Exercise as it relates to Disease/Dance as a means to reduce Depression

=What is Depression?= Depression, or major depressive disorder is one of the most prevalent mood disorders to affect people, with a high proportion of people experiencing this at some stage throughout their life. The aetiology of this disease is complex and it has numerous causes and triggers, including genetic predisposition, cognitive factors (such as a pessimistic outlook) and environmental stimuli (stress) and is often the result of an imbalance of neurotransmitters (notably norepinephrine and seratonin) in the central nervous system. Women are more at risk of major depressive disorder, than men, with the rate of depression in women being 2 to 3 times that in men. The risk for young women is higher at an earlier age and is far greater than the risk for young males. Numerous studies suggest that dance movement therapy, or participation in ballroom (recreational) dance classes may assist in alleviation of the symptoms of depression, and after only short treatment durations of three months.

Symptoms
Whilst it is normal for people to experience ups and downs in mental state, persistence in reduced mood, feelings of sadness, and a loss of enthusiasm for activities that would typically be enjoyable indicate cause for concern. Other symptoms that may indicate depression include feelings of worthlessness, despair and guilt, fluctuations in weight, alterations in sleeping patterns, concentration issues, anxiety, irritability and muscle weakness.

Diagnosis
The diagnosis of depression is made following a thorough clinical interview, in conjunction with a mental status examination, according to criteria in the DSM-IV. This disease is often diagnosed in conjunction with other mental illnesses and other comorbidities, including anxiety and substance abuse disorders. The elderly and also adolescents are at the highest risk of developing depression, although those people living in lower socioeconomic areas are frequently diagnosed with depression.

=Conventional Treatment= Conventionally, the treatment for depression involves treating the symptoms. There are a number of different methods used to treat this disease.


 * 1) 	 Pharmacotherapy – antidepressants and other drugs may be used in an attempt to restore the balance between different chemicals (neurotransmitters) in the brain. These are difficult to prescribe, as each individual may require different drug levels, and they may cause side effects or only partial relief from symptoms, which greatly impact patient adherence to the drugs. Many antidepressant pharmaceuticals are also quite expensive, and therefore adherence to courses of medication among those in lower socio economical areas is often quite low.
 * 2) 	 Psychotherapy – including counselling, cognitive-behavioural therapy and family therapy is commonly prescribed to treat depression. These treatments involve redirecting depressive thoughts, or altering behaviour to reduce the symptoms of depression. This type of therapy is often prescribed in conjunction with pharmacotherapies. Like many pharmacotherapy drugs, psychotherapies often provide incomplete relief from depression symptoms, so many patients stop participating in psychotherapies after only about three weeks. Similarly, the cost associated with psychotherapy may affect patient’s utilisation of these sorts of treatments.
 * 3) 	 Exercise – This is an alternatively prescribed treatment for depression, with a growing evidence base, particularly in patients who are overweight or obese. In addition to symptom-reducing effects, exercise, as a treatment for depression shows an excellent rate of adherence, therefore increasing the benefits from prescribed exercise regimes. However, once the course of prescribed exercise is over, the patients often stop exercising again. Exercise has also been seen to be particularly successful when it is used in conjunction with conventional treatments. Dance movement therapies can be seen as a specialised branch of exercise interventions.

=Dance as Exercise= Dance as exercise can be described as a set of rhythmical movements, performed according to temporal, as well as spatial parameters. There is a distinct relationship between the psychological and physiological responses to moving to music, and these work to alter mood, leading to increased mental health as well as the physical health benefits, as similar to exercise. Indeed, the use of dance as a form of exercise is important, not only to increase aerobic power, muscle endurance, strength, flexibility and improve gait, but also as a means to decrease stress and anxiety, by improving self-esteem, mind-body coordination and overall psychological health. It is also useful as a means of treatment as it requires minimal expense and equipment and also may seem less threatening to non-active or elderly individuals, than conventional forms of exercise.

Dance Movement Therapy
Dance/movement therapy is slightly different to recreational dance in that it is run by a trained dance/movement therapist, rather than a dance teacher. It incorporates the emotional expression and creativity that comes with dance as an art form, and the physical fitness and health benefits of conventional exercise, with the methods and understandings of psychotherapy. This means that dance/movement therapy can be altered easily to suit each patient or group’s individual needs, and it is this adaptability that makes this type of therapy ideal for treating mental illness patients. This may make it less adaptable to other spaces than recreational dance, but participants receive greater benefits, as far as improvements to mental health go, as classes are structured to target specific effects from the course of dance/movement therapy.

=Dance as a means to reduce Depression= It has been shown that dance can cause significant changes in plasma serotonin and dopamine concentrations and decrease the severity and symptoms of depression. The psychological effects of a dance intervention may be greater than those in normal exercise programs, due to the use of music. Dance movement therapy is useful, as it appeals greatly to females, particularly young females, who are at high risk of developing depression, but may not be interested in participation in conventional forms of exercise. It seems that reductions in depression symptoms can be seen after only a period of a three month dance/movement therapy intervention. However, in the current studies, it is not shown if these decreased symptoms are permanent or not, as no follow up is ever made.

=Recommendations= A minimum of 2-3 dance/movement therapy sessions per week for a period of three months has been shown to reduce the symptoms of depression, especially in adolescents. However, the need for further participation in dance/movement interventions, following the initial three month set of sessions, is unclear. Given the health benefits, which are similar to those that occur with regular exercise, it can be inferred that further involvement in dance/movement interventions or recreational dance may increase the benefits and improve the longevity of relief from depression symptoms. Dance/movement interventions, show greater reduction of depression symptoms than recreational dance, although ballroom dancing does provide numerous benefits to depression and other mental illness patients.

=Further Information=
 * WHO - Depression
 * Exercise and Depression
 * Dance Movement Therapy Association of Australia

=References=