According to the World Health Organization, depression is one of the most common illnesses worldwide and one of the leading causes of morbidity and mortality. Depression had a significant negative impact on overall quality of life, both physically and emotionally. Studies have shown that people with serious physical diseases, such as cancer and heart disease, who are also depressed do not respond as well to treatment of their disease and die sooner than those with the same disease but who are not depressed.
Modern medicine has proven the important role of treating depression in achieving optimal physical health for people of all ages. Even for those who are otherwise physically health, identifying and treating depression play major roles in maintaining good physical health. Chronic depression and anxiety have been proven to negatively effect all aspect of the body’s immune system, our body’s defense against illness. The field of study that examines these effects is called psychoneuroimmunology. Importantly, when depression is diagnosed and properly treated, the immune system returns to normal.
Despite being one of the most common illnesses, depression is often under diagnosed. This is a significant problem. Depression is much more than feeling sad. In fact, some patients do not report sadness at all but become irritable (this is common in adolescents). Major depression—the illness not the mood state—includes feelings of hopelessness, helplessness, worthlessness, lack of energy, poor sleep, appetite changes and a loss of the ability to enjoy life and feel passion. These are very uncomfortable feelings that can come on gradually over weeks, months or years. People who are experiencing depression may try to self medicate to feel better and turn to alcohol and/or drugs. Drinking or using drugs to escape feeling bad can have significant adverse consequences. Once the brain’s reward pathway gets hijacked with drugs of abuse, addiction and dependence can be added to the diagnosis of depression. Patients with drug abuse problems who are also depressed are more challenging to treat than those with only one of the conditions alone. The important issue, as with all of medicine, is early diagnosis and treatment.
Depressive symptoms can result from a number of medical conditions and be a side effect of a number of medications. In these cases, the appropriate treatment is to treat the underlying medical illness or change the offending medication. Once depression is accurately diagnosed, what is the best treatment? Many believe the only effective treatment for depression is antidepressant medication. This is not true. Talk therapies (psychotherapy) have been proven to be as effective as medication in mild to moderate forms of depression. Many studies have demonstrated that for more severe forms of depression, medication plus psychotherapy is the most effective. Newer treatment modalities that use magnetic stimulation of the brain may also be effective for some patients, and electric shock therapy is still one of the most effective (and safest) treatments for patients who do not respond to other treatment modalities.
What about the role of exercise and nutrition as a treatment for depression?
The importance of exercise in maintaining emotional and physical health is not new to medicine. Ancient forms of healing frequently discussed the need for patients to move and stay fit. In 1987, the National Institute of Mental Health assembled a panel of experts who produced a consensus statement about the important role of regular exercise as an effective treatment for depression and other forms of mental illness. Typically exercise is recommended not alone but as an important part of an overall treatment strategy.
For exercise to be maximally effective, it must be fun. Too many people associate exercise with something that is painful and not enjoyable. There is no one best form of exercise. The key is to get the heart rate up to about 75%–80% of maximum exertion and maintaining it for at least 20 minutes. This should be done at least 3 times per week. The more fun the activity is, the more likely the person is to stick with it. There can be added benefits from group activities, which bring in a social component. The key factor is understanding how important exercise is for everyone, especially those who are depressed, regardless of age, gender or level of fitness. For those not in shape (most of us), it is important to start easy, listen to your body, increase a little bit each time, stick with it and most importantly ENJOY IT!