Exercise – It Works For Depression

I’m currently reading with great pleasure Tony Schwartz’s new book, The Way We’re Working Isn’t Working – The Four Forgotten Needs That Energize Great Performance. Schwartz’s main premise is that we need balance — between activity and rest on the physical level, between performance and renewal on the emotional level, between left and right brain on the mental level, and between inner and outer work on the spiritual level. If we don’t have this balance, we tread water — we may look like we’re high performers but compared to what we are capable of when we have balance, we don’t produce much, are not very creative, and don’t have as much fun, or as much impact, as we could have.

One chapter of the book is dedicated to movement. Schwartz cites an important study in it — the SMILE study (Standard Medical Intervention and Long-term Exercise, conducted at Duke University), which found that vigorous exercise three times a week for half an hour or forty-five minutes reduced symptoms of depression as effectively as antidepressants.

Figure from Psychosomatic Medicine 62:633-638 (2000)What Schwartz does not mention is that a follow-up study went even further. In the initial study, participants exercised for 16 weeks and were then given a depression test four months later. When participants were investigated another two months later, those that had kept up with the exercise were doing extremely well. When they were interviewed about depression symptoms, according to the Diagnostic and Statistical Manual (DSM IV) and the Hamilton Rating Scale for Depression, those who had exercised were more likely to be partially or fully recovered or were less likely to have relapsed than the group that had only taken medication (Zoloft) or taken medication and exercised. In fact, an illustration shows that there were approximately 60% more in the exercise group than those in the medication group who had recovered, and there were about six times more in the medication group who had relapsed compared to the exercise group.

Is exercise the solution to depression, then? Of course not. While the findings are truly impressive, there were many who had recovered with medication alone or with a combination of the two. There is always a tendency to take the main finding of a study and proclaim it to be the new truth – but neither life nor science is that simple. However, the study is something that we need to seriously think about, or better yet, try out ourselves. One thing is for certain: the benefits of exercise far outweigh its drawbacks.

The heading under which Schwartz talks about the initial SMILE study is “Move and Thrive”. For someone who is in the depths of a major depression, these two may seem far off, and getting oneself motivated to exercise can seem next to impossible. However, starting an exercise routine — or let’s call it a movement ritual, as Schwartz would (“exercise routine” always sounds so serious, doesn’t it?) — when one is not currently in the grips of depression may just be the thing that forestalls or at least alleviates the next bout.


Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, & Krishnan KR (2000). Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosomatic medicine, 62 (5), 633-8 PMID: 11020092

Blumenthal JA, Babyak MA, Moore KA, Craighead WE, Herman S, Khatri P, Waugh R, Napolitano MA, Forman LM, Appelbaum M, Doraiswamy PM, & Krishnan KR (1999). Effects of exercise training on older patients with major depression. Archives of internal medicine, 159 (19), 2349-56 PMID: 10547175

  • Informally, a combination of SSRIs and exercise seems to be optimal. SSRI users often say that exercise helps “switch on” the beneficial effects of the medication. Conversely, when people feel better from the meds, they are likely to exercise more regularly. For an untreated depressive, the response to an exhortation to exercise is often, “you gotta be kidding.”

    • Yes, the “you gotta be kidding” response happens frequently, and it is understandable. I find that one of the most challenging moments in therapeutic conversation is when we navigate the tricky waters of things like exercise, meditation, simply leaving the house, etc. Here you are, you feel like your life has lost pretty much all its taste, and you get a suggestions to do WHAT? Go to the friggin’ gym?!

      One thing to avoid, for sure, are exhortations. I find it sometimes works when I say something like, “You’ve probably read this yourself already, but just in case, would you be interested in reading this article on the connection between depression and exercise?” It’s so important to affirm that many people with chronic conditions (depression being one of them) already know quite a bit.

  • speedwell

    Yes… I knew about this, and told my therapist, who has also heard about it, and so I bought a recumbent bike. But it is physically difficult for me to do a half hour on it anyway (the best I can do is 20 minutes per session right now), and it is especially difficult to exercise when I am feeling worn out from the Sisyphean task of fighting depression all day while remaining functional at work.

    • And kudos for you for doing it for 20 minutes! There’s lots of evidence saying that ANY amount of exercise is beneficial. What do you think – is it beneficial for you?

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  • Alexander Queen

    Yes……but the prescription of excercise for each patient, shouldn’t it be left to the physical therapist? would really love to know what you think.

    • Gabriel Pineres

      This is a question that I see so much of now a days. Exercise shouldnt prescribed but a part of life. If a doctor NEEDS to prescribe physical activity then we as a human race are in trouble.

      We humans were not made to simply sit at home watching tv and work at a desk all day. We need to move, it is a way to release stress. Depression for most is from anxiety.

      The happiest moments in my life are when I am working out on a regular basis. Everything is so much better. Working out becomes meditation, a way to disconnect. Combine that with the endorphane highs and BOOM everything seems to change.

      I havent worked out on a regualer basis for a couple of years and I feel sluggish, and simply “off” mentally and physically.

  • Lyn Murphy

    Movement is so important for so many aspects of our life it is not surprising that depression is aided as well. I was once completely sedentary and now exercise 3-4 days a week week in and week out. Once started it becomes second nature and I actually crave it if I don’t get enough. I think it’s important to remind people too that exercise can take many more forms than just going to the gym, walking the dog, playing with children, walking in nature all qualify and are not like a “work-out” at all. I help my clients get started on an exercise program all the time and rarely do they stop once they have made it a habit.

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  • Yes, exercise works in a depression. Depression is a type of mental disorder that affects a person’s mood.
    Exercise probably helps ease depression in a number of ways.

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Isabella Mori

Isabella Mori is a psychotherapist in private practice in Vancouver. She has been working in the field of mental health, counseling, psychotherapy and movement therapy for 18 years.

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