According to the authors of a recent review, about half of MS patients will develop depression.
This review looked at current research on exercise as treatment for depression and particularly for MS patients with depression.
The review confirmed that exercise may be a useful treatment for depression in general.
The researchers also found limited evidence that a combination of aerobic exercise with resistance training may be an effective treatment of depression in patients with MS.
However, the researchers looked at only a small number of studies that included MS patients. As such, more MS-specific data is needed.
"Ask your doctor about how to start an exercise program."
This review to examine physical activity as treatment for depression in MS patients was conducted by Anthony Feinstein, PhD, FRCPC, from the Department of Psychiatry at Sunnybrook Health Sciences Centre in Canada.
The exact reasons why exercise may improve depression are not well understood. But some researchers suggested that exercise improves mood as well as fitness. Others proposed that exercise might create changes in the brain that may result in enhanced learning and memory.
Results from 23 trials suggested that exercise reduced depression. And no clear differences were found between participants engaged in either aerobic or strength exercise.
Furthermore, the National Institute for Health and Clinical Excellence recommended that patients with mild to moderate depression be treated with "...a structured, supervised exercise program, three times per week (45 minutes to 1 hour) over 10 to 14 weeks.”
According to the authors of this review, “In the broader depression literature there is substantive empirical evidence for the benefits of exercise on depression."
However, with respect to the results of clinical trials that have focused on MS patients with depressive symptoms, they wrote, “Overall, there is no distinct or clear pattern of results from the randomized clinical trials allowing us to arrive at a firm conclusion regarding the effects of exercise training on depressive symptoms in MS.”
Only 11 clinical trials have compared the effects of exercise in MS patients with depressive symptoms. In these clinical trials, MS patients typically exercised between two and five days per week over periods of three and 26 weeks in duration.
While some studies did report an improvement in depressive symptoms after aerobic exercise, others did not find statistically significant differences. Two trials reported a positive effect on depressive symptoms when aerobic exercise was combined with resistance training. And one of the studies found a possible increase in depression symptoms with resistance exercises alone.
However, this review reported many flaws in the clinical trials that may have influenced the inconclusive results. For example, none of the studies included an assessment of depression from a clinician; instead they used different self-reported scales. Other studies didn’t use depression as their main outcome but rather related variables such as quality of life, fatigue and fitness.
Furthermore, none of the studies evaluated whether the stage of multiple sclerosis or degree of disability affected the results.
The researchers highlighted the importance of detecting depression in MS patients since it can be easy to mistake depression symptoms with MS symptoms. Fatigue, insomnia and poor concentration are often shared between the two conditions.
The review concluded that in addition to clarifying whether exercise can be used as a treatment for people with depression and MS, it is also important that researchers agree on which exercise program is most beneficial, and to what degree exercise will not affect patient's mood due to physical limitations. In addition, the researchers wrote that it also should be explored whether the use of other therapies for depression, such as medications and cognitive therapy, may provide better results.
This study was published on October 14 in the Multiple Sclerosis Journal. The authors had no disclosures to make.