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    The researchers speculated that people who attributed their improved mental health to their own personal efforts may have felt more empowered -- and thus were less likely to relapse into depression than people who may have attributed their improvement to taking a pill.

    Now Duke is undertaking a new study to further examine the issue. For instance, how much of the exercise-only group's benefit had to do with the "social support" of getting together with other people to exercise? The new study will include subjects who exercise at home, as well as others who exercise in group settings.

    The Duke researchers also want to focus on a recently identified phenomenon called "vascular depression." They think damage to the vessels that supply blood to the brain may be to blame in up to one third of depression cases. Where depression is caused by such basic plumbing problems, pharmaceutical solutions may turn out to be less effective than exercises that help counteract cardiovascular disease, they believe.

    Depression in older adults is of special concern because it can be mistaken for dementia or other age-related ailments rather than as a potentially treatable illness. And while it is not clear that old age alone increases the risk of depression, the physical ailments that afflict many people as they grow older can cause such a reaction. So can some of their medications.

    Beth Ellis, 69, thinks the camaraderie of exercising at her local YMCA is part of what works for her. "There's something about exercising in a group that's also uplifting," she says. "It's sort of a community feeling."

    What's more, she says, "My experience is that exercise is the most potent antidepressant you can imagine. I've been on Prozac from time to time during really bad periods, and it got me through." But each time she's on it, she eventually wants to stop her medication, and "exercise is one of the things that lets me handle it myself."

    Exercising is no simple matter for Ellis. She has Charcot-Marie-Tooth disease, an incurable neurological disease that degrades sensation and motor control in the hands, feet, and limbs, leading to weakening of muscles through disuse. Ellis once was an avid runner, but as her disease progressed, running became impossible.

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