The best antidepressants may not come from big pharma.
Psychiatrists have zeroed in on what they believe to be the most effective ways for the one in 10 Americans living with depression to alleviate their symptoms and rewire their brains.
A combination of regular exercise and cognitive behavioral therapy – a psychological treatment to help people understand how thoughts drive emotions and behaviors – can treat depression as well as any pharmaceutical, multiple experts have said.
The benefits of combining the lfiestyle changes and therapy can be so effective that Missouri-based psychiatrist Dr Richard Wadsworth said if his patients did so he would ‘lose 75 percent of my patients’ because they would no longer need a psychiatrist.
Roughly 30 minutes of cardiovascular exercise three to five times a week is a key way to alleviate depression symptoms, performing just as well or even better than antidepressant medications
Dr Wadsworth said: ‘This would not work for conditions like bipolar disorder and schizophrenia, but it would work for, I would say, most of the cases of depression and even with anxiety.’
The health benefits of physical exercise, particularly those for mental health, are well documented. Physical exercise causes a cascade of effects that go beyond losing weight and protecting against heart disease and diabetes, lowering blood pressure, and improving sleep.
High-intensity exercise releases feel-good chemicals called endorphins. But moderate-intensity exercise sustained over longer periods of time has an even greater lasting effect.
Researchers from Hong Kong set out to determine which of the following was most effective at treating depression – antidepressants, exercise, or a combination of the two.
Their results were based on data from 21 randomized controlled trials comprising 2,551 participants and 25 comparisons. They indicated no significant differences in treatment effectiveness among the three main interventions, meaning exercise worked as well as medicine.
Another study by Australian researchers reported that exercise is around 1.5 times more effective than either medication or cognitive behavior therapy.
It can actually help rewire the brain to correct behaviors by stimulating the growth of new connections between cells in crucial areas of the brain. This alteration is called neuroplasticity and it capitalizes on the brain’s ability to reorganize processes as a key weapon against depression.
Cognitive behavior therapy has been deemed as effective as antidepressant medications, and even more effective when the two are combined. The idea is to examine one’s negative thought patterns and rewiring them to better confront stressors
Along with exercise, cognitive behavioral therapy can also help combat depression, using what therapists call a top down approach. This focuses on thought patterns and perspectives that inform the way we see the world and how we behave in it.
CBT is a common form of talk therapy. Typical 50-minute sessions involve a therapist working to actively challenge disorted, negative thoughts by asking the patient logical questions about their thought process to identify negative patterns and helping them reframe those patterns to become more positive and productive overall.
It is crucial to note that this approach does not work for every mental health condition and treatmend is highly personal and individualized. No one should stop taking their medications without first consulting with their doctor.
Bipolar disorder typically requires mood stabilizing medication to mitigate severe manic or depressive episodes. These medications act on an array of neurotransmitter systems in the brain and keeps them in balance to regulate mood and reduce the severity of manic and depressive symptoms.
People with schizophrenia also generally require treatment with antipsychotic medications that block the action of dopamine to curtail hallucinations and delusions.
While you shouldn’t shun medication and substitute doctor’s orders with a jog, exercise and CBT have been known to help a long roster of mental diagnoses, including bipolar and schizophrenia.
CBT is highly versatile and can help people across the mental health spectrum rewire their thought patterns.
For instance, a college student who is particularly hard on herself earns a B on a term paper. That disappointment metastisizes and becomes an expression of general self-hatred, i.e. ‘I’m a failure.’
In CBT, a therapist would help their patient re-frame that perspective to reveal alternate perspectives. They would help the patient see that a B grade is still above average, one paper does not determine a person’s entire future, and it’s normal to experience setbacks once in a while.
Dr Wadsworth said: ‘You have a portion of your brain that talks to you all the time. It’s turning ideas into words. And usually, for depressed people, this part of their brain is really, really mean to them. It’s constantly putting them down.
‘Now, if you allow this part of your brain to function on autopilot, for most people, it’ll get them stuck in the swamp. It’s like having a parrot on your shoulder that’s constantly telling you that you’re a loser who doesn’t deserve to live or be happy.’
This mean-spirited inner voice is overly critical and judgmental, and diminishes a person’s ability to make positive changes in their life.
Starting a new hobby is a great way to engage the mind and improve neuroplasticity, but that critical voice can easily creep in to say, ‘you’ll never be good at that, why try?’ which can quickly snowball into ‘I’m not good at anything.’
Dr Wadsworth added: ‘Could you imagine trying to be happy with a parrot constantly shouting that in your ear?
‘You can train this parrot, take it off of autopilot. It’s not actually terribly complicated to do, but it requires consistency on your part. Every time that this parrot puts you down, you need to correct it. And then every day, you need to train your parrot, train the voice in your head.’
Rewiring one’s brain and building new synapses through CBT has been shown to have a more enduring effect on a person’s depression recovery and protects against relapse, something that could not be said for antidepressant medications taken alone.
That kind of enduring effect has not yet been seen in medications that provide relief from symptoms without necessarily addressing the underlying cause of the depression.
Dr Abbie Jones, a licensed psychologist in Indiana, said: ‘What we’re really doing is teaching metacognitive skills. So thinking about the way we think. And what we’re trying to do is encourage a top-down approach to irrational thoughts and disrupt behavior patterns that aren’t helpful or useful for our patients.
‘What patients are often used to doing is employing bottom-up processing. So, fear-based responses or emotional-based responses, activating the limbic system before we get to the prefrontal cortex to rationally think through whatever it is that just happened or whatever it is that we’re having a memory about that’s producing an emotion.’
And combining CBT with antidepressant medication appears to have an even greater effect on alleviating someone’s depression long-term. Social acceptance and declining stigma around mental health and illness have broadened access to treatments.
Since 2020, around 30 percent of American adults have seen a therapist. And according to the CDC, over 13 percent of American adults – approximately 33 million people – take antidepressant medication
Still, neither exercise nor cognitive behavior therapy will disappear all our problems. But, according to Dr Wadsworth, ‘it would do better than anything else that I can do as a psychiatrist.’
Sarah Carter is a health and wellness expert residing in the UK. With a background in healthcare, she offers evidence-based advice on fitness, nutrition, and mental well-being, promoting healthier living for readers.
