Could not prescribing exercise for depression be psychiatric malpractice?

Abstract

The prevalence of depression is increasing, with 290 185 742 people with a documented depression globally in 2019.1 People with depression experience a significantly increased risk of numerous physical diseases, such as obesity, diabetes, high blood pressure and heart failure, among others.2 Traditionally, the primary treatment modalities for depression include antidepressants and psychotherapy. While effective in some instances, a considerable portion of the population (30%–50%) does not respond to these treatments. Further, these interventions do not target and may instead exacerbate physical ailments in some instances.3 There has been increasing recognition of the use of exercise as a treatment for depression. Recent meta-analyses have demonstrated that exercise has anti-depressant effects comparable to those of medications or psychotherapy, with simultaneous multisystem benefits to one’s physical health.4 5 Beyond depressive symptoms, exercise has established efficacy in preventing and managing a plethora of physical comorbidities, many of which disproportionately affect people with depression.6 Exercise has also demonstrated potential to reduce suicide attempts in those with depression.7 As such, exercise has been adopted as a first-line treatment in guidelines for depression globally with good acceptability and safety.6 8 Despite this, clinically, exercise is uncommonly prescribed or prioritised in the psychiatric setting.9 In a survey of mental health professionals, most (92%) stated that they had received no formal training in exercise prescription.9 While medication was …