woman running up stairs

Illustration: Masa

For years, experts have taken a one-size-fits-all approach to treating depression, leaving a significant number of patients unsatisfied and still unwell. But researchers now recognize that there are likely many variations of the illness, and each might respond best to a particular treatment. This shift has led to alternatives to the standard protocol—some of which can be tried today, no prescription required.

Heartening Moves
Runner's high is not a myth. In fact, a meta-analysis involving more than a million subjects has shown that aerobic exercise can help prevent depression. "Adopting and maintaining exercise habits at any age can mean a significantly decreased risk of depression in the future," says lead author Felipe Schuch, PhD.

One possible explanation is that exercise increases levels of brain-derived neurotrophic factor, a protein that helps nerve cells grow and survive, thereby producing antidepressant effects. But since working out activates most of the body's systems, it's likely fighting depression on multiple fronts, says Brandon Alderman, PhD, director of the Exercise Psychophysiology Lab at Rutgers University. His team found that aerobic exercise can reduce rumination; they also discovered that mildly to moderately depressed people experienced a nearly 40 percent decrease in symptoms when they ran for 30 minutes (and meditated for 30 minutes) twice weekly for eight weeks.

Photo: Chattrawutt/istock

Antidepressant Anti-Inflammatories
There's an intriguing connection between bodily inflammation and emotional deflation: Studies reveal that taking the anti-inflammatory celecoxib (Celebrex) can further alleviate symptoms for people on antidepressants. Other research suggests that consuming omega-3 fatty acids may decrease inflammation while improving mood.

Brain inflammation can be 30 percent higher in clinically depressed patients, according to a 2015 study, and even mild depression is linked to elevated levels of pro-inflammatory markers. K. Ranga Krishnan, MD, dean of Rush Medical College, notes that people with psoriasis, an inflammatory skin disease, often have depression—and when they're treated with anti-inflammatories, their mood typically improves along with their skin. Based on these and other findings, researchers hope to develop anti-inflammatory medication that targets depression.

Photo: elenaleonova/istock

Hope in a Hallucinogen
It's known as Special K on the street and as an anesthetic in hospitals. And for about half of the treatment-resistant depression patients who received an IV ketamine infusion in studies, it was a miracle drug that reduced symptoms by 50 percent (or more) within a couple of hours. One of the key things ketamine does is work on the neurotransmitter glutamate, used by about 90 percent of the brain's synapses, says Chadi Abdallah, MD, assistant professor of psychiatry at Yale School of Medicine. "The chronic stress of depression weakens those synapses; ketamine sends the message that they need to be strengthened," he says.

Ketamine clinics around the country offer this off-label treatment even though long-term consequences are unknown. Some patients experience side effects like temporary nausea or an out-of-body sensation, says Carlos Zarate Jr., MD, chief of the experimental therapeutics and pathophysiology branch at the National Institute of Mental Health. He's working to develop a ketamine drug that won't cause negative side effects and plans to begin testing it by next year.

Illustration: bulentgultek/istock

A Twinge of Relief
Approved by the FDA for mildly treatment-resistant depression in 2008, transcranial magnetic stimulation "delivers pure energy into the brain," says Stephan Taylor, MD, a professor of psychiatry at the University of Michigan. Magnetic coils are placed on one side of a patient's head to induce electrical currents that cause neurons to discharge. Therapy typically involves four to six weeks of 30- to 40-minute sessions administered five times a week in a doctor's office and can be as effective as taking antidepressants—with fewer side effects. Says Taylor, "The idea that we're able to ameliorate depression with a magnet is a pretty cool thing."

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