Factors such as advanced age and greater aerobic capacity increase the likelihood that exercise will work as a treatment for depression in elderly patients, a recent study published in the Journal of the American Geriatrics Society has shown.
The research expands the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) study, which found that exercise together with the antidepressant medication sertraline was significantly more effective in reducing depression symptoms than sertraline alone. The combined treatment approach, however, worked well for some but not all study participants.
“There isn’t a lot of information available to help clinicians decide who should receive exercise therapy and who is less likely to benefit from it,” said senior author Klea Bertakis, professor of family and community medicine at UC Davis. “We wanted to better understand the modifiers of exercise therapy for depression.”
The risk of depression, along with its accompanying risks of physical disease and suicide, increases with age. It is thought to affect more than two million Americans over 65. That estimate, however, could be low, since depression is often overlooked or incorrectly considered a normal part of growing older.
Primary care has become a critically important setting for reducing the rates of undiagnosed and undertreated depression among the elderly, Bertakis said.
“We are the sole health care contacts for more than 50 percent of older patients with mental illness,” Bertakis said. “With remission rates of just 28 to 44 percent, even with first-line antidepressants, there is a huge need for find alternative treatments for depression for this population.”
SEEDS involved about 120 study participants between the ages of 65 and 85. All were sedentary, diagnosed with clinical depression and patients of primary care clinics in Italy. Primary care and mental health care are linked services in Italy, making it an ideal location for the study.
One group received sertraline, a selective serotonin reuptake inhibitor thought to work by balancing brain chemistry. Another group received sertraline plus low-intensity exercise such as mat work. A third group received sertraline plus high-intensity exercise using exercise bicycles. Participants who received the combined treatment achieved depression remission more frequently and earlier than those who just received sertraline.
For the current study, all three SEEDS groups were evaluated for depression symptoms as well as sociodemographic, physical, medical, psychiatric and cognitive factors. The results showed that the exercise interventions were especially effective for those who were aged 75 or older, who were taking three or more daily medications, who had higher aerobic capacity before beginning the intervention or who had fewer symptoms of anxiety.
One of the most interesting outcomes was that exercise was more effective at reducing depression for patients with psychomotor impairments, a common outcome of depression that reduces mobility, speech and executive function. Studies have shown that antidepressant medications like sertraline tend to be less effective in patients with psychomotor impairments.
“It’s possible that exercise on its own benefited this group more or that it changed brain chemistry in ways that helped make sertraline more effective,” Bertakis said. “There needs to be more research to tease out the benefits of exercise for this group, because psychomotor impairments can be some of the most disabling features of depression.”
The study overall proves that the elderly are not a homogenous population when it comes to depression treatment.
“We need to continue to find new options for older patients with depression and overcome the ‘one size fits all’ treatment approach,” Bertakis said.
The research team is currently studying alternative treatments to sertraline for depressed elderly patients with anxiety, including breathing and postural exercises.
Bertakis’ primary collaborator was lead author Stamatula Zanetidou from the Consultation Liaison Psychiatry Service in Bologna. Their co-authors were Martino Belvederi Murri, Marco Menchetti, Giulio Toni, Fabrizio Asioli, Luigi Bagnoli, Donato Zocchi, Matteo Siena, Barbara Assirelli, Claudia Luciano, Mattia Masotti, Carlo Specia, Monica Magagnoli, Mirco Neri and Mario Amore.
The study, titled “Physical Exercise for Late-Life Depression: Customizing an Intervention for Primary Care,” was funded by the Emilia-Romagna Region University Programme. It is available online at http://onlinelibrary.wiley.com/doi/10.1111/jgs.14525/full.
More information about UC Davis Health System and its Department of Family and Community Medicine is at www.healthsystem.ucdavis.edu.