Eight Lifestyle Interventions for Major Depression

We know that lifestyle changes are critical to ensuring long-term health and well-being, which positively impact mental and physical health and the synergy between them when included in a comprehensive, personalized treatment plan. It can be hard to separate the signal from the noise when it comes to focusing time and energy on lifestyle-based changes, given the explosion of changeable-reliable information on the web.

Assessing the Evidence for Lifestyle Investments

Researchers Marx et al., in The World Journal of Biological Psychiatry (2023), compiled the relevant literature on lifestyle and MDD. They reviewed thousands of articles and graded the evidence into strong (“should”), limited (“may be”), low (“may”) and no evidence. Eight main lifestyle factors were identified as associated with potential MDD relief. Notably, none had a “strong” evidence-base for what makes “limited” best-in-class.

Source: Marx et al., 2023, Open Access

1. Physical Activity and Exercise Interventions (Limited)

Depression is associated with reduced levels of activity, and may benefit from increased movement and exercise. The mechanisms are unclear, but likely include increasing BDNF (brain-derived neurotrophic factor), increasing neural plasticity, decreased stress/resilience; reduced inflammation, stimulating different areas of the brain; and improved psychosocial factors (see below).

Marx et al., 2023, Open Access

Source: Marx et al., 2023, Open Access

2. Smoking Cessation Intervention (LOW)

Smoking reduces the risk of many health problems, especially cardiovascular and pulmonary health, diabetes and early death, clearly self-destructive. While studies suggest that reducing or stopping smoking can relieve depressive symptoms, limited evidence suggests that smoking cessation definitely improves MDD. Stopping smoking now will secure better future overall health.

Marx et al., 2023, Open Access

Source: Marx et al., 2023, Open Access

3. Task-Directed Intervention (Limited)

Counseling through the workplace and other interventions (wellness programs, resilience training, etc.) can bring relief to people with clinical depression. Work-related psychosocial programs and burnout-prevention may contribute to reducing or preventing depression. Such interventions can improve work performance, increase productivity, and reduce missed days. Reducing mental health stigma, creating effective action-based programs, and removing barriers to mental health care are among best practices.

Marx et al., 2023, Open Access

Source: Marx et al., 2023, Open Access

4. Mindfulness-Based and Stress Management Interventions (Limited)

Approaches including mindfulness-based cognitive behavioral therapy (MB-CBT) and mindfulness-based stress reduction (MBSR) may be helpful. Stress management and relaxation techniques, including breathing exercises and progressive muscle relaxation, can also reduce depressive symptoms when used properly.1,

Marx et al., 2023, Open Access

Source: Marx et al., 2023, Open Access

5. Dietary Intervention (Low)

Surprisingly, given the amount of media buzz and innocuous appeal, the evidence for dietary changes preventing or alleviating clinical depression is of low quality. There is more evidence, as with smoking cessation, that diet and nutrition affect physical health, which can be expected to indirectly improve mental health (eg increased sense of self-efficacy, increased exercise enable etc.). Lack of the right nutrients can lead to depression-like symptoms, and dietary modification may contribute to reducing inflammation and stress-reactions, improving brain health, possibly reducing depression.2,

Marx et al., 2023, Open Access

Source: Marx et al., 2023, Open Access

6. Sleep Interference (Limited)

There is a relatively strong association with improving sleep and reducing or preventing clinical depression. Insomnia is a core symptom of depression, and poor sleep worsens baseline mood and irritability. Lack of sleep also impairs cognitive function. These factors in turn cause problems in personal and professional functioning, creating a vicious cycle. Interventions that improve sleep, such as CBT-I (cognitive behavioral therapy for insomnia), are associated with improved depression. Treating depression also improves sleep quality. Depression and insomnia feed off each other.

Marx et al., 2023, Open Access

Source: Marx et al., 2023, Open Access

7. Loneliness and Social Support Interventions (Low)

Depression includes social withdrawal and low self-esteem as core symptoms, which affect the ability to secure social support. Similarly loss of social support and loneliness can precipitate depression and have been associated with negative effects on physical well-being. Perceived social support is also a key factor for resilience. Yet, research has not conclusively looked at whether interventions targeting social support and loneliness are effective in those with clinical depression.

depression essential reads

Marks et al., 2023, Open Access

Source: Marx et al., 2023, Open Access

8. Green Zone Intervention (Low)

The evidence for green space interventions such as naturopathy, gardening or spending time in green urban spaces does not show a sufficient causal relationship. The study did not detail whether the type of green space mattered, and whether factors such as pollution and noise in urban locations could offset the benefits. Furthermore, with a strong evidence base, increased physical activity and exercise is an important factor in green space interventions. Structured green space interventions often garner social support, making it difficult to tease apart individual effects.

making effective lifestyle choices

At the end of the day, given the lack of strong evidence for any of the above interventions, individualized lifestyle programming is needed, along with appropriate treatment and clinical judgment, to determine what is right for an individual. what would be most effective. Do what feels good and is healthy to you, and consult with the appropriate professionals as needed.

Given the state of the art, an open, experimental approach is likely to yield the best results, with trials of different interventions designed to find out which works best for a given individual at a given time. what works It is advisable to focus on interventions with a strong foundation, and follow recommendations based on available evidence: physical activity and exercise, work-related interventions, mindfulness-based and stress management, and sleep-related interventions. Best available evidence.

The study authors provide guidelines:

  • The delivery of lifestyle-based mental health care is suggested to be consistent with our proposed conceptual framework
  • Explore personal factors (such as financial, geographic, medical, and social considerations) when initiating behavior change to promote rapidity and sustainability
  • Explore the individual’s capacity, opportunity, and motivation to initiate and maintain behavior change
  • Encourage the individual to seek formal programs relevant to lifestyle interventions that provide supervision and structured activity.
  • Encourage the individual to involve social components (such as clubs, community groups, friends and/or family) in the intervention.
  • Clinicians are encouraged to engage with relevant allied health professionals and specialists where warranted
  • Consider integration of digital and online tools for lifestyle interventions to aid in adherence and self-management

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