Western Standard - Doc says exercise for depression as good as meds

00:00:00.320 Could not prescribing exercise be medical malpractice when dealing with depression?

00:00:05.040 This is a question that my guest today asked in a medical paper as well as answered. Hi,

00:00:10.560 my name is Leah Muschid. I'm a reporter here at the Western Standard and today I sat down with

00:00:14.720 psychiatrist resident Dr. Nicholas Fabiano who talked about how exercise has been consistently

00:00:21.440 shown in studies to help reduce mild to moderate depression. Also, his answer to the question I

00:00:28.080 said earlier may also help people understand how exercise can not only benefit depression but

00:00:35.040 can have a multi-system benefit to the body. He elaborates further. Yeah, so for a number of

00:00:42.480 years now there's hundreds of trials probably now looking at exercise as a treatment for depression

00:00:47.200 and there's been a number of meta-analysis which is when you put all the studies together

00:00:51.840 both looking at exercise for depression but also comparing it to the first line

00:00:55.120 measures so usually antidepressants or therapy and they've consistently shown that exercise for

00:01:00.400 mild to moderate depression has pretty equal effects to the the first two that are or the

00:01:05.040 therapy or medications which is pretty powerful and what made me want to write the piece about

00:01:10.080 is it malpractice if we're not prescribing it is you can imagine if you have an intervention that

00:01:15.680 has equal effects to two of the other ones that we are solely prescribing in a simplistic sense if

00:01:21.120 you're choosing not or just not prescribing it because you don't know how to being exercise you

00:01:26.000 can imagine that that might be an element of malpractice the same way that if you went to

00:01:28.880 your psychiatrist and said or had symptoms of depression and said I wanted to start an antidepressant

00:01:34.240 and they said I don't know how to do that you would probably be pretty shocked to hear that and I think

00:01:39.040 the same principles should apply to exercise hmm okay yeah um then also can you explore like um

00:01:49.840 what are like the because you said it was like a multi-system like benefit of exercise as well when

00:01:54.880 it's prescribed for depression depression so like what are also the other benefits that you could like

00:02:00.160 list like most significant yeah so people with depression are have a burden of physical health uh problems

00:02:07.680 more so than the general population or someone without depression so whether it's heart problems

00:02:11.920 kidney problems thyroid problems anything you name pretty much there's an association and we know

00:02:16.720 exercise has benefits beyond just the mental health benefit and usually it's actually prescribed for

00:02:21.280 non-mental health reasons so things like weight things like glycemic control or diabetes um even some

00:02:28.320 cardiovascular conditions obviously there's contraindications for some people that may be higher risk

00:02:32.560 but it can help with your heart it can help with all these different organ systems in your body

00:02:36.960 and we know that again emphasizing people with depression are unfairly burdened by these

00:02:41.760 conditions so having an intervention that can tackle both makes a lot of sense um yeah because

00:02:48.080 i remember in the intro when i was reading it it was like talking about yeah like what you said all

00:02:52.560 the different like like for example uh weight can also be a problem yeah so i was like wondering

00:03:00.560 is it like a so say you're like overweight or something are you more likely to have depression or

00:03:06.080 something like that or is it like i don't know or is it like you say you're depressed and then

00:03:13.440 you kind of like lack motivation so then it's a consequence of the depression yeah i'd say for

00:03:20.560 most conditions obesity included it would be both ways so someone who has obesity has a higher risk of

00:03:27.360 developing depression but in the same way someone with depression also has a higher risk of developing

00:03:31.600 obesity or worsening pre-existing obesity so i think obviously there's exceptions to that rule

00:03:36.800 but for a lot of the conditions that you can imagine it goes both ways so one of the ones i

00:03:40.560 cite is cardiac conditions whether that's a heart attack whether that's heart failure there's a lot of

00:03:45.040 what we call bi-directional associations between the two so depression being a risk factor for that but

00:03:50.800 also the cardiac conditions being a risk factor for depression you can imagine someone after having a heart

00:03:54.960 attack and maybe having some functional impairment after that would be at a higher risk of being

00:03:59.120 depressed and in the same way someone with depression maybe isn't taking as best care of their their

00:04:03.840 physical health because of those aim motivation low energy that it has implications on their cardiac

00:04:08.800 health and you can see that same principle can be applied for a lot of different um conditions

00:04:13.520 including depression and other physical ailments okay yeah so i guess it's just like very connected both ways

00:04:21.200 um okay what else do i want to ask okay yeah you said um so antidepressants in psychotherapy which is

00:04:31.920 usually prescribed for depression where like doesn't work in like 30 to 50 percent on average that's what

00:04:38.560 you said okay good so um exercise on the other hand like how likely is there like has there been

00:04:46.400 measurements to like how likely it'll like help or how much as well yeah it's hard to say exact

00:04:52.720 numbers compared to the 30 50 percent quote for um medications and therapy because we don't see it as

00:04:58.160 used as often in the real world setting but when we look at trials we look at an important metric which

00:05:04.080 is the number needed to treat so it's the number of people you need to treat to have that positive effect

00:05:08.240 for exercise it's around only two which in medicine you don't get numbers that low so essentially the

00:05:13.040 higher the number is the worst because you need to treat more people to get the intended benefit

00:05:17.920 with depression being two that's pretty high antidepressants varies which one you're talking

00:05:22.880 about sometimes it can be around four or five higher than that so you can see how there's a little bit

00:05:27.440 of a difference there but we need more of the research kind of in the real world setting seeing how

00:05:32.160 people are doing and are they adhering to it but it's it's quite impressive from that stance and seeing

00:05:37.120 the small number of people that need to be treated to see that benefit versus other treatments

00:05:41.360 also why do you think um like exercise is not prescribed as much as it should be like in your

00:05:49.280 opinion like is it because like there well i mean there has obviously been research done but like

00:05:55.520 compared to like antidepressants and psychotherapy which is like the majority of what's prescribed

00:06:01.360 is it just because there hasn't been as much done or like yeah what's up with it yeah i think

00:06:06.240 educationally it's not emphasized as much like everyone knows common sense exercise is good for

00:06:10.880 physical or mental health but it's not taught as much in medical school residency is a primary

00:06:14.960 modality it is in our guidelines but it's one thing to be in the guidelines and another for you to be

00:06:19.440 able to feel well equipped to speak to a patient about it so i think that's one of the reasons i think

00:06:23.760 in psychiatry we have a lot of emphasis on the brain and neurotransmitters and everything so we

00:06:28.480 get very fixated on the antidepressants and what they may or may not do um versus exercise that has

00:06:34.560 very similar effects to that but it's not really taught that way the other thing is i think in terms

00:06:39.840 of barriers um we don't have direct referral pathways to get someone exercising like it's

00:06:45.200 commonly people will say just go outside and run and people know that too they don't need their doctor

00:06:49.600 to tell them that they need support to get that going whether that be having a trainer whether that

00:06:55.520 be having some other sort of supervision during exercise or some clear guidance on what to do i think

00:07:00.880 that's lacking and that's a systems issue too where if i want to prescribe an antidepressant i can either

00:07:06.080 click a button or write it on a piece of paper and it's done but if i want to prescribe someone

00:07:10.080 exercise i can't really do that like they have to go to the gym themselves they have to go do all

00:07:14.800 these different things but it would be great if i could write something on a piece of paper they have

00:07:18.800 now a trainer that's paid for them by insurance or a gym membership that's paid for them by insurance

00:07:23.760 similar that a medication would be and that be tackled the exact same way that the other first line

00:07:29.680 treatments are because you can imagine if you're a provider you would go the easiest route to probably

00:07:33.920 you only have so much time to talk so much time to do different things so you're going to go with

00:07:38.480 what's familiar with you what you have an easy route to connect with which is usually just medication uh

00:07:43.760 first line so not that medications are bad there's totally a role for them but i think if we have

00:07:48.720 different first line treatments they all should be equally available to people and not just have

00:07:52.480 biases in terms of which ones might be a little bit more accessible because it's no surprise that

00:07:58.160 that's the one that's going to be used more hmm okay yeah that makes sense um then i guess i'm kind

00:08:04.400 of curious about this as well so say you were to like prescribe exercise like would it be like the

00:08:11.360 first thing you prescribe prior to antidepressants and like psychotherapy or like would it be like a

00:08:17.840 combination or does it depend on the person yeah so it totally depends like the literature shows that

00:08:23.120 exercise can be used as a monotherapy for depression so monotherapy meaning the sole intervention

00:08:29.280 however it can also be used paired with these other agents or it can be used in a sequential sort

00:08:34.640 of treatment so say someone's really depressed they have severe depression it's probably not

00:08:38.800 appropriate to use exercise first if they can't even get out of bed sort of thing but maybe starting

00:08:43.840 an antidepressant medication first even starting therapy or something and as they're getting better

00:08:48.320 being able to incorporate some of those other modalities so it's very patient dependent there's not

00:08:51.840 necessarily a specific patient that will benefit the best we know that most of the literature is

00:08:56.640 in mild or moderate depression just because of those barriers that exist in severe depression

00:09:01.200 but that doesn't preclude being able to introduce it at a later time simultaneously with other

00:09:05.920 treatments like there's a lot of different ways to combine it but i think sometimes people function

00:09:10.480 in the camp that it has to be one or the other you're either lifestyle or you're either medications

00:09:15.360 or therapy but the reality is you should do whatever works best for you and sometimes that's all of them

00:09:20.000 um okay yeah that makes sense i also was wondering uh so like we talked like lots about like the

00:09:29.760 physical effects and stuff like that but i also was thinking like maybe it's also helpful because like

00:09:36.400 i guess since like depression is kind of like a very helpless kind of feeling when it because as well

00:09:43.200 like exercise is a very active thing where it's like kind of a control type thing where giving it's

00:09:50.160 giving you more control over kind of your at least the feeling of like your actions and stuff like that

00:09:57.920 would that be a contributing factor yeah like there's an element of uh maybe not the depression

00:10:03.200 itself but um people describe with antidepressants sometimes they feel that they need something to feel

00:10:09.280 normal which is not necessarily the case but with exercise what we say is it gives you the locus of

00:10:14.240 control so when you're choosing to exercise every day choosing to do all these different things

00:10:19.120 it makes sometimes the patient feel that they're in charge of their recovery versus sometimes and

00:10:24.240 therapy can be the same for two but but sometimes with medications it can feel the opposite where

00:10:28.640 you're more dependent on something which isn't entirely the case but i think it for people when they

00:10:33.360 think about these things it is helpful to get the momentum going and say you know i'm in charge of

00:10:38.400 my treatment right now it's not necessarily my fault that i have depression but i'm in charge of

00:10:43.760 getting out of this and each day that i go for a run each day i spend some time at the gym i'm helping

00:10:49.840 myself get out of that which can be a very powerful mindset for people to have so i think that is part

00:10:54.240 of it it's hard to measure that but that's something that's been reported before in the literature as

00:10:58.480 well too oh and like also because i feel like depression can also be very isolating so maybe as well like

00:11:05.120 going to the gym as well like you're going to like a social environment maybe even just being around

00:11:10.080 people could be yeah and i think that's one of the parts of exercise that we don't give full credit

00:11:16.080 is the social aspect especially for people that are more isolated so a lot of the elderly population

00:11:21.120 specifically during covid times where maybe people weren't going out as much they weren't seeing their

00:11:25.840 family this may be the only time where they did have some sort of an outing where they were able to

00:11:30.640 connect with people or socialize and we know even if you remove the exercise part and you just have

00:11:35.440 the social part that also has very important health effects for both your mental and physical

00:11:39.920 health yeah okay well that's that's it so thank you very much there we go yeah of course thank you

00:11:48.640 for having me oh yeah no problem and thanks for

Western Standard - September 29, 2025

Doc says exercise for depression as good as meds

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