Classification, Prevalence, Exercise Prescription And Treatment/Pharmacology Of Depression, Anxiety And Stress

Any one of us can be affected by depression, anxiety and stress – especially in challenging times such as during the Covid pandemic.

While exercise is recognised as promoting mental wellbeing, some people suffering with mental health issues will also benefit from psychological intervention, cognitive behavioural therapy and/or drug therapy.

Classification and prevalence of depression

Depression is diagnosed when its symptoms are causing clinically significant stress or impairment in a person’s life, for most of the day on most days for at least two weeks.

It is caused by a complex interaction of biological, psychological, environmental and social factors.

A person with depression would usually have five or more of the following symptoms:

• depressed mood
• loss of interest
• significant weight loss or gain or decrease or increase in appetite
• insomnia or hypersomnia
• psychomotor agitation or retardation
• fatigue or loss of energy
• feelings of worthlessness or excessive or inappropriate guilt
• diminished ability to think or concentrate, or indecisiveness
• recurrent thoughts of death, recurrent suicidal ideation without a specific plan or suicide attempt

A medical professional should distinguish between unipolar episodes (recurrent depressive illness) and bipolar disorder (includes episodes of “manic’ elevated mood), as treatment will be different.

Prior to the Covid pandemic, depression was the fourth leading cause of disability and disease in the world. In the UK, the rate of major depression as seen in primary care was 5%-10%; however, many more have depressive symptoms.

The prevalence of depression in the UK (16-74 year olds) was 2.6% in 2000, but when anxiety was also included the rate increased to 11.4%.

Classification and prevalence of anxiety

Anxiety is an emotional state that often exists alongside other mood and physical health disorders. It can be a mild or severe feeling of unease, affecting concentration, sleep, gastric health, sweating and palpitations. Anxiety includes panic disorder, PTSD, OCD, phobias, and acute stress disorder.

Genetics, brain chemistry and environmental factors can all be a factor in the development of anxiety, and it can be exacerbated by addictive substances e.g. caffeine, nicotine, alcohol.

A 2009 survey estimated 4.4% of people in England suffered from anxiety, however this was prior to rises in anxiety among young people linked to social media and other pressures, and prior to the Covid outbreak. Rates of prevalence were 1.5-2.5 times higher in women than men.

Classification and prevalence of stress

Stress is a reaction to a traumatic incident when someone experiences extreme, disturbing or unexpected anxiety, fear or pain, leaving them feeling helpless. While stress is usually considered part of life, regular symptoms can be evidence of an underlying mental illness.

When under stress, the body releases cortisol, adrenaline and noradrenaline. The person under stress might suffer cognitive symptoms such as difficulty concentrating and remembering, negative views and constant worry, and emotional symptoms such as feeling irritable, overwhelmed, isolated or depressed.

Stress can be caused by issues such as money worries, exams, work issues, bereavement or relationship problems. It results in physiological, psychological and behavioural responses as well as emotional states, for example breathlessness, irritability, sleep disorders, high blood pressure, chest pain, nausea, dizziness and nervous twitching.

Around one in six people view their work to be very or extremely stressful, and stress is the second most commonly reported factor for work-related ill health.

Stress can be caused by genetic factors, personality traits and immune-regulated diseases, and the longer a person remains under intense stress, the more harmful it’s likely to be. Long-term stress can lead to other conditions, including depression and anxiety.

Pharmacological treatment for depression, anxiety and stress

Mental health issues are usually treated with a combination of pharmacological options, such as antidepressants, and psychotherapy.

However, the National Institute for Health and Clinical Excellence (NICE) has recommended that drugs are not always the best treatment, and there’s a growing evidence base that exercise can help those suffering with depression, anxiety and stress, alongside dietary changes and advice on stress management.

The effect of exercise on depression, anxiety and stress

Many studies have found a positive relationship between exercise and mental health. It’s not clear if it is the exercise itself or the factors around it, such as social interaction.

The following hypotheses have been put forward to explain how exercise may contribute to mental wellbeing, however some have been challenged and/or need further study:

• Release of endorphins during high-intensity exercise
• Temperature rises during exercise enhance mood
• Exercise distracts from the pressures of daily life
• Overcoming challenges and achieving exercise goals enhances moods

Recommended exercise can focus on aerobic activity, resistance training or flexibility work.

A personal trainer should be aware if a client is taking medication for depression, anxiety or stress, as these can cause side effects such as dizziness, nausea, dry mouth, headaches and tachycardia.

Mental health issues can affect a client’s ability to train, for example they may feel anxious or stressed about attending a group training class, or too depressed to leave the house. A positive relationship with the fitness professional and a connection with the others in the exercise group can lead to a positive social aspect to taking part in exercise. They may, however, need extra attention to reduce the likelihood of fluctuating motivation and drop-out.