There’s growing concern about the risks of antidepressants, including side effects and withdrawal symptoms. Many people who are taking antidepressants are now turning to deprescribing resources, while others who are experiencing depression are wondering whether they should start taking antidepressants at all or if there’s another way.
But there’s one remedy that hasn’t gotten the attention it deserves: exercise.
In what follows, I’ll look at the surprising antidepressant effects of exercise, why it isn’t prescribed more widely, and a simple framework to help people get started.
Exercise Is as Effective as Antidepressants
One of the most astonishing findings in recent depression research is that exercise can be as effective as antidepressants, and some studies suggest it may be even more effective for mild to moderate depression. Millions of people have been prescribed powerful psychiatric drugs, often without being told that something as ordinary as walking, jogging, cycling, or strength training might provide comparable benefits.
The evidence has become increasingly difficult to ignore. Exercise ranks as one of the most effective known lifestyle interventions for depression. These include aerobic exercises, walking, jogging, strength training, and yoga. Intriguingly, evidence suggests that strength training is slightly more effective for women and younger adults, and yoga for men and older adults.
Exercise isn't just about shedding calories. It improves inflammation, metabolism, sleep, and the body's response to stress. These are precisely the factors that can go wrong in depression. But I think there's something deeper going on.
I've argued that depression may be a functional signal: our brain's way of telling us that something in our lives isn't going well and needs more attention. Sometimes the problem is a relationship, a job, or a life goal that no longer suits us. But sometimes the problem is the way we're living.
Humans evolved to move. Our ancestors spent much of their days walking, gathering food, carrying things, and engaging physically with the world. They didn't spend eight hours sitting in front of a computer, followed by another four hours staring at a smartphone. Yet that's how many of us live today.
Is it surprising that our bodies, and our minds, are protesting? Perhaps depression is telling us that something is wrong with the lives we've built for ourselves.
Why Isn't Exercise Prescribed More for Depression?
The evidence for the benefits of exercise is strong enough that a group of psychiatrists recently asked, in the British Journal of Sports Medicine, whether failing to prescribe exercise for depression could amount to “psychiatric malpractice.”
Part of the problem, they argue, is training. In one survey, 92 percent of mental health professionals said they'd received no formal training in prescribing exercise, and 41 percent said they never prescribe it at all.
Still, simply telling people to “be active” rarely works. People who struggle with depression need guidance and support.
The FITT Framework: Designing an Exercise Program to Treat Depression
For those for whom exercise is a real possibility, the same group offers a simple framework called FITT, which stands for frequency, intensity, time, and type. As a rule of thumb (and obviously to be adjusted for each person's physical health and other medical conditions):
- Frequency: Three to five sessions a week
- Intensity: Moderate to vigorous (brisk walking, cycling, swimming)
- Time: 45 to 60 minutes per session
- Type: Aerobic, strength training, or mind-body practices like yoga—whichever you're most likely to keep doing
But they also emphasize that less is better than none. Even one or two sessions a week, or 10 to 30 minutes at a time, can help.
Sometimes, what depression may be pointing to is precisely the mismatch between how we are designed to live and how we actually live. Exercise may be one way of answering its call.
A version of this post appears on my Substack.