Lifestyle Interventions for Depression
Treatments for depression or anxiety, also called “interventions”, fall into one of three categories, and often several are recommended to be taken up at once. These main groupings are: Medical interventions; Psychological interventions; and Lifestyle interventions. In this post we overview a range of lifestyle interventions therapists can suggest when treating depression.
What is it? When a mental health professional directs clients to use books or other written material to help heal the depression, it is a form of self-help called bibliotherapy. By reading through the information and doing the homework exercises, clients are basically doing a form of CBT on themselves.
How effective is it? Of the many studies investigating the effectiveness of bibliotherapy (all of which had clients doing it with mental health professionals, as opposed to alone), pooled data from all studies showed that bibliotherapy reduced depression much more than no treatment. Some of the studies have suggested that bibliotherapy is as helpful as therapy from a professional.
What are the risks? None are known, but bibliotherapy may not be effective for those who do not read well, or who lack concentration (one of the symptoms of depression).
Advice in a line: Bibliotherapy can be helpful for depression if conducted with a professional.
What are they? Similar to bibliotherapy, computer or internet interventions using websites with information on depression or Computerised Cognitive Behavioural Therapy (CCBT) can deliver structured lessons/information to combat depression. Some of these are available only through a health professional, but some are freely available on the internet.
Site addresses for some of these, such as MoodGYM, can be found in Section Five. These programs work well when delivered by/with a professional; the structured nature of them suits computers and computer users.
How effective are they? Several studies of CCBT for depression found some benefit when clients used them without a professional, and more benefit when a professional was involved.
What are the risks? None are known.
Advice in a line: Computer or internet interventions appear to be helpful for depression, especially when a professional is involved.
What is it? There are three types of exercise: Aerobic, which exercises the heart and lungs, such as jogging; anaerobic, which strengthens the muscles, such as weight training; and stretching, which improves flexibility and suppleness, such as yoga.
How exercise works to reduce depression is not clear, but some experts have suggested that it may improve sleep patterns, change levels of brain chemicals involved with depressive reactions (such as serotonin or endorphins), increase perceived coping ability, and interrupt negative thoughts that worsen depression. Exercise done with others may improve mood through the socialising function.
How effective is it? Exercise was found to be moderately helpful in 25 studies combining results investigating the effects on adults of exercising; it was compared with no treatment or socialising as a treatment.
Mostly, the studies used jogging or walking as the exercise, but more work needs to be done to assess which forms of exercise — and for how long — are best to combat depression. Results of the few studies researching the effects of exercise on children showed no benefit.
What are the risks? Injury, if one is not careful. If the person stops exercising, the benefits cease, too.
Advice in a line: As there is good evidence that exercise works to fight depression in adults, but not good information on what form of exercise is best, the depressed adult should find a form of exercise deemed enjoyable, and stick with it.
What is it? This intervention involves the exposure of the person’s eyes to bright light for a length of time, often in the morning. The person sits in front of a box or lamp (often purchased over the internet) which emits the light. Depending on the device, different parts of the light spectrum and different intensities are used.
It originated to treat Seasonal Affective Disorder (SAD), and is said to work by adjusting rhythms in the body thrown off by insufficient sunlight in the winter months. It is not clear how this therapy might work in depression not caused by seasonal changes.
How effective is it? Many studies have shown that this therapy is effective for SAD, so the Beyond Blue guide rates it as a “three thumbs up” therapy for that type of depression. It has also been shown to have some helpful effect for other sorts of depression when used in combination with antidepressants, so it gets a “one thumbs up” rating for that situation. Researchers are unsure whether it works for non-seasonal depression on its own, and this seems also true when applying the intervention to depressed adolescents.
What are the risks? There can be mild side effects such as nausea, headache, jumpiness, and eye irritation. Care must be taken not to use incandescent lights due to the risk of eye damage.
Advice in a line: Light therapy’s best use is for SAD, where it is the most effective treatment, and it may also be helpful for depression when used with antidepressants.
Activity scheduling (also called “pleasant activities”)
What is it? With this therapy, the depressed person works with a professional to schedule in activities that are deemed to be enjoyable, or which engender a sense of achievement. Depressed people tend to engage in fewer activities than non-depressed people, and they also tend to enjoy what activities they do less than non-depressed people. Increasing the activity level tends to counter the isolation and withdrawal that depressed people often experience, and it gives the depressed person an opportunity to experience normal behaviour as rewarding.
How effective is it? The several studies done on this intervention were all done with professionals working with depressed people; most of the studies were small. While large-scale studies should be completed on this therapy, the pooled results of the ones done showed that, when working with a professional, activity scheduling produced results roughly equivalent to psychological therapies such as CBT. There is no evidence on whether this therapy works when a depressed person tries to engage it without the assistance of a professional.
What are the risks? None are known.
Advice in a line: When activity scheduling is conducted with a professional, it helps combat depression to increase pleasant or achievement-oriented activities.
What is it? SAMe (pronounced “sammy”) is a substance made in the body and involved in many biochemical reactions. SAMe seems to work by making cells better able to communicate with each other. It may also be involved in the production of chemical messengers in the brain that are thought to be affected in depression.
How effective is it? SAMe improved depression better than placebos in the results of 28 pooled studies. There was no difference in the effectiveness when SAMe was compared to antidepressants. Anecdotally, people on the internet writing about their experience seemed to be consistently positive about its effects in combating depression, although some said that it was important to get the dosage right (see below).
What are the risks? People with bi-polar disorder or those already taking prescription antidepressants should not take SAMe unless they are under the care of a health practitioner. Users writing on the internet about their experience of taking SAMe sometimes experienced nausea in dosages around 400 mg. Many of these said that that side effect abated after reducing to 200 mg per day. Some found that they could take even less (50 — 100 mg daily) to get the depression-lifting results.
Advice in a line: SAMe appears to work to alleviate depression in adults, but more studies need to be done to confirm what dosage levels are best, and to explore if this compound works for children and adolescents (Jorm et al, 2009).
Note: Content in this article was adapted from the general framework used in Beyond Blue’s Guide to what works for depression (Jorm et al, 2009).
- Jorm, A.F., Allen, N.B., Morgan, A.J., Purcell, R. (2009). A guide to what works for depression. Beyond Blue, Ltd: Melbourne.