psychotherapy, antidepressant medication, or both. That said, there is limited evidence that aerobic exercise such as walking or jogging can be helpful for some depressed patients--even some with so--called major depression.

Recently, James Blumenthal and colleagues published a study in the October 25, 1999 issue of the Archives of Internal Medicine, in which they compared aerobic exercise with a standard antidepressant, Zoloft. The subjects were men and women over the age of 50 diagnosed with major depression, though some were in the milder range of this disorder. The subjects were assigned to a program of aerobic exercise, antidepressant treatment, or combined exercise and medication. After 16 weeks of treatment, all three groups showed clinically significant drops in their depression ratings, with no big differences among the treatments.

However, the medication group showed a faster response. Ten patients dropped out due to medication side effects, while 16 dropped out due to dissatisfaction with the exercise program. But not everybody is in good enough shape for aerobic exercise, and for some, it could be physically dangerous. For severely depressed patients, exercise alone may not be enough. Re: diet--it's certainly true that people who lack vital nutrients in their diet may develop mood problems. For example, people with too little thiamine, folate, vitamin B6, or vitamin B12 in their bodies may become depressed. But that doesn't mean that eating foods rich in these nutrients will cure depression. It's also true that a diet low in omega-3 fatty acids (found in tuna and other fish) has been linked with depression or mood swings.

According to research by Andrew Stoll and colleagues, published in the May 1999 Archives of General Psychiatry, high doses of omega-3 fatty acids from fish oil are helpful in patients with bipolar (manic-depressive) disorder. But again, that doesn't mean you'd notice an upswing in your mood after lunching on a tuna fish sandwich. In fact, it's dangerous to draw conclusions about normal nutrition from studies of medical or mental illness. For example, iron deficiency anemia may lead to feelings of depression, but taking mega-doses of iron can actually cause health problems. The bottom line: eating a healthy, balanced diet and exercising moderately make good sense, in terms of maintaining emotional and physical well-being--but, in my view, serious, clinical depression requires professional evaluation and treatment.

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December 2001

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