Common Mental Disorders Depression - New Zealand Doctor

Exercise
Primary care evidence
We found only two RCTs conducted in primary care settings. 364,376 The participants
in these studies were older adults and this evidence is reported in Chapter 8: Special
Issues for Older Adults/Koroua/Kuia.
Evidence from mixed and other settings
The NICE (2004) 65 guideline included nine studies of exercise but none were primary
care based; all recruited participants through volunteer databases, media advertising
or secondary care. In these populations, structured and supervised exercise had a
clinically significant impact on mild or moderate depressive symptoms. There was
no good evidence to support one form of exercise over another, nor was there any
relevant evidence on relapse prevention or on the provision of ‘maintenance’ exercise
programmes. This evidence from volunteer populations may be of limited relevance
to a primary care population.
A large informal survey was conducted on the Australian Black Dog website asking
people with depression to rate the effectiveness of different interventions. People
with depression (from the general population) rated exercise very highly as a selfmanagement
strategy: of 2692 adult Australian respondents who had been depressed
for at least 2 weeks, 80% had tried exercise and 56% found it at least moderately
effective. 377 It was the most highly-rated self-management strategy in this survey.
Again, this evidence is from a volunteer population and so it may have limited
relevance for a general primary care population.
Exercise: issues for evidence-based practice
These studies of exercise for depressive symptoms among younger adults were
undertaken among highly-motivated populations, and it would seem unlikely that many
primary care patients with depression would be able to undertake such intensive activity.
However, the evidence suggests physical activity may be helpful and exercise is rated
highly as an intervention strategy among people who have experienced depression. 377
Psychological therapies
Primary care evidence
Very few RCTs of psychological therapies for depression have been conducted among
patients recruited from primary care and moreover the comparator in such studies is
often ‘treatment as usual’, which varies significantly between different practices. Most
of the evidence on psychological therapies derives from studies of patients referred to
specialist services or volunteers recruited from the community.
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Identification of Common Mental Disorders and Management of Depression in Primary Care