Steve Herman

Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months

Objective The purpose of this study was to assess the status of 156 adult volunteers with major depressive disorder (MDD) 6 months after completion of a study in which they were randomly assigned to a 4-month course of aerobic e-ercise, sertraline therapy, or a combination of e-ercise and sertraline. Methods The presence and severity of depression were assessed by clinical interview using the Diagnostic Interview Schedule and the Hamilton Rating Scale for Depression (HRSD) and by self-report using the Beck Depression Inventory. Assessments were performed at baseline, after 4 months of treatment, and 6 months after treatment was concluded (ie, after 10 months). Results After 4 months patients in all three groups e-hibited significant improvement; the proportion of remitted participants (ie, those who no longer met diagnostic criteria for MDD and had an HRSD score <8) was comparable across the three treatment conditions. After 10 months, however, remitted subjects in the e-ercise group had significantly lower relapse rates (p = .01) than subjects in the medication group. Exercising on one’s own during the follow-up period was associated with a reduced probability of depression diagnosis at the end of that period (odds ratio = 0.49, p = .0009). Conclusions Among individuals with MDD, e-ercise therapy is feasible and is associated with significant therapeutic benefit, especially if e-ercise is continued over time.

Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder

Objective: To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls. Methods: Between October 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50–200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D). Results: After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of <8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise = 45%; home-based exercise = 40%; medication = 47%; placebo = 31% (p = .057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p = .23). Conclusions: The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, ongoing symptom monitoring, attention, and other nonspecific factors. BDI = Beck Depression Inventory; CI = confidence interval; HAM-D = Hamilton Depression Rating Scale; ITT = intention-to-treat; MDD = major depressive disorder; SD = standard deviation; SSRIs = selective serotonin reuptake inhibitors; TSH = thyroid stimulating hormone.

Development of a brief self-report measure of the type a (coronary prone) behavior pattern

This study reports the development of a brief self-report measure of the Type A behavior pattern based upon a set of adjectives derived from the Gough Adjective Checklist (ACL). Previous work from our laboratory established a set of adjectives identified by experts as being relevant to the Type A construct that subsequently was found to successfully distinguish Type A individuals from their Type B counterparts. In the present study, a Type A self-rating scale based on these adjectives was found to be significantly related to an established Type A self-report instrument, the Jenkins Activity Survey (JAS), and to an independent behavioral rating based upon a standard structured interview (SI). However, no measure of Type A was related to the severity of coronary artery disease (CAD) as documented by coronary angiography. The advantages and disadvantages of the various Type A measures are discussed in the context of their ability to identify individuals at risk for the development of CAD.

Erectile Dysfunction in Early, Middle, and Late Adulthood: Symptom Patterns and Psychosocial Correlates

The prevalence of erectile dysfunction (ED) increases with age. However, it may emerge at any time during the adult years, and may bear a close relationship to ongoing psychosocial issues affecting the patient and his partner. The present study examined ED symptomatology and its associated psychosocial context in 560 men aged 19-87 attending a urology clinic for erectile difficulties. We divided participants into three age groups: early adulthood (age 19-39); middle adulthood (40-59); and late adulthood (60+). They completed a self-report assessment battery evaluating medical, psychological, and lifestyle factors empirically or theoretically related to ED. Results showed that although younger men reported more positive overall ratings of their sex life and better overall erectile functioning relative to older men, they also reported comparatively less relationship satisfaction, greater depressive symptomatology, more negative reactions from partners, and less job satisfaction. Results suggest that older men experience less difficulty than younger men adjusting to life with ED.

Self-ratings of type A (coronary prone) adults: do type A's know they are type A's?

&NA; This study compared self‐ratings and interview‐band ratings of the type A coronary‐prone behavior pattern. A Type A adjective scale was developed from the Gough‐Adjective Checklist (ACL), using adjectives rated as characteristic and uncharacteristic of the Type A individual by a panel of 20 Type A researchers. Scores on this scale were compared with Type A ratings based on the structural interview. Results from a sample of 378 employed males indicate a significant linear relationship between self‐ratings of Type A characteristics and interview‐based Type A classification. Subsequent item analysis identified a subset of adjectives which were endorsed differentially by Type A and Type B individuals, and a subset of descriptors which were not differentially endorsed by the two groups. Implications of these findings for assessment and intervention approaches to coronary‐prone behavior are discussed.

How often do adults recall their dreams

The question of age changes in frequency of dream recall was addressed in a questionnaire survey of 295 college-educated men and women aged seventeen to seventy. Dream recall was found to be maximal for men and women alike during the college years, with a subsequent decline to a much lower level in the forties and beyond. The drop in recall frequency is paralleled by a declining interest in, and valuation of, dreaming among middle-aged and older adults.

Religion and Coping with Sexual Impotence in Later Life

ABSTRACT Eighty-three elderly men with sexual impotence attending a university-affiliated urology clinic underwent psychological evaluations. Religious conservatives and frequent church attenders showed a greater prevalence of help-seeking behaviors; they were also more likely to perceive their partners as supportive of their attempts to get help for impotence problems. There was no evidence that either religious affiliation or activity buffered against the psycho-logical stresses conferred by sexual dysfunction. Moreover, religious conservatives and frequent attenders were more restricted in the range of sexual behaviors they used to facilitate arousal and maximize partner satisfaction. These Findings may help guide clinicians and counselors called on to address male sexual dysfunction among the religious elderly.