Are Sugar Pills Better than Antidepressant Drugs?

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Exercise as a Treatment for Depression

We’ve known for decades that even a single bout of exercise can elevate our mood, but could it be enough to be used as a treatment for major depression?

We’ve known that physical activity has been associated with decreased symptoms of depression. For example, if you look at a cross-section of 8,000 people across the country, those that exercised regularly were less likely to have a major depression diagnosis. That’s just a snapshot in time, though. In that study, the researcher openly acknowledges this may be a case of reverse causation. Maybe exercise didn’t cut down on depression, maybe depression cut down on exercise. The reason depression may be associated with low physical activity is that people may feel too lousy to get out of bed. What we’ve needed was an interventional study where you take people who are already depressed and randomize them into an exercise intervention. 

That is what researchers from Duke University Medical Center did. They randomized men and women over age 50 with major depression to two groups: one who did an aerobic exercise program for four months and another that took an antidepressant drug called Zoloft. In my video Exercise vs. Drugs for Depression, you can see a graph of their changes. Before exercise, their Hamilton Depression scores were up around 18 (anything over seven is considered depressed). Within four months, the drug group came down to normal, which is exactly what the drugs are supposed to do. What about the exercise-only group, though? Exercise had the same powerful effect.

The researchers concluded that an exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons, given that they’ve shown that a group program of aerobic exercise is a feasible and effective treatment for depression, at least for older people.

Not so fast, though.

A “group program?” They had the exercise group folks come in three times a week for a group class. Maybe the only reason the exercise group got better is because they were forced to get out of bed and interact with people—maybe it was the social stimulation and had nothing to do with the actual exercise? Before you could definitively say that exercise can work as well as drugs, what we would need to see is the same study, but with an additional group who exercised alone with no extra social interaction. And those same Duke researchers did just that.

They created the largest exercise trial of patients with major depression conducted to date, and not just including older folks, but other adults as well with three different treatment groups this time: a home exercise group in addition to the supervised group exercise and the drug group as before.

And, they all worked about just as well in terms of forcing the depression into remission. So, we can say with confidence that exercise is comparable to antidepressant medication in the treatment of patients with major depressive disorder.

Putting all the best studies together, researchers indicate that exercise at least has a moderate antidepressant effect, and at best, exercise has a large effect on reductions in depression symptoms and could be categorized as a very useful and powerful intervention. Unfortunately, while studies support the use of exercise as a treatment for depression, exercise is rarely prescribed as a treatment for this common and debilitating problem.

Exercise may compare favorably to antidepressant medications as a first-line treatment for mild to moderate depression, but how much is that really saying? How effective are antidepressant drugs in the first place? Check out my video Do Antidepressant Drugs Really Work?

For dietary interventions that may improve mood, see:

Exercise can also help with ADHD (Treating ADHD Without Stimulants) and improve immunity (Preserving Immune Function in Athletes With Nutritional Yeast), not to mention extend our lives (Longer Life Within Walking Distance). But what we eat matters: Paleo Diets May Negate Benefits of Exercise.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

39 responses to “Exercise as a Treatment for Depression

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  1. I have major depression. I really want to exercise and over the (14) years I’ve been depressed, I’ve made a few attempts. At first I exercised too intensely and found that this left me bereft. Then I tried again going really gently and found I could keep exercise up for a few months, then I would hit a wall and even the thought of exercise would cause me “psychic” pain (depressives will know what I’m talking about when I say psychic pain). So I gave up. I even tried exercising at home, just in case it was the stress of going to the gym, or the fear of being confronted when walking that was stopping me, but no, exercising at home slowly wound down to nothing. What’s really annoying is that at no time did I ever lose interest. In fact towards the end of my last attempt at exercise I became really frustrated that I could not continue it, especially as I thought it was doing me good physically.

    I’ve found nothing on the internet for people who feel mentally worse after exercise, either immediately, or progressively. My theory is that I’m hypersensitive to cortisol and that anything that causes it to rise -even mild exercise – will in the end cause me to feel worse and stop.

    1. hi Ian Gibson, if I may, I’d like to offer a couple of ideas to look into that might help in a daily exercise program. I recall reading that music can be used to lower cortisol levels in patients during medical procecures.. if indeed you are sensitive to rising cortisol, perhaps listening to your favorite music on an ipod or mp3 player during your walk might help ?
      Also, there are foods which can work to gently lower cortisol levels , many of them whole plant foods such as beans and greens, spinach, microgreens (notice a trend here?) as well as zinc. There are more than I list, but perhaps its a start for your research. Planning a nice big salad for lunch on your return from your walk might have a reward effect of lowered cortisol.. worth a try?

      1. Hi Susan, thanks for the suggestions. I’m just getting into vegan eating, although I still have milk in coffee. But I’m down to one cup a day and want to give it up, as I’ve read that coffee + stress is a very bad combination. So I Hadn’t thought about music and exercise and I will need to think about what is soothing, for my walks, when I take it up again.

        1. Ian, I used to drink coffee and found it to be necessary but very unnerving, caffeine-wise. I switched over to green tea which gives me a lift (energy-wise — and mood-wise.) Tea sustains me for a longer period of time at a slightly lower level than coffee, but the lift seems to last longer, and I think it’s healthy, as well. (Steeped greens in water?!)

        2. Hi Ian, pat yourself on the back for wanting to exercise and for starting a vegan diet. Have you checked out the links below the article for further reading on diet and depression?

          1. I might add that many depressed people have a component of SAD, Seasonal Affective Disorder, where the shorter days of winter and absence of sunlight, especially early morning sunlight, may trigger or worsen depression. Ideally early morning exposure to sunlight is best on a walk or other outdoor activity, but where weather or time does not permit, specially designed lights can be bought and take about 20 minutes per day. Placing the lamp or box in front of you while taking time to eat a good breakfast can be very effective, but it does not work for those without SAD. The lamps should be at least 10,000 lux, but always check with your doctor first, especially if you have eye problems. Not all lamps are safe or effective

    2. Ian, I’m sure there are many here who will be rooting for you, as I am. I was wondering if a food journal would help find foods that might(?) give you a mental boost. I have found that certain foods give me a boost. Perhaps it might work for you, too….

      1. Hi Liisa, I eat pretty much the same things every day. I’ve just started getting into a plant based diet. I have found this to be therapeutic. But I should branch out and try and get a more varied diet. I’ve learned so much from the videos on this site. So with that information in mind, I will now try to diversify. Thanks for rooting for me.

        1. Hi Ian, I have much experience but today you would not know it, this site will change your life completely, Dr Greger actually was the main guest speaker for Dr Nedley’s annual EQ Summit meeting that is about to happen very soon, you will find that some of Dr Gregers inspiraion has come from this meeting, be inspired and check it out, the program has a 95% success rate.

          1. Hi Wyman, I’m just wondering if there are people with depression like myself who can’t afford to buy the recommended programs suggested on the website you provided Ian with??

            1. Hi Wanderer yes there is community programs being run around the world at there normally is a small fee of less than half the program cost but to be honest if you can attend the meetings then I am sure they will work something out for you. If these locations are not possible let me know and I may be able to connect you with someone in your area, plus if you contact via the website they also maybe able to accommodate, either way nothing is impossible.

        2. Hello Ian, the variety of food may plays a role, that’s right, but thinking over the edge of the plate, we will see, that a lots of people around the world, mainly in poor countries, can’t afford a big variety of food. But they are not depressed… maybe (for me it is not maybe for me it’s sure) one reason is the starch in their food. Dr. McDougall, one of Dr. Gregers friends, stressed the starch daily intake… maybe to get informed by his website will bring you some more ideas. :-)
          And another thought – even when studies show exersice also work by doing alone – in a group I always find it more pleasant – a group starts by 2 personen. ;-)

    3. Ian, you have lots of people rooting for you here. So far nobody has mentioned the supplement, 5HTP. It was my salvation. I was depressed most of my life, and I have noticed a thread of depression running through my family, including my dad’s mother, my dad, my sister and me. I don’t know about others, but it’s possible.

      At one point a doctor put me of Zoloft, which I didn’t want to take, but knew I had to do something. After three months on a low dose I still had suicidal thoughts, though I knew I’d never act on them. I was never so depressed I couldn’t function. My doctor doubled the dose and after awhile I began noticing a bit of difference, but I never liked the thought of keeping the old serotonin when it was natural for the body to recycle it. Then a friend told me about 5HTP, which boosts the body’s ability to make serotonin. Within two days of starting it I felt the difference. My depression lifted and didn’t come back. I took it for a couple of years, though I probably didn’t need to take it that long. It comes in 50 mg capsules and I only took one daily.

      At one point I took a weekend workshop with Julia Ross, and she talked about using 5HTP to help her addicted patients in transitioning to healthy behavior. She asked each of us to empty a capsule of 5HTP under our tongues before breaking for lunch. Then when we reassembled we shared our experiences. Many of us felt a lift from the supplement.

      It helps most people sleep better, too, but I was one of the 2% or so who have a paradoxical effect, and it interferes with sleep somewhat. She told me to use L tryptophan instead, and it worked great without interfering with sleep. L tryptophan is the precursor of serotonin, and 5HTP is an intermediate step. Apparently you can’t get the effect by simply taking serotonin. L tryptophan comes in 500 mg capsules, and I took one daily.

      I seldom take either any more, but occasionally I’ll feel down without any obvious cause. I take it for a day or two and that solves the problem.

      I should also mention that you may find foods that trigger depression. Years ago I did an elimination diet to discover allergens. The day I added banana to my diet I simply wanted to do nothing but sit and stare. It was so funny. I knew I’d had times like that before, but I’d never associated them with bananas. There may have been other foods that affected my mood, but bananas are the ones I remember most. I don’t seem to be bothered by bananas any more, but I don’t eat them daily.

      Good luck, both with improving your diet, adding lots of healthy greens, beans, and a variety of veggies and fruits, and you may want to consider a trial of one of these two supplements.

    4. Ian, I had another thought: there are some studies in Japan suggesting that walking in nature, (forests,) has a measurable beneficial effect on one’s mood. This will be as opposed to possibly walking in an urban environment w/ traffic, smog, etc. I notice myself that I feel an improvement in mood while walking toward the sun, as opposed to walking “alongside” it or with it at my back. Here’s one link to get you started if you are interested:

    5. Ian, I would recommend a self powered vehicle for exercise, the endorphins are one of the best, if not the best way to feel great, in order to get them flowing you must follow an aerobic program. I’ve tried many, bicycle, Trikke, the Me-Mover which I’ve found that gives the quickest results is the one I chose. Besides it gets you outside, alone if that’s what you want. The exhilaration of using your own body outside to propel yourself is very calming. Many are apprehensive trying something new, I was also leery, after all, I never rode one, and was taking a chance, well, isn’t that what life is about, if you don’t, you’ll never experience things that can make you feel better. Anyway it didn’t take me long to acclimate my 78 yea old body, it was worth it, good things happened soon after, my stamina increased, and I felt like a young kid, even made a 40 mile trip one day. Or find something that makes you happy, but do not take a defeatist attitude, life is too short for that.

    6. Some exercise is better than none?

      Doctors tell us we need to have 150 minutes of moderate activity per week. They say that doing so will prevent premature death and serious illness. Unfortunately, not very many older Americans can meet this goal. The reason is pain.

      Most people over the age of 60 suffer from arthritis in their knees. And it’s the #1 reason most of these folks don’t get up and move. For many of these people, moving that much just sounds miserable. If this describes you, I’ve got some good news for you — and some great news.

      The good news is that a recent study showed that you don’t have to do 150 minutes if you can’t. In the study, Northwestern Medicine researchers wanted to determine if there was a less overwhelming activity goal that would be a “minimum” activity level. The number they came up with was 45 minutes per week (about six-and-a-half minutes a day). Why was that the magic number?

      At lower levels, the researchers found that only one-third of the participants improved or had high function after two years. But those who reached 45 minutes of moderate activity “were 80% more likely to improve or sustain high future function over two years compared with those doing less. This finding was true for both men and women.”

      For some people, even six minutes a day might be too much. The key is to get moving. But if the pain is just too much, there’s something else you can do.

      Many folks who suffer from knee pain will take pain pills. Not only are these highly addictive, they have tremendous side effects. Even over-the-counter pain pills can cause stomach bleeding.

      Your insider for better health, Steve Kroening, ND

    7. I’ve had issues with depression. But I currently have an exercise program that involves an exercise mat and hand weights….2 half hour sessions per week. Sometimes I don’t feel like getting on with it…but feel better after 5 minutes or so.

      My main inspiration for exercising results from my experience of stopping exercise….knee issues and problems getting around etc. It’s either use it or lose it?

      If I exercise regularly…CONSISTANTLY….I can move when I want…pretty much do what I want…with some limitations. Otherwise IT IS ALL DOWNHILL. Think about it?

      I relate to the couch potato sort of approach….oooooooh…it feels good to just lay about….but it is a dead end. Your dead end.

      1. Hi Fred, I am a volunteer for Dr. Greger. Thank you so much for sharing your experience, and I admire your will-power for overcoming your depression and to exercise more. In addition to exercising more frequently if possible (even taking walks, going on hikes, riding a bicycle, going swimming, etc.), have you considered altering your diet to a more whole food, plant-based one? Research shows that diets low in inflammation (a whole food, plant-based diet is exactly this) can benefit mood significantly. If you haven’t already tried, I would recommend to at least give it a shot. I wish you the best on your journey in health, Fred!

  2. An even better study would have included a fourth group: social gathering only. Just because exercise plus social does as well as exercise only does not mean that social only would have no effect (even if only by a Hawthorne effect). I know that Dr. Ornish includes social connections as a foundational element of healthy living.

  3. I can say from professional and personal experience being an Exercise Physiologist where clients ranged from cardiac rehab patients to professional and olympic athletes primarily in endurance sports. Myself being a multi state and national champion in three different disaplines many years ago. For me training (exercise) was never about health There is a dark side to exercise few discuss much like CTE in the NFL. When taken to the levels needed for competition that is if you want to win or as many unwitting people do that are not ever competing believing more is better. In the last several recent years there have been many high level endurance athletes that are now sick ex athletes were the amount of exercise is a contributing factor in developing autoimmune disorders.

    1. On the other hand, there are a lot of athletic groups these days that are focused on participation rather than extreme competition. There are many internet and meet up groups like this in many communities. In my baseball group, when someone makes a great play like a home run, everyone on both teams congratulates him (or her). We get a lot of exercise, but It’s at least as much about socialization. Look for a better balanced group in your area. Also things like gardening, hiking, kayaking, etc.
      John S

    2. I’ve been working out for over 50 years, albeit not in competition, I was always competing with myself, still do in my late 70’s. I’ve found that experimentation of exercise programs and devices is the best way to go, choose those that makes you feel like you’re accomplishing your goals. I chose weight training, not crazy workouts at my age, but I still can use the same weights in most of my routines as I did some years ago. I also use a Me-Mover which I mentioned in other posts here. Works for me, some people are apprehensive to try different, different is non sequitur, they will not budge out of their comfort zone, conditioned after many years of doing the same thing which must be right because they are doing it.
      Diversification is the key, crosstraining, do different, our bodies are designed that way.

  4. I suffer from periodic bouts of depression. Living in California, I have access to legal marijuana and have found its use to be an excellent, cheap and safe palliative for the periodic blues. I’m a 68 year old vegan who has gone to the gym two or three times a week for my entire post-college life. But I still get deeply and, otherwise, uncontrollably depressed and, for me, the legalization was a godsend. Your experience may vary.

    1. If any one is thinking about using medical marijuana please do a lot of research before trying it. Some people it helps and some people it makes worse. There are different strains that have different effects on the body also. Anxiety and depression can be caused by marijuana. I support its use but caution it is not for everyone.

    2. Tired, I know a lot of people who are now dependent on marijuana after using it to self-medicate. This snippet from the Royal college of physiatrists hits all the high points of what I’ve seen.

      “Is cannabis addictive?

      Yes. Even though in the past cannabis was not thought to be addictive, current evidence now suggests that it can be, particularly if used regularly. Cannabis has the features of addictive drugs such as the development of:

      tolerance – which means having to take more and more to get the same effect. In heavy users, you can experience withdrawal symptoms such as:
      decreased appetite
      sleep difficulty
      weight loss
      aggression and/or increased irritability
      strange dreams. .
      These symptoms of withdrawal produce about the same amount of discomfort as withdrawing from tobacco.

      For regular, long-term users:

      3 out of 4 experience cravings;
      half become irritable;
      7 out of 10 switch to tobacco in an attempt to stay off cannabis.
      The irritability, anxiety and problems with sleeping usually appear 10 hours after the last joint, and peak at around one week after the last use of the drug.”

      Especially considering the research suggesting that marijuana exacerbates depression in the long term, I would urge you to look into adaptogens as a much safer alternative.

      1. Ryan, Your comments have been of great help to me. A laugh a day is a wonderful tonic and the only thing that might have made the anti-marijuana dogma more fun is if you had included statistics that showed each and every user of marijuana went on to die…eventually. I don’t know what they’re smoking in the UK these days, but if it makes you think marijuana is addictive, it’s too weird for me.

        1. I only pulled up that article because it was the most scholarly and credible source that I could find quickly. I’m actually from the U.S.

          I know we’ve been lied to for years about the effects and properties of illegal substances. Marijuana, magic mushrooms, LSD, salvia, and certain other drugs actually do have medicinal potential and really don’t cause the harm we were told they do.

          On the other hand, I sincerely believe from both my personal experience and my research that there are much better and safer options available to help treat yourself.

          I’m not some stuck up person that’s never tried the substance trying to warn you away from it. I’m the guy who’s watched my fiance go through THC withdraw and the months of cravings that have come afterwards. I’m the guy who has seen multiple co-workers self-medicate with weed for their anxiety and depression. None of them can now go even a full day with multiple hits of THC.

          I still wouldn’t even care if it actually helped them. However in each case the marijuana only masked the problem while they were high and made their depression and anxiety worse when they were sober.

          So I’m asking you to please consider giving adaptogens a shot before THC consumes your life and turns it into an emotional rollercoaster like it did to people in my life.

  5. Group exercise among like-minded individuals may have the same effect a good party does: increase serotonin/dopamine, etc. from group interaction.
    Humans are social animals. Corporate life/work leads to alienation/isolation due to specialization, social atomization. Alienation is good for business: lonely men/women can easily be persuaded to buy products, take a trip, go to a bar, join a well controlled group to feel better. Hence, misery compounds and profits/growth goes to a few blessed ones….
    Societies where interactions are encouraged seems to have fewer stress related health/socio-psychological problems than those where individuals are isolated. Also, location on the social grid and hierarchy affects health and social interaction significantly. Lots of groups studies were done long ago by Elton Mayo determining group interaction, productivity and individual happiness (with its obvious impact on health). Check Hawthorne effect, Bank wiring room, etc.

  6. Thank you! So glad to see this post. I am living proof that exercise can be, IMHO, just as important as diet. Why, because I didn’t hit my goals for blood chems and elimination of diabetes until i started moving my mass. The Goddess who is my wife ever so deftly blackmailed me into doing the walks, then the hills and so on. The black cloud lifted and my demons vanquished to the corn field. If you find yourself at a plateau and are not getting in a workout…find a Goddess! It really can make the difference.

    1. I am so glad to hear your success story of using diet and exercise to improve your health and happiness! Keep up the good work.

      1. I am an old male senior who has been aging quite quickly at 83 and limited what I can do. Even short walks are hard, Up until 2 years ago my wife and I went biking and played some golf. She handles excercise better than me. I’ve focused on nutrition past year to help feel better. My past is catching up with me. Some handle aging better or their genes are the reason, my dad passed away at 72 after heart disease and cancer.

        1. Hi Ron, I am a volunteer for Dr. Greger. Thanks for posting, and it’s great to see that you are working hard to maintain your health as best as possible. Do you have any underlying health problems, such as chest pain, arthritis, or any other chronic illnesses that are specifically keeping you from moving? Also, while you are focusing on nutrition now (which again, is excellent!), are there certain steps you can take to further get closer to eating a whole food plant-based diet? For example, eliminating all animal products, oils, processed grains and sugar, and increasing fruit and vegetable intake? Just some tips for maximizing the effects of the effort you put towards maximizing your health. Best of luck, Ron!

        2. Ron,

          Hearing the significant changes your experiencing, have you checked your nutrient levels ?

          I’m suggesting a spectracell style of evaluation as it’s done on your cells not just looking at averages along with the obvious and typical blood indices. I’d be very curious what your CoQ10 levels, along with methylation and a host of other potentials might be affecting your aging.

          Clearly also looking at your mitochondrial function should be on the short list. See your physician and get checked asap.

          Remember, your age is not a chronological number, but rather a biological point in time. Look forward to hearing your feeling younger and keeping up with your wife.
          Dr. Alan Kadish moderator for Dr. Greger

          1. I was taking C0Q10 when on statin but stopped taking both I stopped the statin due to side affects I’ve had with all statins over past years. Haven”t had blood tests since last summer. Will see my Dr. when I return home soon from vacarion. Now having constipation and frequent urinary issues, particularly at nights.

  7. A relative of mine was depressed for decades, on anti-depressants that had side effects. One day he just stopped taking the drugs and started going for long walks. This pretty much cured his depression.

  8. I have found that exercise has helped me more than any other from of medication. Some years ago i was prescribed tranquilizers for anxiety, did little to help me. Then during one of the most anxious times of my life when I was being treated for cancer I used exercise to relieve my stress. i still use exercise to maintain my physical condition and emotions. At my age, late 70’s I prefer immediate results, so I weight train with multiple sets of negatives, and lighter weights to failure for my anaerobic conditioning. For aerobics I use a Me-Mover which gives intense exercise quickly, it works most of my body including my core and legs which, they say are the first to go as we age, to my surprise I actually gained size and definition.
    I’ve found that spending too much time indoors, sitting, are the contributing factors for depression, best to get out, move, but not in a motorized vehicle, I made my choice with the Me-Mover, why not make your’s?

  9. Have you ever read the book “Anatomy of an Epidemic”? In this book the author, Robert Whitaker, demonstrates how the over prescription of antidepressants in the U.S. have actually CAUSED the epidemic of depression in our country rather than done anything to fix it. Near the end he cites a study similar to the one you’ve cited above. This study included three groups of depressed patients. Like the study above one group was treated with only exercise and one was treated with only antidepressants. The outcome for these groups was similar to the outcomes for the group’s in your study. The interesting thing was the third group which was treated with BOTH antidepressants and exercise. This group’s outcome was the SAME as those treated only with the antidepressants. Thereby suggesting that the drugs themselves are interfering with the positive effects of the exercise.

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