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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on October 22, 2011, at 21:25:11
For depression, anxiety, schizophrenia all viable options. Benefits of excercise. Phillipa
From Medscape Medical News > Psychiatry
Exercise a Viable Treatment Option for Mental Illness
Absence of Guidelines Should Not Be a Barrier
Caroline CasselsAuthors and Disclosures
October 21, 2011 (Vancouver, British Columbia) Exercise is an effective, but potentially underused, treatment option for mental illness, experts say.
In a symposium presented here at the Canadian Psychiatric Association (CPA) 61st Annual Conference, Christopher Willer, MD, a senior psychiatry resident at the University of Toronto, Ontario, Canada, made the case for exercise as an adjunctive therapy.
Emerging research, he said, strongly suggests that exercise can improve patients' physical and mental health and may help offset some of the metabolic effects associated with older antidepressants and newer atypical antipsychotics.
Dr. Christopher Willer"It's not too soon to talk to patients about exercise as another treatment option, especially if they are asking about it or if they have a history of sport being important in their lives.
"There's often a time lag between the time research comes out and when treatment guidelines are published. Based on the quality of the research that has been published [on exercise and mental illness] in the last 5 years, I think it would be irresponsible to wait," Dr. Willer told Medscape Medical News.
In his presentation, Dr. Willer reviewed the existing literature for aerobic exercise as a treatment for mental illness, some of which suggests it can be as effective as pharmacotherapy and/or talk therapies.
However, potential mental health benefits aside, Dr. Willer noted that the physical benefits of exercise are clear and include reducing cardiovascular risk factors that are often associated with mental illness and the medications used to treat psychiatric disorders.
"Exercise mitigates certain illnesses; it protects against obesity, which certainly is a big problem with much of our patient population; and it has been shown to help with cognition and affective problems in well people.
"As psychiatrists, we have to remember that we're not just concerned with our patients' psychiatric symptoms but also their physical health. It is important that we promote an active lifestyle to our clients as part and parcel of good psychiatric treatment," he said.
Antianxiety Properties
Early research examining exercise and depressive symptoms has been relatively simple, relying on case reports or short-term intervention studies. However, said Dr. Willer, in the past 5 years it has become more sophisticated.
"We've come a long way, and now there are randomized trials that are attempting to compare exercise to a sham version of exercise that include larger numbers of patients, so the studies are higher quality," he said.
Most of the evidence to date supports the use of aerobic exercise in unipolar depression, he added.
However, a Cochrane review published in 2010 and reported by Medscape Medical News at that time showed that regular physical exercise in individuals with schizophrenia and schizophrenia-like illnesses is feasible and may help improve the mental and physical well-being of these patients.
Nevertheless, although the overall results were positive, the review included only 3 small studies, prompting the authors to point out that larger randomized trials are needed "before any definitive conclusions can be drawn."
Dr. Willer also noted that physical activity has been shown to have antianxiolytic properties.
In patients with anxiety, sometimes there is a concern that the somatic expression of exercise elevated heart rate, sweating, and heavy breathing may invoke a panic response, but the literature does not bear this out, said Dr. Willer.
"There are studies that suggest that in the moment, anxiety can be moderated by physical activity, and there are also studies showing 20 minutes of exercise a day for 10 weeks can modify on trait anxiety," he added.
Worthwhile Endeavor
Dr. Willer pointed out that only about 30% of North Americans get the recommended amount of 150 minutes of exercise per week, and that the therapeutic dose for the treatment of mental illness is unclear. However, he noted, as the research becomes more refined, this will be elucidated.
In the meantime, he said, encouraging psychiatric patients to become more physically active is a worthwhile endeavor.
"It is not expensive, and it can be independent of the healthcare system. It doesn't require [the psychiatrist] to be involved, other than to mentor patients and to check in with them," he said.
Dr. Saul MarksAsked by Medscape Medical News to comment on Dr. Willer's presentation and assertion that psychiatrists should consider exercise as a viable treatment option, Saul Marks, MD, a practicing sports psychiatrist at North York General Hospital in Toronto, said it is a routine part of his practice.
"Exercise confers a definite benefit. I have a patient myself who was able to come off antidepressant medication by taking up running, and she is doing extremely well now. There is a growing body of literature that psychiatric patients are at particular risk of metabolic syndrome, especially if they are taking atypical antipsychotics, suggesting psychiatrists need to promote exercise as a treatment," said Dr. Marks.
Dr. Marks added that he routinely talks to his patients about the importance of being physically active every day.
"Even if they do something as simple as walking for 45 minutes a day, that will keep them physically fit and also help their mental health," he said.
Dr. Willer and Dr. Marks have disclosed no relevant financial relationships.
Canadian Psychiatric Association (CPA) 61st Annual Conference: Abstract S11b Presented October 13, 2011.
Posted by bleauberry on October 23, 2011, at 4:43:04
In reply to Excercise A Viable Option In Mental Health, posted by Phillipa on October 22, 2011, at 21:25:11
From my own personal observations of others over the years I do believe exercise is usually helpful for depression. Not always, but usually. If someone were to call it a cure I would not agree with that. I think it is one of our tools to be used in combination with other tools, where multiple tools simultaneously works best.
I think maybe the strongest benefit of exercise is as a diagnostic tool. For example, sometimes people feel worse with exercise instead of better. In those cases, there is a strong clue that we are dealing with low adrenal function and/or low cortisol function. Exercise makes that even worse, so we would feel worse. On the other hand, some people feel better after exercise. Maybe just for a short time, a few hours, a day or so, whatever, but they did feel noticeably better. In those cases, the clues are.....opioids, norepinephrine. If someone goes to Zumba and they come out feeling a lot better, I am pretty confident concluding their problem is not in the serotonin circuitry and any serotonin med probably won't do much for them and maybe even make them feel worse. I would also place bets that the exercise responder folks would not find antipsychotics or mood stabilizers helpful either. That helps us to whittle the list of choices to only meds that would somehow impact the same chemistries exercise does.
A friend of mine had been released from the psych ward for depression and was still doing badly and not doing well with the common prescriptions....lexapro, zoloft, lithium, lamictal, etc....but she said after her weekly dancing class she felt so much better. That told me all I needed to know, and I thus suggested to her Rhodiola Rosea. She is now in remission. It was exercise, or the response to it rather, that gave me the clues to feel confident in helping her decide what to do. Had it not been for her dance class, it would have been a coin toss to randomly choose any med.
Another friend of mine is a marathon runner. He gets depressed if he doesn't run. He doesn't want to take meds. So he runs on a regular basis and it keeps him well. Not to be mistaken, he is not cured, and he is only in a "managed remission", but bottom line is he stays well as long as keeps the running going. That to me tells me he has a deficiency in the opioid circuitry somewhere, and running relieves that deficiency. There are a few meds and herbs that can do that too. Most of them not.
Exercise as a diagnostic tool. I like that. It gives good clues as to what the underlying chemistry is that is causing the problems.
Posted by SLS on October 23, 2011, at 6:21:09
In reply to Re: Excercise A Viable Option In Mental Health, posted by bleauberry on October 23, 2011, at 4:43:04
Hi Bleauberry.
Why did you choose Rhodiola Rosea? What are its properties?
Thanks.
- Scott
Posted by Phillipa on October 23, 2011, at 18:24:57
In reply to Re: Excercise A Viable Option In Mental Health, posted by bleauberry on October 23, 2011, at 4:43:04
I don't know about this for all as all my grown kids now run and working toward marathons and none are or have ever been depressed. One a VP of a bank. As for myself I had to run or jog for certification to teach the aerobic dance I taught. Hated it in the beginning. Only after running for some time did I besides doing the aerobic dance daily teaching, choreographing have to jog after not jogging for two days. So I feel it's different for lots of people.I did run till age 57 or so til I fell and broke my wrist. Now it's the bike. Not aerobic but a feeling of freedom when climbing a hill or going down it. I have to ride daily my six miles no gears beach cruiser. Phillipa
Posted by gadchik on October 25, 2011, at 11:27:39
In reply to Re: Excercise A Viable Option In Mental Health, posted by bleauberry on October 23, 2011, at 4:43:04
Exercise is THE most important thing to my mental health. I get outside and hike up mtns most days.
Posted by creepy on October 25, 2011, at 14:16:20
In reply to Re: Excercise A Viable Option In Mental Health » bleauberry, posted by SLS on October 23, 2011, at 6:21:09
Wiki has an article on it. It might have MAOI properties. Wonder if its strong enough to raise the risk of serotonin toxicity?
Posted by Phillipa on October 25, 2011, at 23:32:48
In reply to Re: Excercise A Viable Option In Mental Health, posted by creepy on October 25, 2011, at 14:16:20
Seriously? Wish you had posted the link as not sure what to google. Phillipa
Posted by huxley on October 30, 2011, at 2:57:42
In reply to Re: Excercise A Viable Option In Mental Health, posted by gadchik on October 25, 2011, at 11:27:39
Regular Exercise saved my life.
A good diet, good exercise can do wonders for your mind.
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