By Joe Tatta, PT, DPT

Depression is not just a state of mind; it is a pervasive health issue that impacts millions, affecting their emotions, physical health, and overall quality of life. With nearly two out of five adults in the United States reporting symptoms of depression, the urgency for effective interventions is greater than ever, particularly in the wake of the COVID-19 pandemic which has exacerbated poor mental health across various demographics. As the country’s population ages, the prevalence of depression, particularly among older adults, is expected to rise, presenting challenges in physical function and daily activities.

Despite the growing need, there exists a stark gap in accessing comprehensive care for depression, exacerbated by a national shortage of mental health providers and often prohibitive costs. In response, the Biden administration in 2022 outlined a transformative strategy focused on understanding, accessing, and treating mental health in America, aiming to broaden the scope of accessible treatments beyond traditional psychotherapy and pharmacotherapy. This is needed as evidence suggests that 40-60% of those with depression fail to reach remission and are left with persistent symptoms and/or disability. Physical therapists have a role in behavioral and mental health. 

Exercise as a First-Line Treatment 

Emerging from this comprehensive approach is the recognition of exercise as a potent, first-line treatment for depression. A landmark systematic review in the 2023 British Journal of Sports Medicine synthesized data from 97 systematic reviews involving over 128,000 participants, which demonstrated that exercise significantly reduces symptoms of mild to moderate depression. This evidence positions exercise not just as a supplementary treatment but as a core component of depression management, highlighting its non-inferiority to established first-line treatments.

Physical therapists, with their expert knowledge in exercise therapy, are uniquely positioned to take a frontline role and close the gap in depression care. As highly trained healthcare professionals, physical therapists have a profound understanding of the interplay between physical activity and mental health. They are adept at designing personalized exercise programs that not only alleviate the physical symptoms associated with poor mental health, such as pain and muscle tension but also boost mental health through the enhancement of neuroplasticity and overall brain function. A PTs scope of practice in mental health is ideally positioned for this type of care. 

Empowering Physical Therapists to Revolutionize Depression Care

The integration of physical therapy into depression care offers multiple advantages. Firstly, exercise as a treatment modality is free from the stigma typically associated with conventional mental health treatments. Moreover, physical therapy provides tangible, side-effect-free benefits that often surpass those offered by standard pharmacological treatments. Despite these advantages, current healthcare policies, including those from Medicare and private insurers, often do not recognize physical therapy as a reimbursable treatment for many mental health conditions, limiting its accessibility despite the clear benefits.

Physical therapists are not just exercise facilitators; they are equipped to serve as primary care providers, especially within the framework of the U.S. military and private healthcare sectors where they have demonstrated considerable success. Enabling PTs to function at the top of their scope of practice in primary care could revolutionize depression treatment by streamlining the diagnostic process, enhancing prognosis, and improving outcomes through a biopsychosocial approach that addresses the complex interplay of biological, psychological, and social factors involved in depression.

Moreover, physical therapists are positioned to deliver integrative care that goes beyond mere symptom management. Through therapeutic exercises and interventions that foster self-efficacy, emotion regulation, and cognitive reappraisal, physical therapists can facilitate sustainable behavioral changes that are essential for the long-term management of many mental health conditions. These interventions can be particularly empowering for vulnerable populations including children, people of color, those with disabilities, LGBTQ+ individuals, and veterans, who may face greater barriers to accessing effective mental health care.

Using Physical Therapists to Close the Gap in Depression Care

To bridge the gap in depression care, it is imperative to recognize the role of the physical therapist in behavioral and mental health. Exercise prescription and counseling on physical activity is first-line evidence for depression. This requires a cultural shift in how we perceive and approach mental health treatment, recognizing the integral role of physical therapists in the mental health care continuum. Advocating for policy changes that allow for the reimbursement of physical therapy services for mental health treatment is crucial.

This call to action is not just for healthcare providers but also for patients, caregivers, payers, and policymakers to reconsider and reshape the landscape of mental health care. By embracing physical therapy as a foundational aspect of depression treatment, we can improve access to care, reduce healthcare costs, and most importantly, enhance the quality of life for millions of Americans struggling with depression.

Physical therapy offers a promising pathway to address the mental health crisis in America effectively. By expanding the role of PTs in mental health care, we can ensure that more individuals have access to the comprehensive, compassionate, and cost-effective care they deserve. Let us harness the power of physical therapy to transform mental health care and foster a healthier, more resilient society.