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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 (JainTexas@gmail.com)

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Physical Exercise & Mental Health Is It Time To Start Prescribing It?

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Depression Are Current Treatment Options Giving Us All That We Want?

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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

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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.

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The Neurobiology of Exercise

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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

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Neurobiology of Exercise: A Complex Cascade Dishman RK et al. Obesity. 2006;14(3):345-356.

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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

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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)

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Physical Exercise A Modulator of Inflammatory Cytokines Nicklaus BJ, et al. J Am Geriatrics Society. 2008;56:2045-2052.

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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

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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

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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.

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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