The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes.
The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes.
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DOI：
10.1038/s41380-022-01819-w
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发表时间：
2023-01
影响因子：
11
通讯作者：
Gregory, Chris M.
中科院分区：
文献类型：
--
作者：
Ross, Ryan E.;VanDerwerker, Catherine J.;Saladin, Michael E.;Gregory, Chris M.
在全球范围内，抑郁症是导致残疾的主要原因，而且几十年来一直如此。抗抑郁药物的效果不佳，而且往往与副作用有关，这突显了替代治疗方案的必要性。尽管运动主要是因为它对身体健康的好处而闻名，但它的心理健康和抗抑郁药物的好处也越来越被人们所认识。经验证据表明，运动在治疗抑郁症方面是有效的；然而，运动发挥抗抑郁作用的机制还不完全清楚。在抑郁症的临床队列中，急性运动被证明可以瞬时调节5-羟色胺和去甲肾上腺素、脑源性神经营养因子和各种免疫炎症机制的循环水平。然而，运动训练还没有被证明持续地调节这种机制，而且缺乏将这些假定的机制与减轻抑郁症联系起来的证据。抑郁症生物学基础的复杂性，再加上运动引起的错综复杂的分子级联，是试图理清运动对抑郁症影响的重大障碍。尽管我们对这些影响的了解有限，但临床证据一致支持使用运动来治疗抑郁症。令人遗憾的是，尽管锻炼是一种可获得的、低成本的替代/辅助干预措施，可以同时减少抑郁和改善整体健康，但锻炼仍然没有得到充分利用。为了解决我们对运动对抑郁症的临床和分子影响的理解上的差距，我们提出了一个利用系统生物学和多学科团队科学与大规模公共卫生投资的模型。在科学与抑郁症带来的复杂程度和负担相匹配之前，我们推进知识和治疗的能力将继续受到支离破碎、不可重现的机械性发现的困扰，也没有护理标准的指导方针。
Globally, depression is a leading cause of disability and has remained so for decades. Antidepressant medications have suboptimal outcomes and are too frequently associated with side effects, highlighting the need for alternative treatment options. Although primarily known for its robust physical health benefits, exercise is increasingly recognized for its mental health and antidepressant benefits. Empirical evidence indicates that exercise is effective in treating individuals with depression; however, the mechanisms by which exercise exerts anti-depressant effects are not fully understood. Acute bouts of exercise have been shown to transiently modulate circulating levels of serotonin and norepinephrine, brain-derived neurotrophic factor, and a variety of immuno-inflammatory mechanisms in clinical cohorts with depression. However, exercise training has not been demonstrated to consistently modulate such mechanisms, and evidence linking these putative mechanisms and reductions in depression is lacking. The complexity of the biological underpinnings of depression coupled with the intricate molecular cascade induced by exercise are significant obstacles in the attempt to disentangle exercise’s effects on depression. Notwithstanding our limited understanding of these effects, clinical evidence uniformly argues for the use of exercise to treat depression. Regrettably, exercise remains underutilized despite being an accessible, low-cost alternative/adjunctive intervention that can simultaneously reduce depression and improve overall health. To address the gaps in our understanding of the clinical and molecular effects of exercise on depression, we propose a model that leverages systems biology and multidisciplinary team science with a large-scale public health investment. Until the science matches the scale of complexity and burden posed by depression, our ability to advance knowledge and treatment will continue to be plagued by fragmented, irreproducible mechanistic findings and no guidelines for standards of care.
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影响因子：
64.8
作者：
Autry, Anita E.;Adachi, Megunai;Nosyreva, Elena;Na, Elisa S.;Los, Maarten F.;Cheng, Peng-fei;Kavalali, Ege T.;Monteggia, Lisa M.
通讯作者：
Monteggia, Lisa M.
影响因子：
11
作者：
Bus, B. A. A.;Molendijk, M. L.;Voshaar, R. C. O.
通讯作者：
Voshaar, R. C. O.
影响因子：
6.8
作者：
Carboni, Lucia;McCarthy, Dennis J.;Domenici, Enrico
通讯作者：
Domenici, Enrico
影响因子：
16.2
作者：
Chen, Pei-Chun;Chan, Yen-Ting;Li, Chung-Yi
通讯作者：
Li, Chung-Yi
影响因子：
7.4
作者：
Birnbaum, Howard G.;Kessler, Ronald C.;Greenberg, Paul E.
通讯作者：
Greenberg, Paul E.