You can boost the ben­efits of psychotherapy and antidepressant medications—and perhaps even help prevent depression in the first place—with some simple lifestyle changes. Start by getting up off the couch and increasing your activity level. Several studies have shown that exercise can help alleviate depression and improve mood. Cardiovascular (aerobic) exercise, in particular, has been shown helpful for depression.

Researchers speculate that exercise helps by stimulating brain chemicals such as serotonin and norepinephrine. Strenuous aerobic exercise also stimulates the release of “feel-good” chemicals called endorphins, which reduce pain and may create a feeling of euphoria. In addition, it may provide a sense of control and accomplishment, serve as a distraction from anxieties, and possibly lead to increased social contacts.

Two reviews of the evidence published in 2013 back up the antidepressant effects of exercise. An analysis by the independent Cochrane Collaboration, based on 35 stud­ies, concluded that exercise is moderately effective for reducing depressive symptoms, often as useful as medication or psycho­logical therapy. The second review, in the American Journal of Preventive Medicine, included 25 studies and found that people who exercise regularly, even at low levels (such as walking or gardening), are less likely to develop depression.

Subsequently, a 2014 British study published in JAMA Psychiatry followed 11,135 people (initially in their early twen­ties) for more than 25 years and found that the more physically active they were, the less likely they were to have symptoms of depression. Sedentary people who started exercising three times a week, for instance, reduced their risk of depression five years later by almost 20 percent. Of course, the relationship between depression and phys­ical activity goes two ways, since depressed people are less likely to exercise.

“Our find­ings emphasize the potential importance of activity to prevent and alleviate depres­sive symptoms in adulthood,” the research­ers said, while acknowledging that “depressive symptoms before midlife could be a barrier to activity.”

Diet and depression

Foods can improve mood in some people, but can diet really affect depression? On the positive side, chocolate does seem to have a beneficial effect on mood, especially for women—but don’t overdo the choco­late and its calories. Caffeine also improves mood in some people. Some evidence sug­gests that tryptophan in the diet—from foods such as turkey or oatmeal—may increase levels of serotonin in the brain.

On the other hand, a diet high in junk food is associated with depression—and obesity—though it’s hard to know which comes first. When people are depressed, they often spend more time sitting in front of the TV and eating fatty, salty, sugary foods, instead of getting out to exercise and improving their diet. Several observational studies over the years have suggested that diet can indeed influ­ence the risk for depression, independent of education, socioeconomic status, and other potential confounding factors.

In 2017, the first controlled clinical trial on the link between diet quality and depression gave stronger support to this connection. Dubbed SMILES (Support­ing the Modification of Lifestyle In Low­ered Emotional States) and published in BMC Medicine, this Australian study enrolled people who had moderate to severe depression and poor diets at the start and randomized them into two groups:

• A diet group received ongoing person­alized nutrition counseling on how to follow a modified Mediterranean diet. Participants were encouraged to eat whole grains, vege­tables, fruits, legumes, low-fat and unsweet­ened dairy foods, nuts, fish, lean meats, and olive oil; reduce refined grains, sweets, fried or fast foods, processed meats, and sugary drinks; and consume moderate alcohol.
• A social support (control) group dis­cussed neutral topics such as sports and music with a trained “befriender” or engaged in board games and other activities, over the same time frame.

After 12 weeks, the diet group had a greater reduction in depression and anxiety symptoms than the social sup­port group, even with variables such as weight loss taken into account. Moreover, more participants in the diet group (32 percent versus 8 percent) achieved depres­sion remission. These encouraging find­ings—which come out of the new field of nutritional psychiatry—provide prelimi­nary evidence for dietary improvements as an “efficacious treatment strategy” for depression, the authors concluded.

Diet may influence depressive illness by affecting inflammatory and oxidative stress pathways, brain plasticity, and possibly the gut microbiota, according to the authors. “Moreover, behavioral changes associated with food (cooking/shopping/meal pat­terns) are an expected outcome of a nutri­tion intervention, and these changes in activity may also have a therapeutic bene­fit,” they wrote. As a bonus, improving diet may improve physical illnesses that often occur with depression.

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