Examining the Neurobiology of Exercise & Meditation in Depression Rakesh Jain, MD, MPH Clinical...
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Examining the Neurobiology of Exercise & Meditation in Depression Rakesh Jain, MD, MPH Clinical Professor Department of Psychiatry Texas Tech University
Examining the Neurobiology of Exercise & Meditation in
Depression Rakesh Jain, MD, MPH Clinical Professor Department of
Psychiatry Texas Tech University School of Medicine Texas, USA
([email protected])
Slide 2
Physical Exercise & Mental Health Is It Time To Start
Prescribing It?
Slide 3
Depression Are Current Treatment Options Giving Us All That We
Want?
Slide 4
Lets Take A Look At STAR*D Results 1 Trivedi MH et al. Am J
Psychiatry. 2006;163(1):28-40; 2 Trivedi MH et al. N Engl J Med.
2006;354(12):1243-1252; 3 Rush AJ et al. N Engl J Med.
2006;354(12):1231-1242; 4 Nierenberg AA et al. Am J Psychiatry.
2006;163(9):1519-1530; 5 Fava M et al. Am J Psychiatry.
2006;163(7):1161-1172; 6 McGrath PJ et al. Am J Psychiatry.
2006;163(9):1531-1541. HighLowWindow of Opportunity Patients in
Remission Remission: (HAM-D 17 7) Level 1 Level 2 Level 3Level 4
27.5 % 29.9% 21.2% 20.3% 16.1% 13.7% 6.9% STAR*D Remission Rates
1-6 MonoAugSwitchAugSwitchAugSwitch
Slide 5
And STAR*D Reveals Two Striking Shortcomings of Current Therapy
1.Low rates of remission 2.High rates of relapse STAR*D, Sequenced
Treatment Alternatives to Relieve Depression.
Slide 6
The Neurobiology of Exercise
Slide 7
Does Exercise Have A Place In The Integrative View of Mind-Body
Disruptions In Depression? Adapted from Goldstein BI, et al. J Clin
Psychiatry. Published online ahead of print, June 2, 2009. Pain
Neuropsychological impairment Neurodegeneration Mood D/Os Sleep
D/Os Osteoporosis Obesity, Insulin & Lipid abnormalities
Coronary artery D/O I nflammation Substance misuse
Slide 8
Neurobiology of Exercise: A Complex Cascade Dishman RK et al.
Obesity. 2006;14(3):345-356.
Slide 9
Exercises Effects on Hippocampal Cell Proliferation &
Neurogenesis Van der Borght K, et al. Hippocampus. 2009 Ki 67
positive newly generated cells DCX positive young neuronal cells #
p< 0.10 *** p< 0.001
Slide 10
Fitness & Hippocampal Volume Further Reason To Prescribe
Exercise Erickson KI, et al. Hippocampus. 2009; ahead of
publication. Scatterplots showing increase in fitness (VO 2 peak)
is related to increase in hippocampal volume (cm 3 ) Correlations
significant for both left and right (even after including age, sex,
years of education as covariates)
Slide 11
Physical Exercise A Modulator of Inflammatory Cytokines
Nicklaus BJ, et al. J Am Geriatrics Society.
2008;56:2045-2052.
Slide 12
Are Cytokines Pro-inflammatory In Adipose Tissues &
Anti-inflammatory In Skeletal Muscles? Rosa Neto JC et al. Eur J
Appl Physiol. 2009;106(5):697-704. Adipose tissueMuscle tissue C =
controls ED =immediately after exercise E2 = 2 hrs. after exercise
E6 = 6 hrs. after exercise
Slide 13
Exercises Effects On Immune Functioning Giraldo E, et al.
Neuroimmunomodulation. 2009;16:237-244. Single bout of 45-60
minutes of exercise in sedentary women Moderate exercise = 45
minutes at 55% VO 2 max Intense exercise = 60 minutes at 70% VO 2
max
Slide 14
Does Exercise Make Us Happy? Exercise Augments Endo-Cannabinoid
Signaling Rat study, 8 days of voluntary exercise CB 1 receptor
site binding density Hill MN, et al. Hippocampus. 2010
Apr;20(4):513-23.
Slide 15
Endogenous Opioids & Exercise Runners High It is A True
Biological Phenomenon Boecker H et al. Cerebral Cortex.
2008;18:2523-2531. VAS Scores before and after exercise. Euphoria
and Happiness were significantly different (p