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The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes

Molecular Psychiatry volume 28, pages 298–328 (2023)Cite this article

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Abstract

Globally, depression is a leading cause of disability and has remained so for decades. Antidepressant medications have suboptimal outcomes and are too frequently associated with side effects, highlighting the need for alternative treatment options. Although primarily known for its robust physical health benefits, exercise is increasingly recognized for its mental health and antidepressant benefits. Empirical evidence indicates that exercise is effective in treating individuals with depression; however, the mechanisms by which exercise exerts anti-depressant effects are not fully understood. Acute bouts of exercise have been shown to transiently modulate circulating levels of serotonin and norepinephrine, brain-derived neurotrophic factor, and a variety of immuno-inflammatory mechanisms in clinical cohorts with depression. However, exercise training has not been demonstrated to consistently modulate such mechanisms, and evidence linking these putative mechanisms and reductions in depression is lacking. The complexity of the biological underpinnings of depression coupled with the intricate molecular cascade induced by exercise are significant obstacles in the attempt to disentangle exercise’s effects on depression. Notwithstanding our limited understanding of these effects, clinical evidence uniformly argues for the use of exercise to treat depression. Regrettably, exercise remains underutilized despite being an accessible, low-cost alternative/adjunctive intervention that can simultaneously reduce depression and improve overall health. To address the gaps in our understanding of the clinical and molecular effects of exercise on depression, we propose a model that leverages systems biology and multidisciplinary team science with a large-scale public health investment. Until the science matches the scale of complexity and burden posed by depression, our ability to advance knowledge and treatment will continue to be plagued by fragmented, irreproducible mechanistic findings and no guidelines for standards of care.

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Fig. 1: Early conceptual model of the effect of exercise on depression.
Fig. 2: Proposed solution to advance the state of the art of the mechanistic understanding of exercise treatment for depression.

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Funding

This work was supported by grants from the United States Department of Veterans Affairs ([RER] grant number RR&D IK1 RX002962), Craig H. Neilsen Foundation (CJV), and National Institutes of Health ([CMG] grant number R01HD095137). The views in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or United States government.

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  1. Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA

    Ryan E. Ross & Chris M. Gregory

  2. Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA

    Ryan E. Ross, Catherine J. VanDerwerker, Michael E. Saladin & Chris M. Gregory

  3. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA

    Michael E. Saladin

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Initial conception of the manuscript (RER, MES, CMG). Literature review and screening of articles (RER, CJV, MES, CMG). Preparation of initial version of the manuscript (RER, CJV). Revision of manuscript for important intellectual content (RER, CJV, MES, CMG). Final approval of the version to be published (RER, CJV, MES, CMG).

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Ross, R.E., VanDerwerker, C.J., Saladin, M.E. et al. The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes. Mol Psychiatry 28, 298–328 (2023). https://doi.org/10.1038/s41380-022-01819-w

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