Efficacy of nonconventional interventions in depression

Healthy Lifestyle

Many people affected by depression or anxiety turn to nonpharmacological and unconventional interventions like exercise, yoga, meditation, tai chi, and qi gong to manage their symptoms. Research has indicated that these approaches can help improve the signs of both depression and disorders related to anxiety.

Exercise is particularly beneficial when used as a supplementary treatment for cases of unipolar depression, post-traumatic stress disorder, and treatment-resistant depression. Yoga on its own or when added to therapy has been shown to ease the effects of depression; additionally, it can be an adjunct in dealing with certain anxieties – especially panic disorder.

Although there have been mixed results concerning tai chi and qi gong aiding depression, mindfulness based meditation has provided notable results in reducing depressive symptoms which can persist for up to six months or longer. Although not as many positive outcomes have been documented in people suffering from anxiety disorders, evidence still supports their use together with other treatments.

Depression and anxiety disorders are among the most prevalent psychiatric issues, affecting about one in every five U.S. adults for anxiety in the past year alone.1 Nearly half of those with depression have a comorbid anxiety disorder, and many others will have symptoms that do not fit the necessary criteria for diagnosis. For these individuals, complementary and integrative therapies such as exercise, meditation, tai chi, qi gong or yoga may be beneficial. This article outlines the evidence on how effective these treatments are when it comes to treating depression and anxiety.

Practicing yoga

Yoga has long been seen as an Eastern practice combining physical postures, breath control, and meditation. Systematic reviews and several individual studies of this type of unconventional interventions against depression have shown positive outcomes. Comparisons to treatments like exercise or medication show similar benefits with yoga. Although electroconvulsive therapy may be an option for resistant depression, one study observed a lasting effect with yoga when used as an adjunctive treatment for female patients with persistent depression. Yoga was also found to be effective in decreasing perinatal depressive symptoms, but the style of yoga was noted to matter; exercise-based yoga had no impact while styles emphasizing meditation and breath control proved successful.

The effectiveness of utilizing yoga in the management of anxiety disorders is not entirely clear. A meta-analysis of hatha yoga (the most common style in the United States) revealed that those with more serious conditions attained the best results; nonetheless, the overall effect was quite modest leading to it being proposed as an adjunct to cognitive behavior therapy, selective serotonin reuptake inhibitors, or other anxiety medicines. There exist studies which advocate for yoga as a more powerful option than no treatment at all when it comes to reducing signs and symptoms of distress, while others demonstrate no improvement. One research showed that utilizing yoga either by itself or combined with other treatments could be beneficial with regard to panic disorder.

A sufficient amount of evidence is lacking to determine the optimal duration or frequency of yoga. Studies have found no difference in reducing depression symptoms when practicing yoga once vs. twice a week. Most reports indicate that more frequent sessions of treatment reduce anxiety symptoms. Durations vary from three to 24 weeks, with frequency varying from once a week to daily for 40 to 100 minutes each.

The optimal frequency and duration of yoga sessions are unclear, but studies have shown symptom reduction with one 60-minute session per week. Yoga can be used as a monotherapy for depression. However, it is preferred as an adjunctive treatment for depression and anxiety disorders.

Qi Gong and Tai Chi

Tai chi and qi gong are mindfulness and body practices that involve postures, movements, mental focus, breathing, and relaxation. They can be practiced while walking, standing or sitting. Though the evidence is somewhat limited, research on these two interventions suggests that they may be useful for alleviating depression symptoms. Systematic reviews and meta-analyses however show varying effectiveness depending on the population studied or method of study. A tai chi study determined that people with more severe symptoms of depression may benefit more from its unconventional intervention than those with mild symptoms; bit others have seen only minimal effects on depression in general. Similarly, qi gong has been found to have a small but variable effect on depressive states.

A further investigation discovered reduced anxiety in elderly with anxiety issues given medical therapy who participated in tai chi, with a 9.09% recurrence rate compared to the control group at 42.86%. A study on qi gong based stress-reduction had more significant reductions in state and trait anxiety within the treatment group. However, these results oppose a meta-analysis of four RCTs that found no influence from qi gong for diminished anxiousness. All in all, there is a minimal collection of documentation showing conflicting results for these treatments.

Meditation based on mindfulness : a promising form of interventions against depression

Meditation is an often-debated topic and its definition has yet to be defined. However, virtually all approaches to the practice involve training the mind to reach a state of detached observation. Common meditation techniques used in studies of depression and anxiety are mindfulness-based intervention (MBIs), mindfulness-based training, mindfulness-based stress reduction, and mindfulness-based cognitive therapy – each technique having its special focus while all still relying on calming the mind.

A systematic review and meta-analysis of mindfulness-based intervention (MBI) for psychiatric disorders found the greatest benefit in those with depression. These resulted in improved outcomes when compared to no treatment, alternative active therapies, and evidence-based treatments such as selective serotonin reuptake inhibitors. Another meta-analysis assessing patients with diagnosed anxiety and mood disorders revealed that MBIs were moderately successful in reducing anxiety symptoms and improving mood; effect sizes were consistent regardless of session quantity and maintained over an average 27 weeks. Additionally, a systematic review of 209 studies reported effect size estimates whereby mindfulness-based training had a moderate impact on decreasing depression and anxiety symptoms when tested against waitlist control, pre-post comparisons, cognitive behavior therapy, other behavioral interventions, or pharmacologic treatments. In conclusion, the authors determined that MBIs are an effective strategy for various psychological disorders – particularly those involving anxiety, depression and stress.

An analysis of RCTs found that MBIs were effective in people currently experiencing depression but not in those experiencing anxiety. However, not all studies showed immediate benefit. Participants with depression showed significant differences after intervention, with a large effect size favoring the intervention on primary symptom severity. No evidence was found for a benefit in anxiety.

Stand-alone MBIs are not clear whether they are beneficial without a larger therapeutic framework.

The treatment of depression and anxiety disorders seems to be effective with MBIs. Because no data suggests that these interventions cause harm in patients with depression, they can be recommended with the understanding that additional medications or psychotherapy may be needed.