Three Longs & Three Shorts

Running From the Pain

This is an interesting case study about how the financial incentives that doctors across the world face has a major impact on the treatments they prescribe to their patients. “In clinical studies, regular aerobic exercise is as effective as antidepressants in reducing symptoms of mild to moderate depression. And that’s not just because moving might help you get into shape and feel better about yourself. Exercise actually causes the same structural changes to the brain as antidepressants—neuroplasticity, or creating new neural pathways, and growth in the hippocampus, a part of the brain that’s generally shrunken in people with depression.” Inspite of this, none of our friends in India who have sought medical help for depression have been prescribed; almost everybody in India seems to be prescribed antidepressants. This article says that the situation is similar in the US. And yet in other countries, running is prescribed as a line a treatment for depression.
“Guidelines in countries such as the United Kingdom, the Netherlands, and Canada present exercise as a first-line treatment. Canada, for example, recommends exercise as an initial stand-alone treatment for mild to moderate depression and a second-line, or next-round, treatment in conjunction with other treatments for more severe cases. Guidelines in Australia and New Zealand view exercise even more favorably. Psychiatrists there consider exercise a “step-zero” treatment. A sedentary depressed patient in Sydney or Auckland will first be encouraged to start working out, on the grounds that lack of exercise could explain the depression. Only if regular exercise proves to be insufficient will medication and psychotherapy be recommended.”
So why this difference? “Money” could the one word answer. “The U.S. health care system famously incentivizes procedures and pills over a holistic approach. That might be especially true with antidepressants, which the National Institute of Mental Health concedes are increasingly prescribed for “off-label” uses, meaning conditions like insomnia, pain, eating disorders, and migraines, rather than depression. This tendency to prescribe, and specifically to prescribe antidepressants, contributes to the aura of “they might help, and they probably won’t hurt,” despite warranted debate over their effectiveness for depression….
In contrast, single-payer systems incentivize low-cost options first. So official treatment guidelines in, say, Canada or Holland have more reason to take into account the exercise-as-antidepressant evidence…”