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Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder

From the Department of Psychiatry and Behavioral Sciences (J.A.B., M.A.B., P.M.D., L.W., B.H., K.B., S.H., A.L.B., A.S.), Duke University Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences (W.E.C.), Emory University, Atlanta, Georgia; Department of Medicine (R.W.), Duke University Medical Center, Durham, North Carolina; and Department of Medicine (A.H.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

View larger version (31K): [in this window] [in a new window]   Figure 1. Flowchart of participant recruitment and retainment throughout the study. MDD = major depressive disorder; ITT = intention-to-treat.

View larger version (11K): [in this window] [in a new window]   Figure 2. Mean aerobic capacity and exercise tolerance after 16 weeks of treatment, adjusting for pretreatment levels of outcome variable, age, gender, race, and past major depressive disorder. Participants in the exercise conditions showed greater aerobic capacity (left panel) and exercise tolerance (right panel) compared with patients in the medication or placebo conditions. Error bars represent 95% confidence limits. Planned contrasts for aerobic capacity were as follows: all exercise versus placebo, p = .0001; medication versus placebo, p = .420; all exercise versus medication, p = .0001. For exercise tolerance, the contrast results were: all exercise versus placebo, p = .0001; medication versus placebo, p = .410; all exercise versus medication, p = .0001. VO2 = oxygen consumption; Sup = supervised exercise; Med = medication; Plac = placebo.

View larger version (12K): [in this window] [in a new window]   Figure 3. Predicted probability of remission, defined as no major depressive disorder diagnosis and Hamilton Depression Rating Scale (HAM-D) score of <8 after treatment, using intention-to-treat (left panel) and limited to patients who did not exhibit an early response (n = 183) (right panel). Early responders are defined as patients with >50% reduction from baseline in Beck Depression Inventory scores after the first week of treatment. Probability estimates are for a patient with the most typical profile in the study: age 52 years, female, Caucasian, one prior major depressive episode, and a baseline HAM-D score of 17. Error bars represent 95% confidence limits. Planned contrasts using intention-to-treat yielded the following test results: all active treatment versus placebo, p = .057; all exercise versus medication, p = .636; supervised exercise versus home exercise, p = .666. After removing early responders, the contrast results were: all active treatment versus placebo, p = .022; all exercise versus medication, p = .879; supervised exercise versus home exercise, p = .519. Sup = supervised exercise; Med = medication; Plac = placebo.

View larger version (11K): [in this window] [in a new window]   Figure 4. Hamilton Depression Rating Scale (HAM-D) scores after 16 weeks of treatment using intention-to-treat analysis (left panel) and limited to patients who did not exhibit an early response (n = 183) (right panel). Probability estimates are for a patient with the most typical profile in the study: age 52 years, female, Caucasian, one prior major depressive episode, and a baseline HAM-D score of 17. Error bars represent 95% confidence limits. Planned contrasts for the HAM-D using intention-to-treat analysis yielded the following test results: all active treatment versus placebo, p = .231; all exercise versus medication, p = .574; supervised exercise versus home exercise, p = .624. After removing early responders, the contrast results were: all active treatment versus placebo, p = .123; all exercise versus medication, p = .514; supervised exercise versus home exercise, p = .510. Sup = supervised exercise; Med = medication; Plac = placebo.