Tuesday, February 7, 2012

Hills not Pills

My article in this month's TGO is called Hills not Pills and looks at the psychological benefits of exercise in the outdoors. (some references for the piece are here) Others have written about this recently - like Chris Kresser - but one of the things that prompted me to write was learning just how many people rely on antidepressants.  It is true here in the UK but also across the world as this graphic shows.

Created by: MedicalBillingAndCodingCertification.net

Just go outside for a walk


Purposelessness said...

I agree that antidepressants (and axiolytics, for that matter) are overprescribed.

But on the other hand I believe that the anti-antidepressant (hehe) sentiment is troublesome too - personally, I was in a place where I couldn't bring myself to exercise or even go outside, and taking ADs enabled me to go for brisk walks and engage in psychotherapy in the first place. After which I could discontinue the AD.

ADs have, as medications go, a low success rate (~30%, or if you try multiple drugs maybe 50%), but they have their place IMHO.
The chochrane review, on which most "SSRIs are no better than placebo"-sentiments are based had problems, which have been adressed many times (in journals, not on the internet, alas)..

I believe the drugs themselves are not the problem (though prescribing antipsychotics for depression, which seems to be common practice as second line treatment, is utter madness IMHO - but thats another topic..), but how the whole treatment of depression is handled. The problem is that prescribing drugs is much cheaper and easier to do than psychotherapy or getting your patient to exercise.. Takes much less time also.
IMHO the first line treatment for depression should be CBT (cognitive behavioral therapy), which should enable the patient to start exercising/moving more and making other important lifestyle changes (getting outside more, more social engagement, less TV, junkfood etc), and if that fails to treat depression sufficiently, drugs.

So, in an ideal world, drugs should be far less important in the treatment of depression, but in the real world you often have the choice between an AD and no treatment at all - and here, ADs are, whithout question, preferred..

Sorry for the rant!

Chris said...

The rant is ok - you make some great points.

Phil Bear said...

Great article - reminds me of a favorite quote of mine:
"A man's health can be judged by which he takes two at a time - pills or stairs."

Steve Parker, M.D. said...

Americans in general are indeed over-medicated. Doctors have a pill for every complaint you make. So be careful. It's often easier for the doc to jsut write a prescription and send you on your way than to get to the source of the problem.