Do lifestyle interventions work in depression? Acta Psy Scand.June 2013.

20.05.2013

Treatment of depression is largely focused on Antidepressants and CBT. Diet, exercise, smoking, alcohol misuse, green space exposure, social networks, peer support, substance use, economic and employment environment etc play significant role in depression.These factors (lifestyle factors) are important enough to consider targeted interventions to treat depression.Berk M, Sarris J, Coulson CE and Jacka FN  from Melbourne University provide a clinical overview of  some of these factors.

Regular exercise is associated with less depression. Regular physical activity in childhood is associated with reduced risk of developing depression in adulthood.Twin studies suggest that genetic factors may influence both a tendency to exercise and a reduced risk of depression .Exercise elevate mood.This might be via neuro endocrine actions ( improved expression of serotonin, increased BDNF, reduced oxidative stress, increased endorphins ) , improved self image / improved body image/social engagement or  improved self efficacy.Cochrane review found  an effect size of 0.67 (95% CI: 0.90-0.43) in favour of exercise over standard treatment or control in depression.Longterm benefits are unknown.Krogh et al 2009 did not find benefit for exercise in depression.Yoga and Tai chi are found to be effective.

Green exercise ( physical activity in the presence of nature) is considered good for mood and self esteem. Meta analysis of 10 UK studies involving 1252 participants found that the overall effect size for green exercise in improving self-esteem was d = 0.46 (95% CI: 0.34, 0.59) and for mood d = 0.54 (95% CI: 0.38, 0.69). (Barton 2010).

Fish oils: A meta-analysis showed that there was a small beneficial effect of treatment with n-3 PUFA  compared with placebo, but that the benefit of supplementation was restricted to those with more severe clinical depression  (Appleton 2010)

Folate: Low folate and B12 are associated with risk of depression. Cochrane review suggested that folate may be useful as an adjunctive treatment for depression.

Zinc: Low dietary intake is associated with depression. Supplementation studies suggest benefit.

Diet:  Studies from various countries suggest that dietary patterns with higher take-away foods, red meat , sweets/high calorie foods are associated with higher depression risk.Therapeutic impact of dietary changes is yet to be convincingly shown.

Smoking: Smoking increases the risk of the development of mood disorders. Stopping smoking is associated with  a risk of aggravation of depression (likely to be temporary).

Alcohol: lifetime risk of both anxiety and depressive disorders in those with alcohol abuse or dependence is  two- to three fold increased.(Swendsen  1998).The STAR D study (depression treatment) showed that those with comorbid substance use disorder experienced greater depressive symptoms and more previous suicide attempts.It has to be noted that  there is no consistent evidence to say  that moderate alcohol intake is associated with poor outcomes for those with depression. Problem drinking and episodic heavy use should be addressed in those with depression.Motivational interviewing and CBT are effective in reducing both alcohol intake and depression.

Conclusion: Lifestyle modification is an important intervention for our patients with depression.Physical and mental health benefits are likely and clinician’s should routinely explore this area.

Summary of the article:

Lifestyle management of unipolar depression. Berk M, Sarris J, Coulson CE, Jacka FN. Acta Psychiatr Scand Suppl. 2013;(443):38-54.

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