From the Guidelines
Non-pharmacological management options for depression, anxiety, and stress should prioritize cognitive behavioral therapy (CBT), mindfulness meditation, and regular physical exercise, as these approaches have been shown to provide benefits comparable to medication for mild to moderate symptoms. According to the most recent and highest quality study 1, nonpharmacologic treatments, including psychological interventions, complementary and alternative medicine (CAM) options, exercise, and yoga, have similar benefits to second-generation antidepressants as first-step treatments for acute major depressive disorder (MDD).
Some key non-pharmacological management options include:
- Regular physical exercise, such as 30 minutes of moderate activity like walking, jogging, or swimming at least 3-5 times weekly, which releases endorphins and improves mood
- Cognitive Behavioral Therapy (CBT), which helps identify and change negative thought patterns through 12-16 weekly sessions with a trained therapist
- Mindfulness meditation, practiced for 10-20 minutes daily, which reduces stress by focusing attention on the present moment
- Establishing consistent sleep hygiene with 7-9 hours of sleep nightly, which regulates mood
- Social connection through regular interaction with supportive friends and family, which counteracts isolation that worsens mental health symptoms
- Proper nutrition emphasizing whole foods, fruits, vegetables, lean proteins, and omega-3 fatty acids, which supports brain health
- Stress management techniques like deep breathing, which can be practiced multiple times daily
- Environmental enrichment, which has been proposed as a non-pharmacological tool to ameliorate several aspects of health, including anxiety, depression, and pain 1.
These approaches work by addressing the biological, psychological, and social factors that contribute to mental health conditions. The certainty of evidence for most comparisons is low, and findings should be interpreted cautiously 1. However, clinicians and patients should focus on options with the most reliable evidence and take adverse event profiles and patient preferences into consideration.
From the Research
Non-Pharmacological Management Options
The following non-pharmacological management options are available for depression, anxiety, and stress:
- Cognitive Behavioral Therapy (CBT) [(2,3,4,5)]
- Mindfulness-Based Interventions (MBIs) [(3,6)]
- Exercise [(2,5)]
- Psychoeducation [(2,5)]
- Problem Solving Therapy 5
- Guided Self-Help 5
- Behavioral Activation Treatments 5
- Marital/Couples/Family Therapy and Counseling 5
- Inclusion of Family Members 5
- Participative Decision-Making 5
- Development of the Therapeutic Alliance 5
- Cognitive Behavioral Analysis System for Psychotherapy 5
- Computerized Cognitive Behavior Therapy 5
- Electroconvulsive Therapy 5
- Phototherapy 5
- Sleep Deprivation 5
- Repetitive Trans-Cranial Magnetic Stimulation (rTMS) 5
- Acupuncture 5
- Zen Meditation 6
- Mindfulness-Based Stress Reduction (MBSR) 6
- Mindfulness-Based Cognitive Therapy (MBCT) [(3,6)]
Specific Recommendations
- The American College of Physicians (ACP) recommends monotherapy with either CBT or a second-generation antidepressant as initial treatment in patients in the acute phase of moderate to severe major depressive disorder 4
- ACP suggests combination therapy with CBT and a second-generation antidepressant as initial treatment in patients in the acute phase of moderate to severe major depressive disorder 4
- ACP suggests monotherapy with CBT as initial treatment in patients in the acute phase of mild major depressive disorder 4
- MBCT is strongly recommended as an adjunctive treatment for unipolar depression 6
- MBSR and MBCT have broad-spectrum antidepressant and antianxiety effects and decrease general psychological distress 6