Major depressive disorder, more commonly known simply as depression, is a mood disorder that leaves sufferers with an increased sense of malaise and low self-esteem. Other symptoms include losing interest in normal, everyday activities. Major depressive disorder is an extremely prevalent phenomenon, being a contributing factor to decreasing life expectancy (the fourth leading cause for disability-adjusted life-years) (Blumenthal et al., 2007, p. 587). Causes of depression are myriad, and can be caused by anything from chemical imbalances in the brain to psychological factors and even drug and alcohol abuse. Depression contributes to significant mortality and morbidity for sufferers and the families of sufferers (Blumenthal et al., 2007, p. 587). Over the past 25 years, study and treatment for MDD has shifted from a strictly psychological disorder to a mood disorder that may have neurochemical causes; different psychiatric and medical treatments have been developed to treat the condition. To that end, it is extremely vital that viable and effective treatment methods are found. Currently, the best chances of treating major depressive disorder with a significant degree of success are exercise, pharmacotherapy and psychotherapy (often combined in a sequential model of treatment).
One way in which major depressive disorder (MDD) can be treated is with exercise. Exercise and non-medical methods of treating psychological and mood disorders have been promoted since the late 1950s as ways to improve overall self-assessment. Physical exercise as therapy for MDD has proven to have positive outcomes on the self-esteem and depressive symptoms of patients (Blumenthal et al., 2007, p. 587). Research indicates that exercise may actually be equally as effective as anti-depression medication in reducing these symptoms (Blumenthal et al., 2007, p. 587). Despite this, it is still relatively unknown what the actual mechanisms are that contribute to exercise related improved outcomes for depression. Researchers theorize, however, that psychological factors and changes pertaining to exercise can result in greater self-efficacy, as well as “a sense of mastery, positive thoughts, distraction from negative thoughts, and enhanced self-concept” (Blumenthal et al., 2007, p. 594). Chemically, exercise increases the release of central norepinephrine to the brain, as well as amine metabolites and serotonin, which may lead to a chemical response that decreases depression symptoms. Research supports the assertion that exercise is a potent and powerful remedy against MDD, due to its ability to increase self-esteem and self-concept, as well as overall improve the metabolism and general health of practitioners, whether the exercise is supervised or home-based.
The second treatment method for MDD is psychotherapy, which involves approaches such as cognitive-behavioral therapy (CBT) and normal talk therapy (Fava and Tomba, 2010, p. 453). Psychotherapy has existed as a method to deal with all manner of mood and depressive disorders since the early 20th century, and as such has always been a viable treatment method for those suffering from symptoms of MDD. In CBT therapy, patients are tasked with discovering what thoughts lead to depressive and self-destructive behaviors, and are trained and encouraged to find alternate ways of thinking. These better cognitions provide more positive outcomes and discourages counterproductive actions and thoughts. CBT has also been stated to be very helpful in staving off relapse of MDD symptoms after successfully going into remission (Fava & Tomba, 2010). In many interventions, CBT is combined with other methods of psychotherapy, including lifestyle modification, clinical management, well-being therapy, mindfulness-based cognitive therapy, and more (Fava & Tomba, 2010).
The third (and most recent) treatment method for MDD is pharmacotherapy; the creation and dissemination of anti-depression medication has been shown to have tremendously positive effects on depression symptoms (Blumenthal et al., 2007, p. 587). Pharmacotherapy is the latest method to combat MDD, especially given its comparatively recent classification in the DSM-IV and recent advances in medical science that make pharmacotherapy possible. The typical classification for anti-depression medication is selective serotonin reuptake inhibitors, or SSRIs, which include such medications as Zoloft and Pfizer (p. 588). SSRIs are also noted to be the most widely used kind of anti-depressant, and they have been proven to be effective and tolerable for a large number of patients; its toxicity level is also low (Blumenthal et al., 2007, p. 588). SSRIs and exercise have been shown to be equally as effective; SSRIs do little for those with mild or moderate MDD symptoms, but have very positive outcomes for those with severe symptoms of MDD (p. 543).
It has been argued that combinations of any of these treatment methods might result in better outcomes for patients suffering from MDD. Fava & Tomba (2010) discuss the use of a sequential model combining psychotherapy and pharmacotherapy to create a more comprehensively positive outcome in reducing MDD symptoms. In essence, one stage of treatment involves one specific tool (either pharmacotherapy or psychotherapy) performed to completion, then switching to another. In sequential models of treatment, the second stage is administered “regardless of the outcome of the first component,” to find out if the cumulative effect is still positive (Fava & Tomba, 2010, p. 455). The authors argue that “the sequential use of pharmacotherapy and psychotherapy was found to improve long-term outcome after termination of treatment compared with clinical management and treatment as usual” (p. 453). Given the non-conflicting methods and treatment platforms for these varying treatments, it is possible that a sequential model provides greater outcomes for MDD sufferers than using one treatment method only.
In conclusion, the history and breadth of treatments of major depressive disorder (MDD) has vastly increased in the past 25 years. The ability to link MDD symptoms to neurochemical impulses and chemical imbalances in the brain has allowed for SSRIs and other antidepressants to join existing treatment methods of exercise and psychotherapy. Exercise has the effect of bringing about positive outcomes for patients by increasing their health and their sense of self-efficacy, while pharmacotherapy corrects the aforementioned chemical imbalances that lead to MDD. Psychotherapy, including methods such as CBT, also provide effective treatment for the psychological causes of MDD, thus leading to reduced symptoms. Any combination of these treatments can lead to successful remission, but sequential models have been proposed to administer different treatments in stages. The effect of this is, in theory, more positive outcomes for MDD sufferers.
References
Blumenthal, J.A., Babyak, M.A., Doraiswamy, P.M., Watkins, L., Hoffman, B.M., Barbour,
K.A., Herman, S., Craighead, W.E., Brosse, A.L., Waugh, R., Hinderliter, A., & Sherwood, A. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine 69: 587-596.
Fava, G.A. & Toma, E. (2010). New modalities of assessment and treatment planning in
depression. CNS Drugs 24(6): 453-465.
