Exercise as an augmentation treatment for nonremitted major depressive disorder: a randomized, parallel dose...

Area of Science:

• Psychiatry
• Exercise Science
• Clinical Psychology

Background:

• Major Depressive Disorder (MDD) often requires augmentation strategies beyond initial antidepressant treatment for remission.
• The Treatment with Exercise Augmentation for Depression (TREAD) study investigated aerobic exercise as a second-step treatment.
• A clinicaltrials.gov Identifier: NCT00076258.

Purpose of the Study:

• To test the efficacy of aerobic exercise as an augmentation treatment for MDD patients who did not achieve remission with selective serotonin reuptake inhibitor (SSRI) treatment.
• To compare the effects of two different exercise dosages (16 kcal per kg per week vs. 4 KKW) on depressive symptom remission.
• To explore potential moderating effects of gender and family history of mental illness on exercise treatment response.

Main Methods:

• A randomized controlled trial involving 126 sedentary adults (aged 18-70) diagnosed with nonpsychotic MDD and treated with SSRIs.
• Participants were randomized to augmentation with either 16 KKW or 4 KKW of aerobic exercise for 12 weeks, with SSRI treatment held constant.
• Remission was defined as a score ≤ 12 on the Inventory of Depressive Symptomatology, Clinician-Rated.

Main Results:

• A trend for higher remission rates was observed in the higher-dose exercise group (16 KKW) compared to the lower-dose group (4 KKW) (P < .06).
• The number needed to treat (NNT) for the higher-dose group was 7.8.
• Significantly higher remission rates were found for men (85.4% vs. 0.1%) and women without a family history of mental illness (39.0% vs. 5.6%) in the high-dose exercise group compared to the low-dose group.

Conclusions:

• Higher-dose aerobic exercise demonstrated a trend towards improved remission rates in MDD patients, with a clinically meaningful NNT.
• Significant benefits of higher-dose exercise were observed in men and in women without a family history of mental illness.
• These findings suggest that tailored exercise prescriptions, considering gender and family history, may enhance depression treatment outcomes.