The Missing Connection

Below Is an Excerpt on Exercise and Treatment for Anxiety.
Excerpt From: John J. Ratey & Eric Hagerman. “Spark.”

The mind-set that any sound treatment for anxiety must involve medicine isn’t restricted to the courtrooms of divorce proceedings. In 2004 the New England Journal of Medicine (NEJM) published a review of treatments for generalized anxiety disorder that failed to even mention exercise. It was primarily a rundown of our most common antianxiety drugs, with a nod to therapy and relaxation. Of the thirteen pharmaceuticals charted in the review, all bear a formidable list of possible side effects. None have been endorsed by the U.S. Food and Drug Administration as explicitly safe during pregnancy — not an incidental point given that women are twice as likely to suffer from anxiety and depression as men.

The article was positioned as advice for doctors, but how is it that a summary of treatments for general anxiety disorder in the bible of medical research simply left out exercise? It’s a case of what I would call clinical blindness. The mounting research on the neurological and psychological benefits of exercise seems to be hidden in plain sight.

“Interestingly, it was the cardiologists who spoke up. The NEJM published a letter from doctors Carl Lavie and Richard Milani of the Ochsner Clinic Foundation in New Orleans. It read, in part, that the author “discusses generalized anxiety disorder and its treatment with pharmacologic agents and psychotherapy. We are surprised, however, that there is no mention of exercise as an additional means of treating anxiety.” The letter noted that cardiologists are interested in anxiety as a risk factor for heart problems, and then pointed out, “Exercise training has been shown to lead to reductions of more than 50 percent in the prevalence of the symptoms of anxiety. This supports exercise training as an additional method to reduce chronic anxiety.”

The letter was a polite way of saying that the original article missed the boat. Lavie has written more than seventy papers on exercise and the heart, eleven of which focus on anxiety. Every single one of his studies has shown a marked improvement in anxiety and depression.

The importance of this exchange is that it’s a case of cardiologists (“real” doctors) taking psychiatrists to task about how to treat the whole patient. If we go all the way back to Hippocrates, the wisdom of the day was that emotions come from the heart and that that’s where treatment should start for maladies of mood. Modern medicine has separated mind and body, but it turns out that, in a very concrete way, Hippocrates had it right from the start. Just in the past ten years scientists have begun to understand how a molecule that originates in the heart plays on our emotions.”

Excerpt From: John J. Ratey & Eric Hagerman. “Spark.” Little, Brown and Company, 2008-01-10. iBooks.
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