Assignemnt: how effective is exercise as a treatment for depression when compared to pharmacological treatment?

PICOT question (200 points) Submit to Project

To complete this week, after reading chapter two in Melnyk and reviewing the lectures you submit a 2-3 page paper that explores the background of your issue. For this paper #1 you will be defining this issue or disease using the literature. It will end with the PICOT question. The parts of your paper should include:

Introduction
Definition
Epidemiology
Clinical Presentation
Complications
Diagnosis
Conclusion with PICOT Question

The effects of exercise on depression is a topic of special interest during my years of practice as a nurse. As a bedside nurse, I have always wondered and questioned on weather or not so many patients need to be on anxiolytic and antidepressant medications. My practice has made me question often if our medical world is too quick to prescribe medications instead of prescribing non pharmaceutical methods of treatment. I have also wondered how the incidence of depression would be lowered if individuals were educated on exercise instead of given prescriptions.

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My background question for the capstone will be as follows:

In adult patients how effective is exercise as a treatment for depression when compared to pharmacological treatment?

Antidepressants are the main treatment considered for depression disorder, unfortunately, antidepressants are known to have many side effects. Many clinicians are willing to view and in fact encourage exercise as an adjunct therapy, however, clinicians are skeptical about substituting pharmaceutical treatment with exercise. My question is rooted in the fact that many adult patients with depression are not compliant with pharmaceutical treatment given all the unwanted side effects these medications are likely to produce. Second, much available research indicates many antidepressants are not effective for many individuals. Given these facts, exercise has been under the radar as an option for treating depression (Netz, 2017).

In order to arrive at my PICOT, I will be examining numerous research and reviews conducted which present evidence-based facts regarding the effects of exercise on depression disorder. Kandola et al, 2016 concluded the “hippocampus in depressed individuals may be affected by neuron atrophy. Additionally, the study identifies aerobic exercise as a potentiator for promoting neuroplasticity and facilitating hippocampus function. Kandola et al, 2016 further backed this claim by concluding an increase in neuroplasticity in the hippocampus may change the structure of the region’s function thereby producing beneficial effects on cognitive malfunction of depressive disorder.

According to another study “it is possible that the antidepressant effect of exercise is caused by the interaction of several neurobiological mechanisms rather than by one mechanism exclusively. It is certain that exercise generates both acute and chronic responses, mainly in hormones, neurotrophines, and inflammation biomarkers” (Schuch et al, 2016).

References:

Kandola, A., Hendrikse, J., Lucassen, P. J., & Yücel, M. (2016). Aerobic Exercise as a Tool to Improve Hippocampal Plasticity and Function in Humans: Practical Implications for Mental Health Treatment. Frontiers in human neuroscience, 10, 373. doi:10.3389/fnhum.2016.00373

Netz Y. (2017). Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based?. Frontiers in pharmacology, 8, 257. doi:10.3389/fphar.2017.00257

Schuch F. B., Deslandesc A. C., Stubbs B., Gosmannb N. P., Silva C. T., Fleck M. P. (2016a). Neurobiological effects of exercise on major depressive disorder: a systematic review. Neurosci. Biobehav. doi: 10.1016/j.neubiorev.2015.11.012

Major Depressive Disorder (MDD) is a common condition affecting millions of Americans each year (NIMH, 2019). The first-line treatment for MDD is antidepressants, specifically of the SSRI and SNRI classes (Bousman et al., 2017). Exercise is often prescribed as an adjunctive treatment for depression, but there is some skepticism about using exercise as monotherapy for treating MDD; that said, exercise has been under the radar as a treatment for depression (Netz, 2017).

This research seeks to determine if, in a population of adults who have been previously diagnosed with MDD (P), exercise can be used as monotherapy to treat depression. The intervention group would partake in an exercise regime tailored to their level of physical fitness and ability that is evidence-based and supervised by medical personnel (I). The intervention group will be compared to a group that receives no intervention as well as a group that receives standard of care, that is, an antidepressant that is titrated to an appropriate dose (C). As antidepressants take from 4-6 weeks to work at full strength, the exercise regime will also be four to six weeks in duration (T) (Bousman et al., 2017).

The outcome that I would like to measure is patient scores on a depression screening tool such as the PHQ-9 (O). The PHQ-9 is a quick and efficient way to gauge a patient’s depression symptoms and severity, and scores are easy to analyze statistically. Scores on the PHQ-9 range from 0 to 27 points, with higher scores indicating more severe depression. Patients in the study will complete the PHQ-9 at the start of the trial and then weekly thereafter, and final scores will be analyzed to see if there is a statistically significant difference in scores between groups.

References

Bousman, C. A., Forbes, M., Jayaram, M., Eyre, H., Reynolds, C. F., Berk, M., … Ng, C. (2017). Antidepressant prescribing in the precision medicine era?: A prescriber’s primer on pharmacogenetic tools, 1–7. doi.org/10.1186/s12888-017-1230-5

National of Mental Health (NIMH). (2019). Major depression. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml

Netz Y. (2017). Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based? Frontiers in Pharmacology, 8, 257. doi:10.3389/fphar.2017.00257