[jdietrich]

There's one big problem with that - getting seriously depressed people to do 30 minutes of exercise (or anything else) five days a week. "Get more exercise" is excellent advice for someone who feels a bit down, but it's absolutely useless for someone who can barely summon up the strength to eat or brush their teeth.

[jasonfarnon]

It gets even harder if you offer them the alternative of just taking a pill. For widespread health policy, we should want the proportion of depressives who will never learn to manage it themselves because a pill is offered to be smaller than the proportion for whom the pill is effective. I had always assumed these pills were effective enough but studies like these make me wonder.

[jdietrich]

They are by no means mutually exclusive. If you want depressed people to get more exercise, then a really useful starting point is to give them a pill that could rapidly increase their energy and motivation. The idea that people will be stuck on those pills forever is just lazy psychiatry; ongoing maintenance treatment is often the best option for patients with a history of severe depression and a high risk of relapse, but antidepressants are equally useful as a stepping-stone towards self-management.

Bluntly, if someone is capable of actually starting and sticking with an exercise routine, then they aren't very depressed and should not be offered medication as a first-line treatment. Antidepressants are markedly less effective in patients with milder illnesses, so psychotherapy and lifestyle interventions are a far better initial treatment option. It's only when these treatments fail - or when engaging with them is severely impaired by the severity of the illness - that medication becomes the favoured option.

[ltbarcly3]

It's also very hard to get severely depressed people to make a Dr's appt and get out of bed and show up to it. It's hard to get them to do anything.