Private insurers should cover physical activities prescribed to combat depression in the same way they cover medication. This is the clinical opinion of Dr. Nicholas Fabiano, a third-year psychiatry resident at the University of Ottawa.
Described as a “rising star” by the neuroscience journal Brain Medicine, this young doctor, who is already very active in his specialty, has been quoted in numerous media outlets, including The Washington Post.
In an editorial published in the British Journal of Sports Medicine, entitled Could not prescribing exercise for depression be psychiatric malpractice?, he argues that physical activity should not be overlooked in the treatment of depression; on the contrary, it should be part of any treatment plan. And he believes that these programs should be covered by private insurers.
Depression and its treatment
According to the Canadian Mental Health Association (CMHA), 14% of Canadians will experience major depressive disorder in their lifetime.
Depression affects more women than men, according to the World Health Organization (WHO) and other health authorities. However, CMHA points out that men are significantly less likely to seek mental health support or access professional care.
"Depression tends to affect women more than men, but no gender or age group is immune," notes Manulife. The insurer also emphasizes that mental health disorders—including depression—are among the leading causes of absenteeism from work across Canada, “comprising more than one-third of long-term disability claims.”
Depressed individuals have a significantly increased risk of many physical illnesses, such as obesity, diabetes and high blood pressure, says Dr. Fabiano in the British Journal of Sports Medicine article co-authored with two other researchers.
Depression also increases the risk of heart disease, according to the University of Ottawa Heart Institute, as it disrupts immune system function. The WHO has also identified links between depression and other serious conditions, such as cancer and respiratory diseases.
“Traditionally, the primary treatment modalities for depression include antidepressants and psychotherapy, summarizes Dr. Fabiano in his article. 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.”
Comparable antidepressant effects
In a written exchange with the Insurance Portal, Dr. Fabiano highlighted the positive impacts of the method he advocates in psychiatry. “Exercise has similar antidepressant effects compared to first-line treatment such as medications and therapy”, he states. “Beyond depression, exercise has numerous benefits to one's overall health.”
In his article published in the British Journal of Sports Medicine, he further notes that exercise is increasingly recognized as a valid treatment for depression. It has been adopted as a first-line treatment in guidelines for depression globally.
“Beyond depressive symptoms, exercise has established efficacy in preventing and managing a plethora of physical comorbidities, many of which disproportionately affect people with depression. Exercise has also demonstrated potential to reduce suicide attempts in those with depression,” he explains in his introduction.
Paradoxically, the article points out that 92% of mental health professionals surveyed said they had received no formal training in prescribing exercise.
Despite all its clinical benefits, physical exercise is rarely prescribed or prioritized in psychiatric settings, Dr. Fabiano says.
A change is needed
According to Dr. Fabiano, a change is needed. In the British Journal of Sports Medicine, he argues that it would be wrong to neglect physical activity as part of treatment for depression. In the contrary, it should be an integral part of the treatment plan.
“Ignoring exercise as a treatment for depression isn’t just a missed opportunity. It might even cross the line into negligence,” Dr. Fabiano contends in a University of Ottawa news release. “The research is clear: physical activity really does help with depressive symptoms. So why is it still so rare for psychiatrists to prescribe it right alongside medication or therapy?”
Dr. Fabiano advocates for exercise to become as common a prescription for treating depression as antidepressants. That doesn’t mean simply telling everyone to go for a walk: to address the specific needs of individuals with depression, he recommends structured, personalized exercise plans based on the F.I.T.T. principle—Frequency, Intensity, Time and Type.
He therefore encourages the medical community to take physical activity seriously as a treatment for depression. In his statement, he urges that it be taught in medical schools, included in clinical guidelines, and covered by insurance.
He also wants doctors to more readily refer patients to physical activity specialists and for technologies such as physical activity monitors to be integrated into follow-up care.
“If we don’t hesitate to prescribe a pill, why do we hesitate with exercise?” Dr. Fabiano says in the press release. In his view, exercise should be treated as a central component of mental health care—not as a complementary option that patients can choose to pursue or ignore based on personal preference.
Insurers’ role
Insurance companies could play a very important role in this strategy, he told the Insurance Portal. “Just as private insurers cover costs for medications and therapy, they should also cover aspects to facilitate exercise in people with depression.”
In particular, he points to covering gym memberships, trainers, among other things.
“By covering exercise plans for people with depression, insurers are investing in the overall health of their patients,” explains Dr. Fabiano. “Depression is associated with a multitude of medical conditions (which also require medications) which bidirectionally worsen one another if not well controlled. Here, exercise can treat both simultaneously, while potentially reducing medication requirements from both a mental and physical health perspective.”
[With the collaboration of Amélie Cléroux.]
