Affective Disorders

Affective  disorders,  also  known  as  mood  disorders, are clinical psychological disorders. The most common  affective  disorders  are  major  depressive disorder, dysthymic disorder, bipolar disorder, and cyclothymic  disorder.  A  core  feature  of  these  disorders  is  dysfunction  in  emotion  processing  and neurohormonal  regulation  leading  to  subjective feelings  of  sadness,  depressed  mood,  and  loss  of pleasure  in  things  normally  pleasurable  (anhedonia)  for  2  weeks  or  more.  These  symptoms  must also  subjectively  impair  the  fulfillment  of  social or  occupational  responsibilities.  Additional  possible symptoms include cycling episodes of mania in  bipolar  disorder;  insomnia  or  hypersomnia; feelings  of  worthlessness,  guilt,  suicidal  thoughts; and  psychomotor  agitation  (restlessness,  pacing) or  psychomotor  retardation  (fatigue,  tiredness). Affective  disorders  often  co-occur  with  anxiety disorders, such as panic disorder, generalized anxiety  disorder,  posttraumatic  stress  disorder,  and social phobia. Women are at greater risk than men for the development of both affective and anxiety disorders.

Diagnosis  of  an  affective  disorder,  mood  disorder,  or  anxiety  disorder  requires  an  extensive in-person  interview  with  a  licensed  clinical  psychologist  or  psychiatrist  to  establish  whether criteria  for  the  diagnosis  are  met.  A  score  on  a self-report survey of depression or anxiety symptoms, even when administered by a licensed clinician,  is  not  sufficient  for  diagnosis.  The  primary diagnostic  criteria  have  been  set  forth  by  the American  Psychiatric  Association  (APA)  in  the Diagnostic  and  Statistical  Manual  for  Mental Disorders,  4th  Edition,  Text  Revision  (DSMIV-TR)  and  by  the  World  Health  Organization in   the   International   Statistical   Classification of  Diseases  and  Related  Health  Problems,  10th revision (ICD-10). Adherence to these diagnostic standards have been difficult in the fields of sport and  exercise  psychology,  as  few  in  the  field  have the  necessary  credentials  or  lack  the  financial  or collegial resources.

affective-disorders-sports-psychologyNevertheless,  it  is  critical  to  understand  the effects  of  leisure-time  physical  activity  and  acute and  chronic  exercise  on  affective  and  anxiety disorders.  The  focus  here  will  be  on  the  use  of exercise  as  a  treatment  intervention  among  individuals diagnosed with affective or anxiety disorders. However, it is also important to understand how  these  disorders  may  affect  physical  activity behavior  in  general.  Symptoms  of  depression  are associated  with  lower  levels  of  physical  activity  and  inhibition  of  behavioral  activation.  For example,  feelings  of  hopelessness  and  fatigue  are difficult to overcome, and, as such, these patients experience difficulty in engaging in effortful tasks. In  addition,  among  athletes,  there  is  evidence that  a  core  feature  of  the  staleness  syndrome  (as a  result  of  overtraining)  is  depressed  mood,  and the  symptoms  of  staleness  map  directly  onto  the diagnostic criteria for a major depressive episode. Monitoring  depressed  mood  in  athletes  may  be a method to help avoid staleness during an overtraining period.

Major Depressive Disorder

Epidemiological  studies  consistently  indicate  that greater  levels  of  physical  activity  or  cardiorespiratory  fitness  are  related  to  reduced  risk  for  the future  development  of  major  depression  in  both men  and  women.  Engaging  in  regular  physical activity  provides  protection  against  symptoms of  depression,  compared  with  being  sedentary. However,  there  is  not  strong  evidence  for  a  dose response effect, so greater levels of physical activity are not necessarily more protective. Exercise training has been shown to be an effective treatment for major depression. Both aerobic exercise (walking, jogging) and resistance exercise, compared with a wait  list  or  non-exercise  control  condition,  have been  shown  to  effectively  reduce  symptoms  of depression and result in a remission in symptoms of  depression.  Walking  or  jogging  exercise  interventions,  4  to  6  months  in  duration  (but  longer is  better),  have  been  shown  to  be  as  effective  as antidepressant drug therapy and cognitive behavioral therapy compared with a placebo. Exercise is a good treatment option or adjuvant to treatment for  major  depression;  however,  adding  exercise training to pharmacologic or cognitive behavioral therapy  does  not  produce  synergistic  effects.  The behavioral  deactivation  and  extreme  feelings  of hopelessness  and  fatigue  present  clear  challenges to  the  initiation  of  and  adherence  to  a  physical activity or exercise training program, although one possible advantage of exercise training over pharmacotherapy  is  that  remission  of  symptoms  may persist for a longer time after the exercise and drug treatments have ended.

Bipolar Disorder

Although  there  is  increasing  interest  in  using exercise  as  a  treatment  in  bipolar  disorder,  and high-functioning  bipolar  disorder  patients  report exercise as one of many methods they use to help maintain  emotional  stability,  very  little  empirical research  and  no  clinical  trials  for  exercise  have been  conducted  in  patients  with  bipolar  disorder. One  study  has  shown  that  markers  of  cardiovascular disease risk can be improved with exercise in patients diagnosed with bipolar disorder, but it is unknown  if  exercise  can  improve  the  core  symptoms of bipolar disorder.

Panic Disorder

Patients  diagnosed  with  panic  disorder  tend  to be  less  physically  active  than  their  healthy  counterparts.  This  may  be  due,  in  part,  to  feelings  of discomfort experienced during exercise. The physiological  arousal  due  to  exercise  (increased  heart rate  and  respiration)  is  similar  to  the  core  symptoms of a panic attack, and thus may be avoided. Another  reason  may  be  due  to  false  beliefs  that exercise  will  cause  a  panic  attack.  The  evidence, however, clearly indicates that exercise is safe for people  diagnosed  with  panic  disorder  and  exercise,  even  at  maximal  capacity,  does  not  cause panic attacks. The very few documented instances of  panic  attack  during  exercise  can  be  viewed as  chance  occurrences  relative  to  the  number  of documented  exercise  and  physical  activity  sessions that did not involve a panic attack. Exercise training  is  known  to  be  a  very  useful  treatment for panic disorder and can be useful as a cognitive restructuring tool (“I can sweat and breathe hard and  my  heart  can  beat  very  fast,  and  it  does  not mean I am about to die or that I am going crazy”). Exercise  is  comparable  to  pharmacological  treatments  for  reducing  clinician  rated  symptoms  of panic disorder. However, the combination of drug treatment with exercise training does not produce a synergistic effect.

Generalized Anxiety Disorder

There  is  epidemiological  evidence  that  greater levels  of  physical  activity  or  cardiorespiratory fitness  are  related  to  reduced  risk  for  the  future development  of  anxiety  disorders.  However,  very few studies have tested the effects of exercise as a treatment for generalized anxiety disorder (GAD). In  two  clinical  trials,  both  aerobic  exercise  and resistance exercise resulted in significant symptom reductions compared with a wait-list control condition.  Exercise  has  not  currently  been  compared with  drug  treatments  or  other  treatment  methods.  Additionally,  the  affective  experience  during or immediately after exercise in GAD patients has not  been  examined.  There  is  very  little  information about how a single session of exercise affects symptoms  in  people  clinically  diagnosed  with affective or anxiety disorders.

References:

  1. Babyak, M. A., Blumenthal, J. A., Herman, S., Khatri, P., Doraiswamy, M., Moore, K. A., et al. (2000). Exercise treatment for major depression: Maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine, 62(5), 633–638.
  2. Blumenthal, J. A., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P., et al. (1999). Effects of exercise training on older patients with major depression. Archives of Internal Medicine, 159(19), 2349–2356.
  3. Dishman, R. K., Berthoud, H. R., Booth, F. W., Cotman, C. W., Edgerton, V. R., Fleshner, M. R., et al. (2006). Neurobiology of exercise. Obesity (Silver Spring), 14(3), 345–356.
  4. Herring, M. P., O’Connor, P. J., & Dishman, R. K. (2010). The effect of exercise training on anxiety symptoms among patients: A systematic review. Archives of Internal Medicine, 170(4), 321–331.
  5. Hoffman, B. M., Babyak, M. A., Craighead, W. E., Sherwood, A., Doraiswamy, M., Coons, M. J., et al. (2011). Exercise and pharmacotherapy in patients with major depression: One-year follow-up of the SMILE study. Psychosomatic Medicine, 73(2), 127–133.

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