clinical study insights

Procognitive Effects of Exercise in Depression

by Madhukar Trivedi, MD

Overview

Clinical Study Title:
Evaluation of the Benefits of Exercise on Cognition in Major Depressive Disorder

Clinical Study Abstract:
Cognition plays an important role in major depressive disorder (MDD) throughout the lifespan. Exercise has shown direct positive benefits on mood and cognitive symptoms in depression, and exercise impacts the subserving neural regions and modulatory systems implicated in MDD. Still, the focus on cognition in MDD is relatively recent, and relevant data are limited. The present review explores current evidence and outlines concepts likely to advance knowledge in this area. Investigators find that the effects of exercise on cognition in depression are promising. They also propose future directions for research that may help to clarify the role of exercise-based interventions for patients with MDD.

Reference:
Greer TL, Furman JL, Trivedi MH. Evaluation of the benefits of exercise on cognition in major depressive disorder. Gen Hosp Psychiatry. July 6, 2017. pii: S0163-8343(17)30102-0. [Epub ahead of print].

Expert Commentary

Madhukar Trivedi, MD

Professor of Psychiatry
Director, Center for Depression Research and Clinical Care
Peter O’Donnell Jr. Brain Institute
UT Southwestern Medical Center
Dallas, TX

The effects of exercise on cognition have been studied more thoroughly in other disorders (eg, Alzheimer’s disease, Parkinson’s disease, and schizophrenia) than in MDD. There are links and parallels between MDD and these other disorders, however, which suggest that insights might be gained from past work on the effects of exercise on cognition in these other disorders.

From the mechanistic perspective, there are many reasons to believe in the potential for benefits of exercise on cognition in MDD.

TABLE

Future studies examining procognitive effects of exercise in MDD should account for important sources of heterogeneity that currently limit data interpretability. These include: clinical heterogeneity with respect to the MDD diagnosis and symptom severity; differences in the tools used to measure cognitive function; and differing exercise modalities and control interventions. Variability in cognitive effects of exercise in comparison to antidepressant medication will also be of interest.

In short, we place importance on identifying future directions that may help better clarify the role of this potentially beneficial intervention for cognition in depression. Given the functional consequences associated with depression-related cognitive impairments, it is essential that the field work toward treatments that target cognitive issues.

References

Blumenthal JA, Babyak MA, Murali Doraiswamy P, et al. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Med. 2007;69(7):587-596.

Brondino N, Rocchetti M, Fusar-Poli L, et al. A systematic review of cognitive effects of exercise in depression. Acta Psychiatr Scand. 2017;135(4):285-295.

Greer TL, Grannemann BD, Chansard M, et al. Dose-dependent changes in cognitive function with exercise augmentation for major depression: results from the TREAD study. Eur Neuropsychopharmacol. 2015;25(2):2482-2456.

Hoffman BM, Blumenthal JA, Babyak MA, et al. Exercise fails to improve neurocognition in depressed middle-aged and older adults. Med Sci Sports Exerc. 2008;40(7):1344-1352.

Toups M, Carmody T, Greer T, et al. Exercise is an effective treatment for positive valence symptoms in major depression. J Affect Disord. 2017;209:188-194.

Trivedi MH. Evaluating and monitoring treatment response in depression using measurement-based assessment and rating scales. J Clin Psychiatry. 2013;74(7):e14.

Wroolie TE, Williams KE, Keller J, et al. Mood and neuropsychological changes in women with midlife depression treated with escitalopram. J Clin Psychopharmacol. 2006;26(4):361-366.

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