Exercise and pharmacotherapy in the treatment of major depressive disorder.
OBJECTIVE
To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls.


METHODS
Between October 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50-200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D).


RESULTS
After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of <8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise = 45%; home-based exercise = 40%; medication = 47%; placebo = 31% (p = .057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p = .23).


CONCLUSIONS
The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, ongoing symptom monitoring, attention, and other nonspecific factors.
Blumenthal
James A
JA
Department of Psychiatry and Behavioral Sciences, Box 3119, Duke University Medical Center, Durham, NC, USA. Blume003@mc.duke.edu
Babyak
Michael A
MA
Doraiswamy
P Murali
PM
Watkins
Lana
L
Hoffman
Benson M
BM
Barbour
Krista A
KA
Herman
Steve
S
Craighead
W Edward
WE
Brosse
Alisha L
AL
Waugh
Robert
R
Hinderliter
Alan
A
Sherwood
Andrew
A
D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011615:Psychotherapy, Group; D020280:Sertraline / Q000627:therapeutic use*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D020280:Sertraline