Lifestyle changes may be as effective as therapy at easing depression

Lifestyle changes may be at least as effective at easing symptoms of depression as cognitive behavioural therapy (CBT). CBT, which involves working with a therapist to change how a person thinks or acts, is often the go-to therapy for depression. But an eight-week course consisting of advice about diet, exercise and sleep was as effective as CBT, even among people with severe depression and bipolar disorder. “Each positive change begets another, so [this approach] may be helping people build a healthier platform for their lives, rather than just treating individual symptoms,” says Patricia Dixon at Manatee Associates of Counseling & Assessment LLC, a private practice in Palmetto, Florida, who wasn’t involved in the research. About 1 in 20 adults worldwide have depression. Therapy can be effective, but a 2021 review of the evidence found that more than half of people don’t respond to it. Lifestyle interventions, such as exercise, have shown promise for relieving depression, but most previous trials haven’t compared them against established therapies. Advertisement To address this, Adrienne O’Neil at Deakin University in Australia and her colleagues studied 267 adults with depression or bipolar disorder who had moderate-to-severe symptoms. The participants received either CBT or lifestyle advice, both delivered remotely over eight weeks. The advice, given by accredited dietitians and exercise physiologists, included information on mindful eating, finding enjoyable forms of exercise, managing alcohol intake and getting good-quality sleep. At the end of the eight weeks, a scientist who wasn’t involved in the trial rated the participants’ depression on a standard 60-point scale. It was decided in advance that if the lifestyle advice reduced depression within 1.6 points of that achieved by CBT, the two approaches would be deemed comparably effective. A reduction of 1.6 points is the generally accepted cut-off for detecting a minimal clinically important difference in individuals with mental health conditions, according to the researchers. On average, the lifestyle intervention led to an 8.55-point decrease, 1.73 points more than the 6.82-point decrease in the CBT group. These were the average results, so the researchers can’t be sure that lifestyle advice is routinely superior to CBT, but they do seem to have established non-inferiority, says O’Neil. The effects on self-reported depression were maintained at 16- and 24-week follow-up periods. Targeting someone’s lifestyle probably reduces their risk of depression through multiple mechanisms, says Ashwini Nadkarni at Harvard Medical School. “Changes in one’s lifestyle can impact depression through several pathways, including inflammation, stress and neuroplasticity, which is the reorganisation of structure, function and connections in the brain,” she says. “Such pathways also include metabolism of feel-good chemicals or neurotransmitters, along with the relationship between the brain, gut and all of the microorganisms that live in the gut and make up the intestinal microbiome.” O’Neil hopes to see lifestyle advice included in depression-treatment decisions. “Accredited practicing dietitians and exercise physiologists are well placed to assist in the provision of mental healthcare,” she says. This advice could also be given alongside other approaches, such as CBT and antidepressants. Ahead of further research, Dixon stresses that people undergoing CBT shouldn’t discontinue it without consulting their doctor. She also notes that depression can be related to life circumstances, such as bereavement, where lifestyle interventions may be less helpful. The researchers are now adapting the programme to test its effects in children with anxiety and veterans with mental health conditions, says O’Neil. They are also looking into its cost-effectiveness, she says.