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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Minding Your Mind Minding Your Mind
 

Treating Mild or Moderate Depression Without Drugs


November 26, 2013

By Michael Craig Miller M.D.

Harvard Medical School


Major depression is the most common mood disorder in the United States. It affects about 15 million American adults (almost 7% of the population) each year.

Many people with depression are reluctant to take antidepressants. So it's worth reviewing nondrug options, some of which (like exercise and relaxation techniques) are widely available. At the same time, it's important to understand who is most likely to benefit from these practical, nondrug approaches.

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Putting Antidepressants in Perspective

Many experts are persuaded that, if you have severe depressive symptoms, antidepressant medication is a very good idea. About 30% of Americans with depression fall into the "severe" symptoms group.

But that leaves a lot of people (70%) who have mild to moderate forms of depression. In the past decade, researchers have debated how effective antidepressants are for these people. In many studies that include such patients, antidepressants have not been shown to be clearly better than placebo.

To be clear, people with mild to moderate depression may get a great deal of benefit from medication. But many may want to try nondrug treatments first.

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Exercise. Relax. Talk.

People with mild or moderate symptoms of depression may find the following options work well enough on their own to improve mood. For people with severe depression, these approaches may be a useful addition to drug therapy.

Exercise

People who exercise regularly tend to feel good about their achievement. This boosts self-esteem. But regular exercise also improves the way the brain regulates mood. It promotes the release of the neurotransmitter norepinephrine. This may have a direct effect on improving mood.

Exercise can indirectly improve mood by releasing endorphins, the body's natural painkillers. Continued exercise may also stimulate nerve cell growth in parts of the brain that adjust mood. Even moderate levels of regular physical activity, such as walking briskly or taking a bicycle ride, significantly improve mood in people with mild to moderate depression. In one study, people reduced symptoms of depression when they exercised a total of three hours a week.

Relaxation

Stress feeds depression, so it makes sense that techniques to calm the mind and body can help improve mood. These techniques also help people sit with painful emotions rather than react to them in ways that can add to their stress. Mindfulness meditation, controlled breathing and yoga are examples of techniques that may help.

Psychotherapy

The aim of psychotherapy is to encourage more constructive ways of thinking about and managing problems that may trigger depression.

There's a lot of good evidence supporting the value of several different therapy approaches. Cognitive behavioral therapy, for example, tries to replace deep-rooted patterns of negative thoughts and behaviors with more positive ones. Interpersonal psychotherapy helps patients identify and cope with recurring personal conflicts. Psychodynamic therapy helps patients become more aware of their psychological distress and its causes.

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Finding What's Best for You

For the most painful types of depression, it is probably not enough to rely on the above treatments. Antidepressant medication is an important option if you fall into that group.

One frustrating fact about how drugs affect mood (psychopharmacology) is that there is no way to predict which of the many drug options will be best for you. That's true whether your depression is mild or severe.

Scientists hope to have tools in the future to help us make such predictions, but — for now — finding the right drug is still a process of trial and error.

It is common for patients diagnosed with depression to try several antidepressants before finding one drug or combination of drugs that works best. If you are suffering, it is often worth going through that process.

Depression is a complex illness. The research on treatments for this illness is a reminder that there's no one-size-fits-all solution to improving mood. Knowing what your options are gives you a better chance of getting relief.

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Michael Craig Miller, M.D. is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

 

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