Running vs. Meds: Which Works Best to Beat Depression?

Exercise has been dubbed “nature’s antidepressant” by doctors for years, and now a new study confirms the notion.

The finding follows a four-month look at the impact that running had on anxiety and depression when compared to a common antidepressant.

SSRIs (selective serotonin reuptake inhibitors) work by boosting levels of serotonin, a neurotransmitter that’s a key player when it comes to regulating mood, depression and anxiety.

But among 140 depression patients, those who engaged in regular group running — meaning two or three 45-minute runs each week — actually saw their depression levels drop a bit more than those who took the popular SSRI medication escitalopram (Lexapro).

And those who treated their depression with exercise reaped an added reward, with improvements seen in their physical health as well.

That group, said study author Brenda Penninx, also “lost weight, improved fitness and reduced heart rate and blood pressure.” The medication group did not see those benefits.

Penninx, a professor of psychiatric epidemiology and vice chair of the department of psychiatry at Amsterdam University Medical Center in the Netherlands, presented her findings this weekend at the ECNP meeting, which focuses on the science and treatment of brain disorders. The research was published earlier this year in the Journal of Affective Disorders.

All told, she said, the findings suggest that “we should pay much more attention to lifestyle improvement in mental health care.”

Patients in the study all struggled with depression and/or anxiety.

When given a choice between the two options, nearly two-thirds chose to tackle their depression with running sessions that were regularly scheduled over a four-month period. The remaining third chose to take escitalopram.

The team noted that in both groups there were patients who saw no benefit of any kind when it came to curtailing depression or anxiety.

In fact, only just over 4 in 10 patients (44%) in both the running and medication groups experienced a mental health boost.

But those in the running group who did also went on to shed some weight and reduce their waist circumference. Improvements in blood pressure and overall heart function were also seen.

That was not the case among those taking escitalopram.

There was one downside seen in the running group: The likelihood that a running patient stuck with the full exercise program was considerably lower than it was for patients who chose escitalopram. Somewhere between 52% and 58% of runners maintained their running routine throughout the study period, compared with 82% to 85% adherence in the medication group.

Expressing little surprise at that finding, Penninx noted that “lifestyle change is known to be difficult.”

Still, patients might benefit by being given a choice as to what they feel might work best for them, she said.

“Unfortunately we don’t know yet what works for whom,” Penninx acknowledged, adding that a combination of both treatments “may be best” when it comes to upping the chances for managing depression.

For Ahmed Jérôme Romain, an assistant professor with the School of Kinesiology and Physical Activity Sciences at the University of Montreal, it’s physical activity in general, not just running, that works this mental health magic.

Romain, who was not part of the new study, said he was not surprised by the findings “because it is well described that physical activity can be used to alleviate depressive symptoms, but also to prevent depression.”

He noted, for example, that in Canada “physical activity is included in the recommendations to manage depressive disorders. So, physical activity such as running is definitely an important strategy in people with depression, because it can help in mental health, but also [with] physical health.”

The other thing to consider, Romain noted, is that exercise does not come with the side effects that a medication can bring.

As for what might lower the chances that patients will give up on running over time, he suggested a few strategies.

“First, it is important to have a focus on pleasure during exercise, because it is likely that if patients don’t like their exercise sessions it will be more difficult to maintain it over time,” Romain said.

He also cited the importance of enlisting social support, such as having someone to exercise with you; setting exercise goals to boost confidence; tracking depression symptoms before and after exercise, and having a physical activity plan.

Having regular exercise reminders in place — via friends, family or phones — is also helpful when it comes to sticking with any exercise regimen, Romain added.

“Physical activity is medicine for your physical, mental and psychological health, so it’s time to start,” he said. “If it is too difficult, try to find a professional in exercise to help you in this process. And more importantly, please find something pleasant. The most important [issue] is not how hard you exercise, but how long you will maintain it over time.”

More information

There’s more on the impact of exercise on depression at the Mayo Clinic.

SOURCES: Brenda Penninx, PhD, professor, psychiatric epidemiology, and vice chair, department of psychiatry, Amsterdam University Medical Center, The Netherlands; Ahmed Jérôme Romain, PhD, assistant professor and researcher, School of Kinesiology and Physical Activity Sciences, University of Montreal; presentation, Oct. 7, 2023, ECNP Meeting, Barcelona Spain; Journal of Affective Disorders, May 15, 2023