Exercise may be just as crucial to a depression patient’s good health as finding an effective antidepressant.

A study of nearly 18,000 participants found that those with high fitness at middle age were significantly less likely to die from heart disease in later life, even if they were diagnosed with depression. The research – a collaboration between UT Southwestern and The Cooper Institute – underscores the multiple ways in which depression may ultimately impact health and mortality.

“Maintaining a healthy dose of exercise is difficult, but it can be done. It just requires more effort and addressing unique barriers to regular exercise,” said Dr. Madhukar Trivedi, co-author of the study and Director of the Center for Depression Research and Clinical Care, part of the Peter O’Donnell Jr. Brain Institute at UT Southwestern.

The study, published in JAMA Psychiatry, utilized a Cooper Institute database of participants who had their cardiorespiratory fitness measured at an average age of 50 years. Researchers used Medicare administrative data to establish correlations between the participants’ fitness at midlife to rates of depression and heart disease in older age. Among the findings, participants with high fitness were 56 percent less likely to eventually die from heart disease following a depression diagnosis.

“The earlier you maintain fitness, the better chance of preventing depression, which in the long run will help lower the risk of heart disease,” said Dr. Trivedi, also Professor of Psychiatry.

Depression has been linked to several other chronic medical conditions such as diabetes, obesity, and chronic kidney disease, which studies show can affect whether antidepressants are likely to help. For patients with these conditions, the more appropriate treatment may be exercise.

Dr. Trivedi said the reasons behind this may partly be connected to the general health effects of physical activity, including the fact that exercise decreases inflammation that may cause depression. By reducing inflammation, the risk for depression and heart disease are lowered.

“There is value to not starting a medication if it’s not needed,” said Dr. Trivedi, who’s leading a national effort to establish biological tests for choosing antidepressants. “Being active and getting psychotherapy are sometimes the best prescription, especially in younger patients who don’t have severe depression.”