Is working out always better for depression than therapy and medication? Not so fast, experts say

New research boosts the case for working out — but the study has limitations

By Mary Elizabeth Williams

Senior Writer

Published March 5, 2023 7:30PM (EST)

Woman running, stretching and meditating (Getty Images/We Are)
Woman running, stretching and meditating (Getty Images/We Are)

A new study suggests that exercise might work better than therapy or medications for treating mental health issues — but don't ditch your therapist and your Zoloft just yet.

In a promising research review on the "Effectiveness of physical activity interventions for improving depression, anxiety and distress" published late last month in the British Journal of Sports Medicine, researchers indicated that physical activity can be up to "1.5 times more effective" than counseling or leading medications for certain types of mental health issues.

Yet while this is yet another important validation, the research comes with caveats.

"Physical activity can significantly reduce symptoms of depression and anxiety in all clinical populations."

The University of South Australia (UniSA) review, which Science Daily has called "the most comprehensive to date," examined research on the effects of exercise on healthy individuals, those with mental health issues, and those with chronic physical conditions. And what's exciting — if not entirely surprising — is that, as lead UniSA researcher Dr Ben Singh told Science Daily, "Our review shows that physical activity interventions can significantly reduce symptoms of depression and anxiety in all clinical populations, with some groups showing even greater signs of improvement."

That little word, "all," is key there.

Singh further noted that "higher intensity exercise had greater improvements for depression and anxiety," but "all types of physical activity and exercise were beneficial, including aerobic exercise such as walking, resistance training, Pilates, and yoga."

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We know instinctively that moving around makes us feel good; "an early-morning walk is a blessing for the whole day," wrote Henry David Thoreau. Scientific research into the benefits of fitness stretches back decades: a 1978 study published in The Physician and Sports Medicine found running an "effective supplement to psychotherapy for treating depressed patients." And a 1985 study published in Public Health advised that "physical activity and exercise might provide a beneficial adjunct for alcoholism and substance abuse programs."

The reasons exercise can be so powerful for our emotional health are manifold. Among the easiest to identify are the immediate and external ones. Practiced regularly and safely, it can instill a confidence-boosting sense of strength and achievement. "Exercise can help us develop a sense of purpose by providing structure and giving us something to strive for," says Dr. Flora Sadri-Azarbayejani, medical director at Psyclarity Health in Boston. "This in turn can increase our sense of self-efficacy, the belief that we are capable of achieving our goals."

In the midst of our national epidemic of sleep deprivation, physical activity also helps us sleep better, which is an enormous, and often overlooked, component of overall mental health. 

There's more. Dr. Joseph Trunzo, Professor & Chair of the Department of Psychology at Bryant University and President Elect of the Rhode Island Psychological Association, notes the cathartic benefits. "Exercise can serve as a distraction, allowing you to find some peace and quiet to break the cycle of gloomy ideas that promote depression." He also observes that "You might let your anger out through exercise. Exercise can divert you from unpleasant thoughts."

But science shows us the advantages go even deeper. Exercise affects our stress hormones like adrenaline and cortisol. "This allows for the body to physically expel stress and any trauma which may be stuck within our bodies," explains Katie McLaughlin, a licensed professional clinical counselor and owner of Cedar Rose Counseling & Wellness. "It also helps the nervous system learn to regulate which means we can recover from stress quicker." There's more — "Moving your body also churns out a powerful neurochemical called Brain-Derived Neurotropic Factor. Without getting too sciencey here," she says, "BDNF allows us to think helpful/positive thoughts more easily by increasing our brain's ability to create brand new neural pathways and neural connections." And because creating those new thoughts and patterns is also the bedrock of Cognitive Behavioral Therapy, it's easy to see how helpful exercise could be for people who are also good candidates for CBT, including individuals with OCD, PTSD and anxiety. 

An assumption that working out — or working out in a way that doesn't work for every body — is the cure for mental illness is an extremely disheartening message for a depressed person struggling just to get out of bed. 

Some of the most fascinating work on this has tied the effects of exercise on the human endocannabinoid system, which plays a key role in emotional processing. Harvard Health explains, "All of us have tiny cannabis-like molecules floating around in our brains." And recent research from Wayne State demonstrates that "Exercise reliably increases levels of the body's endocannabinoids." In other words, the runner's high appears to be real — and endorphins aren't the only game in town.

But despite the encouraging advantages of physical activity, mental health is never a one-size-fits-all proposition. While exercise can be a component of a strong mental health plan, in excess, it can also be a symptom of an underlying problem. Over-exercising behavior often shows up in individuals with compulsive disorders and addiction, as well as those with body dysmorphia and eating disorders.

And Dr. Flora Sadri-Azarbayejani reminds that "There are certain risks associated with physical activity, such as injury or overtraining, which should be monitored and managed appropriately." Sadri-Azarbayejani continues: "Some individuals may also find exercise difficult due to existing mental health issues, medical conditions, or physical impairments."

An assumption that working out — or working out in a way that doesn't work for every body — is the cure for mental illness is an extremely disheartening message for a depressed person struggling just to get out of bed. Los Angeles clinical psychologist Dr. Lauren Cook says, "While another person may be able to go out for a run fairly easily, that can be a monumental task when someone is struggling with their mental health. Medication and therapy can provide that stepping stone for improvement when exercise is feeling too difficult."

And while exercise isn't a replacement for other forms of mental health treatment and maintenance, it is certainly effective enough to make you wonder why it's not more routinely introduced into the conversation about it. A 2018 study out of Michigan State found that "fully 84% of respondents reported a link between [physical activity] and their mood or anxiety level and 85% wanted to be more active," but "only 37% reported their [mental health] providers regularly discussed [physical activity] with them."

Maybe it's in part because exercise takes time and effort. While it should be a part of everyone's life to their own ability level, we live in a quick-fix culture in which Americans will literally spend thousands of dollars for a drug to make them not eat. If we really want the mental health benefits of physical activity, we need to look realistically at how committed and consistent we are about making it a priority.

Mental health is never a one size fits all proposition, and all those memes telling us that a walk in the woods an antidepressant but medication is somehow "sh*t" are not actually helping anybody. As London counseling psychologist Dr Raffaello Antonino, founder of Therapy Central, says, "Exercise on its own can rarely resolve a mental health problem. Especially if the problem is fairly severe and has a long history, exercise alone would hardly be able to remove all symptoms. There are numerous individuals who are very physically active and still have depression, anxiety, or other issues." 

I know the life changing effects of therapy and medication, and have seen it firsthand in members of my family and myself. I likewise know that when I am regularly blasting my workout jams and running through my park, I'm less anxious all day and I sleep better at night. 

It's not a competition; it's a toolkit. We all just need to figure out the best ways to build ours, in conversation with our mental health providers, and without denigrating any one aspect of treatment over any other. Dr. Raffaello Antonino reminds, "All three — exercise, medication, and psychotherapy are ways to deal with mental health problems, and they are not mutually exclusive."

By Mary Elizabeth Williams

Mary Elizabeth Williams is a senior writer for Salon and author of "A Series of Catastrophes & Miracles."

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