# Exercise as it relates to Disease/Exercise as a clinical treatment for depression amongst adolescents
## What Is Depression?

Depression is one of the most prevalent mental illnesses not only in Australia but also the world, with one in every five adolescents likely to experience a diagnosable depressive episode by the age of 18. The term ‘Depressed’ is used often in general conversation to describe feeling down after a particular unpleasant event, which is usually short lived and resolved rapidly. A depressive mood is not necessarily a mental illness; it is often a normative response to life events, or certain circumstances. Depression as a mental illness however, describes a much more prolonged and persistent negativity. It is often categorized as;
* A state of low mood
* Aversion to activity that can affect a person's thoughts, behavior, feelings and sense of well-being,
* Constant or sustained depressive mood as a primary factor.
Depression is regularly seen in conjunction with other mood/mental disorders, in particular anxiety, and can trigger and/or is triggered by eating disorders, schizophrenia and stress.

## Diagnosis

Diagnosing depression is a difficult task, as it does not involve a particular type of pathogen.Thus, a blood test or any similar sort of test cannot be undertaken. To determine if one is suffering depression a doctor will often run through a series of questions to determine things the patient may be going through or feeling including:
* major changes in weight
* irregular sleep (too much or too little)
* feelings of hopelessness or worthlessness
* problems with concentration or making decisions almost every day
* recurring thoughts of death or suicide
The culmination of the patients response, as well as factoring in certain circumstances such as patient history, physical signs and ruling out physical conditions; for example hypothyroidism, helps the doctor achieve a diagnosis.

## Common Treatments

| Treatment | Description | Advantages | Disadvantages |
| Cognitive Behaviour Therapy | Identify and stop patterns of thought and behaviour leading to depressive episodes | Found to be useful across all demographics | Only addresses current problems, focus on ability to change, not address wider problems |
| Antidepressants | Prescribed when other treatments aren’t working, often effecting serotonin production and sensitivity | Make people feel better, removes chemical imbalances in the brain | Don’t change personality or cognitive behaviour, varied side effects including nausea and weight gain |
| Lifestyle Changes | Changes to diet, exercise, conversations with family/friends | Cheap, long lasting results, often used to amplify other treatments results | Lack of GP supervision, recovery may take longer |

## Successful Exercise Treatments

Several clinical studies have shown strong a strong relationship between prescription of exercise and reduced depressive symptoms amongst adolescents.
These studies all varied greatly, one tested only 49 female adolescent participants, whilst another had over 20 thousand participants. They also measured depressive symptoms in different ways, some with questionnaires, another with a scale from the Centre for Depression studies. Some were followed up two, or even six years later, whilst another wasn’t followed up longitudinally at all. Despite all the variances, each study came to the same conclusion. All the studies showed evidence to suggest a strong positive correlation between prescription of exercise and a decrease of depressive symptoms amongst adolescents. Two trials showed that 16 weeks of regular moderate exercise was just as effective as a prescription of anti-depressants.

## Benefits of Exercise as a Treatment

* Self esteem boost
* Increased social interaction via team sports
* Distracts from pessimistic thinking
* Improved sleep
* Increased energy
* Relatively side effect free
* Added physical benefits such as cardiovascular adaptation, prevention of numerous diseases, maintain healthy weight.

## Recommendations

Currently there is no true optimal recommendation, however there are still guidelines.
* Exercise does not need to be vigorous to help alleviate symptoms. $^{16}$
* Exercise for at least 10 minutes at a time, for a minimum of 30 minutes a day $^{16}$
* Moderate intensity on most days of the week, if not all, is most beneficial $^{16}$
* Live a more active lifestyle, e.g taking the stairs more often $^{15}$
* Choose a range of fun activities, as enjoyment and adherence are most important $^{15}$

## Limitations

* Further longitudinal studies are required to ensure reliability over time
* Adherence is the biggest potential issue
* Unsure of optimal frequency, intensity, type and time $^9$

## Further reading

* Black Dog Institue
* Beyond Blue Foundation
* Kids Helpline

## References

* ↑ Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE, Perel J, Nelson B. Childhood and adolescent depression: a review of the past 10 years.Part I. J Am Acad Child Adolesc Psychiatry. 1996 Nov;35(11):1427-39.
* ↑ Salmans, Sandra (1997). Depression: Questions You Have – Answers You Need. People's Medical Society.ISBN 978-1-882606-14-6.
* ↑ Depression and Other Mental Illnesses. (n.d.). Cleveland Clinic. Retrieved September 12, 2013, from http://my.clevelandclinic.org/disorders/depression/hic_depression_and_other_mental_illnesses.aspx
* ↑ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
* ↑ Blue Foundation. (n.d.). Psychological treatments for depression. beyondblue - Home. Retrieved September 22, 2013, from http://www.beyondblue.org.au/the-facts/depression/treatments-for-depression/psychological-treatments-for-depression
* ↑ Blue Foundation. (n.d.). Medical treatments for depression. beyondblue - Home. Retrieved September 22, 2013, from http://www.beyondblue.org.au/the-facts/depression/treatments-for-depression/medical-treatments-for-depression
* ↑ Blue Foundation. (n.d.). Other sources of support. beyondblue - Home. Retrieved September 22, 2013, from http://www.beyondblue.org.au/the-facts/treatment-options/other-sources-of-support
* ↑ Timbremont, B., & Braet, C. (2004). Cognitive Vulnerability In Remitted Depressed Children And Adolescents. Behaviour Research and Therapy, 42(4), 423-437.
* ↑ Ströhle, A. (2009). Physical Activity, Exercise, Depression And Anxiety Disorders. Journal of Neural Transmission, 116(6), 777-784.
* ↑ Biddle, S. J., & Asare, M. (2011). Physical Activity And Mental Health In Children And Adolescents: A Review Of Reviews. British Journal of Sports Medicine, 45(11), 886-895.
* ↑ Rothon, C., Edwards, P., Bhui, K., Viner, R. M., Taylor, S., & Stansfeld, S. A. (2010). Physical Activity And Depressive Symptoms In Adolescents: A Prospective Study. BMC Medicine, 8(1), 32.
* ↑ Jerstad SJ, Boutelle KN, Ness KK, Stice E. Prospective reciprocal relations between physical activity and depression in female adolescents. J Consult Clin Psychol. 2010 Apr;78(2):268–272.
* ↑ Demoor, M., Beem, A., Stubbe, J., Boomsma, D., & Degeus, E. (2006). Regular Exercise, Anxiety, Depression And Personality: A Population-based Study. Preventive Medicine, 42(4), 273-279.
* ↑ Nabkasorn, C. (2005). Effects Of Physical Exercise On Depression, Neuroendocrine Stress Hormones And Physiological Fitness In Adolescent Females With Depressive Symptoms. The European Journal of Public Health , 16(2), 179-184.
* ↑ Victorian Government. (n.d.). Depression and exercise | Better Health Channel. Home | Better Health Channel. Retrieved October 15, 2013, from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Depression_and_exercise
* ↑ Black Dog Institute - Home - Black Dog Institute. Black Dog Institute - Home - Black Dog Institute. Retrieved October 15, 2013, from http://www.blackdoginstitute.org.au
* ↑ Welch, L (2011) Fight depression with exercise Fawshaw Focus; 7:4