运动如何影响青少年抑郁:回顾与展望

Mechanism and Future Prospect of Exercise in the Treatment of Adolescent Depression

近年来,运动能否作为青少年群体抑郁症治疗的替代疗法受到了越来越多的关注。本文通过系统梳理前人研究,分别回顾相关横、纵向调查和实验干预研究,分析总结了运动影响青少年抑郁的研究进展,同时对该作用现有心理假说和神经生理假说分别进行了阐述和分析探讨。我们认为,未来研究应不断完善实验设计,关注不同运动类型的抗抑郁效果,适当结合中国国情,深入探讨在青少年抑郁障碍群体中的最佳抗抑郁运动方案及其作用机制。

Given that adolescents are suffering a high prevalence risk of depression,it is essential and urgent to investigate the effective prevention and early intervention in terms of depressive disorders among adolescents.However,there are some limitations of drug therapy and psychotherapy.The FDA(Food and Drug Administration)recommends that we should use a black-box warning in antidepressants to show that antidepressants may deteriorate disease and/or increase suicide risk among patients aged<24 years old.Moreover,since the treatment effects of psychotherapy are limited,the high recurrence rate and high treatment cost remind that we need to identify and evaluate new effective treatment of adolescent depression.As the advantages of low consumption,time control,harmlessness makes exercise easier to execute,there is a growing interest in the potential role of exercise in the reduction of depressive symptoms among adolescents.In this paper,we reviewed the studies on the association of exercise and depression among adolescents,including cross-sectional and longitudinal investigations,as well as experimental interventions.Accumulative studies agree that exercises do decrease depressive symptoms among adolescents,while there are also a few studies holding that exercises do not decrease depressive symptoms among adolescents.In view of the abovementioned fact,we recommend that future research should improve the experimental paradigm and base on clinic research.We also summarized how exercise influenced depression:the psychological mechanisms(self-efficiency,self-esteem,and distraction)and the neurobiological mechanisms(neuroendocrine,neurotrophies,oxidative stress,inflammatory,changes on cortical structure and activity,and epigenetics).Unfortunately,these hypotheses were not proved consistently by empirical studies as the findings of some studies did not support these hypotheses.In addition,some researchers argued that there were some differences in the functionary mechanisms between adults and adolescents.Therefore,more studies are needed to figure out the mechanism of how exercise influences depression.Next,we analyzed the deficiencies of the present status and future directions.First,future studies should improve the experimental design.The participants of previous studies included clinical patients,subclinical patients,and healthy adolescents.Future studies should pay special attention to clinical patients,and try to figure out whether exercise can be used as an effective treatment of depressive disorders or not.Moreover,we must consider the placebo effect in the treatment of depression,social contact,and abandonment rate of exercise when designing experimental paradigms.The exploration of exercise types,exercise intensity,and duration is also important.Besides,less research can be obtained on this field in China.Further studies can be combined with Chinese characteristics on the basis of domestic and foreign research to explore whether the traditional exercises in China(Tai Chi and Kungfu,etc.)or easy exercises during class interval could influence adolescent’s depression level.Finally,we should be more rigorous and scientific when facing and examining the validity of the existing hypothesis and do our best to figure out the psychological and neurobiological mechanisms on how exercises influence depression.All in all,future research could further focus on methodological improvements and explore the best exercise program of antidepressant and the mechanisms.Remarkably,we should verify whether there truly exists the best exercise type,the intensity and duration for decreasing depressive symptoms,or the preferred exercise programs for the youth.For the psychological and neurobiological mechanisms,we should also figure out whether these mechanisms work together or work independently.