From the Guidelines
Walking depression should be treated with individual or group therapy, focusing on options such as cognitive therapy, behavioral activation, structured physical activity, mindfulness-based stress reduction, or psychosocial interventions. This approach is supported by recent guidelines, including the 2023 update from the Journal of Clinical Oncology, which emphasizes the importance of these therapies for managing moderate symptoms of depression 1. The treatment of walking depression, characterized by persistent low mood, lack of enjoyment, and fatigue despite continued functioning in daily life, requires a multifaceted approach. Key components include:
- Cognitive therapy or Cognitive Behavioral Therapy (CBT) to address negative thought patterns
- Behavioral Activation (BA) to encourage engagement in activities
- Structured Physical Activity (PA) and exercise, which has been shown to reduce depressive symptoms
- Mindfulness-based Stress Reduction (MBSR) to help manage stress and improve mood
- Psychosocial interventions that incorporate empirically supported components like relaxation and problem-solving techniques. While medication may be considered in some cases, the primary recommendation from the most recent and highest quality study emphasizes therapy and lifestyle interventions 1. Regular physical activity, such as walking, can be particularly beneficial as it combines the benefits of exercise with the opportunity for social interaction and exposure to natural environments, which can further enhance mood and overall well-being.
From the Research
Treatment for Walking Depression
The treatment for walking depression, also known as depression that is not severe enough to require bed rest, can include various forms of exercise and physical activity.
- Exercise has been shown to have therapeutic effects on depression in all age groups, as a single therapy, an adjuvant therapy, or a combination therapy, with benefits comparable to traditional treatments for depression 2.
- Moderate intensity exercise is sufficient to reduce depressive symptoms, but higher-dose exercise is better for overall functioning 2.
- Aerobic exercise and mind-body exercise, such as walking, are recommended for 3-5 sessions per week with moderate intensity lasting for 4-16 weeks 2.
- A single bout of walking has been shown to have acute effects on affective responses in patients with major depressive disorder, including increased energetic arousal and decreased negatively valenced affective responses 3.
Medication Treatment
In some cases, medication may be necessary to treat walking depression.
- The combination of bupropion and sertraline has been shown to be effective in treating refractory depression, with no adverse effects reported in some studies 4.
- However, the combination of bupropion and SSRIs can also increase the risk of serotonin syndrome, a potentially fatal complication 5.
Physical Activity as a Clinical Tool
Physical activity and exercise have been shown to be effective in treating mild-to-moderate depression and reducing mortality and symptoms of major depression.
- Despite the benefits of physical activity, it is still underused in clinical practice, and there are several barriers that block its use in fighting depression, including lack of accessibility and representation 6.
- To optimize mitigation strategies, actions can be taken to increase the accessibility of physical activity, and technology can be used to help both clinicians and patients 6.