Exercise as a Treatment for Depression

An extensive body of research throughout the past decade indicates that exercise may be an effective treatment for depression, and could potentially act as a preventive measure against depression. Outcomes from research, and a 2016 pool of studies involving over one million men and women, strongly suggest that regular exercise can not only alter our bodies, but also transform the brain so that the resistance to despair & depression is heightened and increased.

For many years, scientists have investigated the correlation between physical activity and mental health. While it has long been understood that exercise alters the body, how physical activity affects emotional health is less clear: some randomized controlled trials have found that exercise programs ease symptoms in people with major depression.

A group of global researchers in public health, however, has worked to further support the case for exercise as a treatment for–and preventive measure against–depression. For the newer analyses, they initially gathered all of the most recent and most well-designed studies surrounding depression and exercise. The ‘most innovative’ of the new studies, published in 2016 in Preventive Medicine, focused on whether exercise could help to prevent the development of depression.

Due to the frequent unreliability of how we report our exercise and workouts, the researchers solely utilized past studies that had “objectively measured participants’ aerobic fitness,” which will rise or fall depending on whether and how much someone exercises. Other parameters for the study included a measurement of participants’ mental health, at both the initial outset and conclusion of the study, coupled with follow-up time of at least a year.

The researchers found several large-scale past studies that met their criteria, which collectively contained data on more than 1,140,000 adult men and women. Among these million-plus people, the links between mental health and fitness was fairly strong. When the researchers divided the group into thirds, based on their respective aerobic fitness, those men and women with the lowest fitness were about 75 percent more likely to have been given diagnoses of depression than the people with the greatest fitness. The men and women in the middle third were almost 25 percent more likely to develop depression than those who were the most fit.

In a separate study (some of the scientists were involved in each of the reviews), researchers looked at whether exercise might be useful as a treatment for depression. In that analysis, which was published in Journal of Psychiatric Research in June 2016, they pooled data from 25 past studies in which people with clinically diagnosed depression began some type of exercise program. The pooled results demonstrated that exercise, specifically a moderately strenuous workout such as brisk walking or jogging, has a “large and significant effect” against depression. People’s mental health tended to improve considerably if they were physically active. The final review further clarifies reasons as to why this may be true. Published in Neuroscience & Biobehavioral Reviews in February 2016, it sought to understand what happens to the body during and after exercise that might impact and enhance mood. The researchers analyzed 20 previous studies, all of which included results from blood samples from people with major depression before and after they had exercised. Overall, the findings in the samples indicated that exercise “significantly reduced various markers of inflammation and increased levels of a number of different hormones and other biochemicals that are thought to contribute to brain health.”

As reported in The New York Times, Felipe Barreto Schuch, an exercise scientist at the Centro Universitário La Salle in Canoas, Brazil and primary author on all of the reviews, confirms that the studies provide a strong case regarding the link between exercise and mental health. While further experiments are needed to specify the types and amounts of exercise, Dr. Schuch stated that “the main message” of the reviews “is that people need to be active to improve their mental health.”

SOURCES
https://www.theatlantic.com/health/archive/2014/03/for-depression-prescribing-exercise-before-medication/284587/
https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression-and-exercise/art-20046495
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/

Applications of Clinical Cannabis in Medicine

As clinical cannabis is rapidly becoming accepted as a treatment for an array of chronic diseases and disorders, there is a growing and pressing need for clinical education surrounding medical marijuana—and alternative treatments for pain control. The use and acceptance of medical cannabis continues to evolve, as demonstrated by the growing number of states that now permit its use and applications for specific medical indications. 

While the marijuana plant contains over 100 different chemicals—or cannabinoids—each one produces a different effect on the body. Tetrahydrocannabinol (THC) was originally identified by Raphael Mechoulam, who later also described and named anandamide: a naturally occurring endogenous cannabinoid neurotransmitter that binds to cannabinoid receptors. The human endocannabinoid system is a biological system involved in regulating a variety of physiological and cognitive processes, including appetite, pain sensation, mood, memory, fertility, etc. The CB1 receptor (THC) occurs in the central and peripheral nervous system, while the CB2 receptor is located on immune cells, and the peripheral nervous system. Cannabidiol (CBD) does not have the psychotropic effects of THC, nor does it have the memory impairment or appetite effects; the two main chemicals used in medicine are THC and CBD.

The most common use for medical marijuana in the United States is for pain control: while marijuana is not strong enough for severe pain (i.e. post-surgical pain or a broken bone), it is said to be highly effective for the chronic pain that plagues millions of Americans, particularly as they age. Part of its attraction is that it is clearly safer than opiates—almost impossible to overdose, and far less addictive—and it can take the place of NSAIDs such as Advil or Aleve, if people cannot take them due to problems with kidneys, ulcers, or GERD.

Marijuana specifically appears to ease the pain of multiple sclerosis, and nerve pain in general. This is an area in which few other options exist; moreover, those that do—such as Neurontin, Lyrica, or opiates—are highly sedating. Patients claim that marijuana allows them to resume their previous activities without feeling drugged or disengaged. Marijuana is also said to be a highly effective muscle relaxant; many users swear by its ability to lessen tremors in Parkinson’s disease. Other successful clinical applications include fibromyalgia, endometriosis, interstitial cystitis, and most other conditions where the final common pathway is chronic pain.

Further users of marijuana include management of nausea and weight loss, and treatment for glaucoma. A highly promising area of research is its use for PTSD in veterans who return from combat zones. Many veterans and respective therapists have reported drastic improvements, recommending more research and studies, and a loosening of governmental restrictions on its study. Medical marijuana is also reported to help patients suffering from pain and wasting syndrome associated with HIV, as well as irritable bowel syndrome and Crohn’s disease.

Despite lingering controversy, use of botanical cannabis for medicinal purposes represents the revival of a plant with historical significance reemerging in today’s healthcare system. Legislation governing use of medicinal cannabis continues to change quickly, necessitating that pharmacists and other clinicians stay abreast of state regulations and institutional implications. Ultimately, as the medicinal cannabis landscape continues to evolve, hospitals, acute care facilities, clinics, hospices, and long-term care centers must consider the implications, address logistical concerns, and explore the feasibility of permitting patient access to this treatment.

Senior Vice-President of A4M/MMI Joseph Maroon, MD—Clinical Professor and Vice Chairman in the Department of Neurosurgery at the University of Pittsburgh Medical Center, and expert in clinical cannabis therapies—has published a white paper on the neurological benefits of cannabinoids.

SOURCES
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/
https://www.cannabis-med.org/?lng=en

Member of the Month: Yelena Lapidus, MD

A4M valued member Yelena Lapidus shares insight from her professional experience in this Member of the Month feature. 

I was born in Samara, a city situated in the southeastern part of European Russia. I lived there until I graduated from Medical School in 1996. I then moved to the United States and got my second residency at UC Davis Medical School. Currently, I own a clinic I am very proud of filled with unique integrative medicine that we personalize for each patient. I am fortunate to live on the coast in beautiful California where I get to be near my son who attends college at California Polytechnic State University, San Luis Obispo. I base my life around learning and I do not intend to stop!

Q1: Before joining A4M what was your medical background?

I began my medical background at Samara State Medical University in Russia 1994 with an OB/GYN Residency in 1996 specializing in surgeries and treatments for infertility and endometriosis. I studied Family Medicine at UC Davis with a rural track allowing me to do Obstetrics and prenatal care. In 2005 I started a Family Practice and also joined the World Hormonal Society. In 2006 I became board certified with the American Academy of Anti-Aging and Regenerative Medicine and bioidentical hormone therapy.

Q2: What anti-aging techniques have you incorporated into your practice? How did you do so?

I based my whole medical practice on a variety of Anti-Aging medicine technologies. Every single disease condition I treat with integration of this knowledge. I have studied all of the modules of the fellowship and incorporate this knowledge through protocols to evaluate every system of the body. We personalize our approach by getting a baseline of major systems through extensive hormone care, nutraceuticals, allergen testing, neurofeedback, and a variety of other methods. We strive to help our patients achieve whole body health and well-being through implementing new scientific discoveries and technological advances. Anti-Aging individualized patient care is our priority.

Q3: What are the benefits of practicing Anti-Aging Medicine, both as a professional and for your practice?

Practicing anti-aging allows me to focus on developing personalized programs for the health of my patients. I am able to focus on more healthy individuals and fewer sick patients. Seeing life changes my patients make are very rewarding. Our practice is health oriented, not disease oriented.

Q4: What are the changes you see in your patients?

Through Anti-Aging medicine my patients have more vitality and energy, better cardiovascular performance, lower A1C, lower weight, clearer skin, and improved strength. Outcomes of treatment and personal patient goals are achieved faster and are more sustainable.

Q5: Why would you recommend Anti-Aging Medicine to your peers?

I would recommend Anti-Aging Medicine to my peers because it allows you to help make significant life changes with your patients that will create a foundation for longevity. This is way more fun and personally rewarding than only taking care of sick patients. It is preventative & proactive health versus reaction/symptom/disease-oriented medicine.

Q6: Where do you see the future of Anti-Aging medicine 20 years from now?

20 years from now I believe Anti-Aging medicine will be a cornerstone to medical care. I hope that by then this way of practicing medicine will have grown in popularity as it proves itself again and again to be very effective in helping individuals become and stay healthy.