Depression is one of the most common mood disorders out there. While a number of effective, safe, and medically-approved treatments for it currently exist, many of these involve the use of pharmaceutical drugs that can sometimes have unwanted side-effects. Because of this, some people are reluctant to use a medication-based approach, and instead choose to look for other, non-drug-based forms of treatment. In this post, we’ll review some of these “complementary” approaches, and what the science currently says about them. Do any of these actually work? Read on to learn more!
Disclaimer: This post is not a recommendation or endorsement for any particular type of mental health treatment. The only way to be sure you get effective treatment is to discuss your options with your personal doctor — and none of the complementary approaches described below should ever be used to replace what your doctor has prescribed or recommended. We have written this post for informational purposes only, and its goal is simply to inform our readers about the science behind some complementary treatment strategies, and what we know about how they might work.
Many of the most common treatments for a person diagnosed with clinical depression (major depressive disorder, or MDD) involve the use of prescription medications (such as SSRIs) to alleviate or manage the symptoms.
While these medications can be highly effective in many cases, it is also unfortunately the case that many of these pharmaceutical drugs can potentially cause a number of unwanted side-effects in people who take them.
For this reason, some people are reluctant to rely on pharmaceutical treatments, and prefer to try non-chemical treatments instead.
In this post, we’ll review some of the many “non-pharmaceutical” approaches to mental health treatment — such as psychotherapy — as well as discuss what the science currently says about a number of lifestyle and dietary factors that may also have effects on a person’s mood.
We’ll also review a number of supplements and other compounds with at least some suggestive evidence of having effects on mood, although these findings are still early and are generally not yet strong enough to draw solid conclusions from.
However, before we begin we want to stress that this post is not an endorsement for- or against any particular mode of treatment! Nor are the strategies outlined in this post intended to be used as a replacement for conventional medical care in any way.
If you are ever diagnosed with a mental health condition of any kind, the only way to decide what the best treatment for your specific case might be is to discuss it with your doctor. Only a fully-qualified medical professional fully understands all the different advantages and drawbacks associated with the many different possible modes of treatment — and they will work with you to come up with the safest and most effective approach for your individual needs.
With that in mind, in the rest of this post we’ll discuss some of the many non-drug-based treatments for depression and other mood disorders, and what science currently says about them. Although most of these only have weak or insufficient evidence to support them, many of them have early studies that suggest that they could have some potential when used to complement other, more conventional forms of treatment. Nonetheless, all of these preliminary findings will still have to be extensively followed up on by future research to confirm their efficacy, safety, and underlying mechanisms.
Before we get into some of the “alternative” or “complementary” strategies for potentially improving mood, it’s important to be aware of what some of the more typical treatment approaches for clinical depression are, and how they work.
The approaches below are some of the ones that you might be likely to encounter if you were to book an appointment with a traditional qualified psychiatrist, psychologist, or other mental health professional.
Many of these treatment modalities have been used for a long time, and have been extremely well-studied. Therefore, these approaches are widely-used by doctors due to their having a lot of evidence to support them.
One of the most common forms of therapy used by mental health professionals is cognitive-behavioral therapy — also known as “CBT”. This highly “evidence-based” approach to therapy is one of the most widely-used for preventing and reducing depression (as well as many other mental health conditions) .
The main idea behind the use of CBT in depression is to help patients change their patterns of thinking and make behavioral changes to improve coping and reduce distress .
CBT has been reported to be effective for both acute depressive episodes, as well as long-term prevention .
One specific type of CBT, called “acceptance and commitment therapy” (“ACT”), has been reported to decrease symptoms in cases of mild-to-moderate depression. It has also been claimed to help reduce overall severity of depression cases, as well as the occurrence of suicidal thoughts (“suicidal ideation”) [5, 6].
According to some reports, CBT may help reduce the negative perceptions of emotions .
Some early neurobiological evidence suggests that CBT may work by reducing the activity in parts of the brain that are involved in emotional processing (such as the amygdala and hippocampus) as well as cognitive processing (such as the prefrontal and anterior cingulate cortex) .
“Psychodynamic” therapy is probably the therapy you most associate with mental health treatment. It focuses on conscious and subconscious feelings from past experiences, and how they affect the patient.
The effectiveness of psychodynamic therapy for depression treatment is generally well-supported. In some cases, psychodynamic therapy was as effective as prescription antidepressants .
Internet-delivered psychodynamic therapy for 10 weeks was reported to reduce symptoms in a study (RCT) of 100 patients with mood and anxiety disorders .
The results from some preliminary neurobiological studies suggests that psychodynamic therapy may act by reducing metabolic activity in the right insula, a brain region important in emotion control and depression. This decreased activity was, in turn, reportedly associated with greater symptom reduction over 4 weeks of treatment .
Interpersonal therapy emphasizes the social context of depression, and aims to improve communication skills and relationship-building .
Interpersonal therapy has a few central goals :
- increasing social support
- lowering stress
- improving emotional processing
- improving relationship skills
Interpersonal therapy is claimed to be one of the best-supported treatment options for depression .
According to some studies, it is effective in treating depression and preventing relapse both on its own as well as when used as a complement to antidepressant drugs .
In one study (RCT) of 120 women with postpartum depression, interpersonal therapy was reported to improve depression symptoms and social adjustment .
Interpersonal therapy is typically delivered by a therapist over 12 weekly sessions.
However, internet-delivered, self-guided interpersonal therapy also lowered depressive symptoms in a study of over 1800 people .
In addition to some of the “official” forms of psychotherapy discussed above, there are also a number of other forms of therapy that you might encounter when working with mental health professionals.
In general, these are less well-studied, and their effectiveness may be more specific to certain individuals and mental health conditions. However, some evidence does support them in certain cases, so we’ll review these below.
Art therapy encourages free self-expression with painting, drawing, or modeling .
Despite the way it is often depicted in the popular media, hypnosis is actually a real phenomenon that some mental health professionals use to address certain types of problems.
However, there are still many popular and misleading “myths” about it. For example, despite what you see in many movies and stage shows, hypnosis cannot be used as a form of “mind control”! Experts in hypnosis often stress that it can’t be used to make a person do anything they don’t already want to do — in other words, it only works when the patient is actively cooperating and collaborating with the person administering the hypnosis.
It also doesn’t work on everyone: some people are simply more “hypnotizable” than others.
Hypnosis is defined as a state of focused attention and reduced awareness of the environment. It enhances the ability to respond to suggestions .
Being in a hypnotic state is not beneficial on its own. But when individuals internalize beneficial suggestions, they may be able to improve their thoughts and behavior.
Although it’s not particularly well-studied, one or two meta-analysis (of RCT studies) have claimed that hypnosis can sometimes be a viable treatment for depression, whether by itself or paired with more traditional psychotherapy [26, 27].
In theory, hypnosis may change how people view themselves, and may promote coping skills to help them manage depression . However, the techniques and mechanisms behind hypnosis are still highly mysterious, and not much is known about the biology behind its touted effects.
In 14 adolescents with depression, listening to rock music reportedly decreased levels of cortisol, and reduced activity in the right prefrontal cortex — each of which are factors which have been associated with increased negative emotion, and which are often reported to be higher in individuals with diagnoses of depression .
Dance/movement therapy has been reported to reduce depression and stress according to one study in 104 participants with diagnosed depression. Some researchers have speculated that it may work by increasing levels of serotonin and dopamine [33, 34, 35].
Swimming with dolphins daily for 2 weeks, and spending time with farm animals for 12 weeks, were each reported to improve depressive symptoms, self-confidence, and coping in 120 depressed patients (RCTs) [38, 39].
Although it’s not known exactly why human-animal interactions are reported to be beneficial, some researchers have proposed that these interactions may reduce cortisol reactivity to stress. They may also increase oxytocin — sometimes called the “social bonding” hormone — which could in turn affects the HPA axis, various neurotransmitters, and even some mechanisms related to inflammation .
In addition to consulting with trained mental health professionals to get specific forms of therapy, there is some evidence suggesting that a number of lifestyle and other behavioral adjustments may be helpful in keeping mood issues at bay, and may even boost mood in otherwise-healthy users.
However, these lifestyle-based approaches should not be used to replace conventional treatment — especially for people who have been officially diagnosed with a specific psychiatric condition! These are complementary approaches only, meaning that while they may help support and enhance the effectiveness of conventional treatments, they are probably not sufficient just on their own.
As always, be sure to discuss any significant lifestyle, dietary, or other changes with your doctor first before embarking on any of the “complementary” strategies discussed throughout this post! In other words, you can consider trying the strategies listed below if you and your doctor determine that they could be appropriate for you.
The goal of mindfulness meditation is to become a “witness” rather than a “judge” of events that happen to you.
Mindfulness meditation has been reported to alleviated depression, with benefits lasting up to 6 months .
It has also been reported to reduce symptoms associated with acute major depressive episodes .
According to one randomized control trial (RCT) of 99 depression patients, those who practiced mindfulness meditation for at least 3 days per week were reported to be half as likely to relapse into depression as those who did not .
Mindfulness reportedly decreased activity in the amygdala, a part of the brain associated with negative emotions and depression symptoms .
According to a study of 16 healthy people, mindfulness meditation for 27 minutes/day for 8 weeks increased gray matter in the hippocampus — a brain area is often smaller in people in depression, and which is believed to play some role in the development of depression symptoms [48, 49].
Several large-scale meta-analyses of yoga studies (RCTs) suggest that it may have a number of potential benefits for alleviating depression and other mood issues, compared to standard antidepressant treatments [50, 51].
For example, yoga has been reported to:
- reduce depression symptoms (in an RCT of 139 seniors) .
- reduce symptoms in 100 patients with mild depression (RCTs) [53, 54].
- reduce PTSD symptoms, depression, and anxiety (in women with diagnosed PTSD) .
- reduce depression more than standard antidepressants in a study of 137 patients .
Practicing yoga has also been reported to increase levels of BDNF, endorphins, and serotonin — all mechanisms that have been associated with mood, and which may in part account for some of the claimed benefits of yoga [60, 61].
According to one study, just one single yoga session was reported to increase GABA levels in 8 participants . However, most of the other studies described above only reported significant results from longer periods of yoga practice, ranging from 1-3 weekly sessions of 30-75 minutes each, for 4 – 12 weeks. Therefore, if you’re interested in adopting a yoga practice to potentially boost your mood, it’s probably better to develop a consistent long-term habit in order to increase the likelihood of seeing benefits from it.
Exercise is another lifestyle factor with a lot of evidence supporting a major role in regulating — and even potentially improving — mood.
Individuals with a prior history of depression who maintain physical fitness are also reportedly less likely to relapse into depression .
According to one 156-person study (RCT) of exercise vs sertraline (an antidepressant medication), aerobic exercise reportedly improved depression symptoms to a similar degree as the drug .
Similarly, according to another study (RCT), exercisers reportedly maintained lower depression symptoms and improved quality-of-life for a longer period than people who went through cognitive behavioral therapy (CBT) .
Inflammation and oxidative stress in the brain are believed to contribute to depression. Although exercise promotes short-term inflammation, it has long-term anti-inflammatory and antioxidant effects, which may partially explain some of the reported benefits of exercise on mood and overall mental well-being [70, 71].
Some evidence also suggests that exercise may increase serotonin, dopamine, BDNF, norepinephrine, and endorphins — all mechanisms that have been associated with mood and mental health in some way or another [72, 73, 74].
Several studies suggest that people with depression often have an overactive HPA axis, a brain system that is believed to play a major role in stress and mood. Regular exercise has been associated with lower HPA-axis reactivity in both humans and animals, and is therefore another mechanism which may account for some of the reported mood benefits associated with exercising regularly [75, 76].
Both moderate-intensity exercise (e.g., cycling, brisk walking) and high-intensity exercise (e.g., running, swimming) have been associated with potential benefits in depression .
For moderate-intensity exercise, some studies suggest that the potential benefits may be best achieved with at least 150 minutes per week, broken up into multiple 30-minute sessions .
Some evidence also suggests that how much natural light (sunlight) we get can also sometimes play a significant role in a person’s overall mood and well-being.
For example, exposure to bright light in the morning helps synchronize the circadian rhythm of several neurotransmitters involved in regulating mood, and which are often reported to be disrupted in people experiencing depression and other mood-related conditions [78, 79, 80].
The first enzyme of serotonin production (tryptophan hydroxylase) is found in human skin. By interacting with and “activating” this enzyme, sun exposure may help increase serotonin (and the number of its receptors) throughout the brain, according to a few studies [85, 86].
Sunlight also increases relaxation by producing endorphins — hormones that are most well-known for their role in producing the “runner’s high” that some people associate with exercise .
While a considerable amount of evidence suggests that sunlight can be quite important for mood and mental well-being, it’s simply not always possible to get as much sunlight as you might need! This is where “light therapy” can come in.
“Light therapy” typically involves placing a “light box” (usually with a brightness of about 10,000 lux) nearby for 30 minutes each morning shortly after waking up .
Light therapy has been reported to be especially effective for seasonal affective disorder (“SAD”), as the bright artificial light offsets the lack of sunlight that people often experience during the winter months .
Bright light therapy was reported to reduce depression in one study (RCT) of 99 people with winter seasonal depression .
Even though light therapy is best for seasonal depression, some evidence suggests that it may also help non-seasonal forms of depression as well. For example, light therapy was reported to reduce depression symptoms according to one study (DB-RCT) of 122 patients with non-seasonal depression .
All in all, light therapy alone will probably not “cure” depression or other mood issues entirely on its own — but it may be a helpful addition to other strategies for managing mood problems in psychiatric patients, and may potentially have some “mood-boosting” effects in otherwise healthy people as well. As long as it’s used at an appropriate time of day (i.e. not at night or too close to bedtime), it may be a relatively low-risk lifestyle strategy to try out.
Although some evidence suggests that natural light and light therapy may have some effects on mood, there are also contexts in which light can potentially have negative effects.
One major example of this is exposure to light in the evening or at night. This can potentially throw off the circadian rhythm (for example, by “tricking” the brain into thinking it’s daytime), which can in turn have negative effects on a person’s ability to get enough high-quality sleep.
One good (and low-risk) way to potentially manage light issues at night is to minimize your “screen time” in the evenings. This is because many modern digital devices — including phones, tablets, and computers — emit a lot of blue light, which has a particularly strong effect on how our bodies regulate its circadian rhythm.
The amount of (high-quality) sleep that a person gets can be a major factor when it comes to influencing their overall mood and mental well-being.
Additionally, sleep problems such as insomnia have been reported to be a potential trigger of depression. Furthermore, depression may sometimes even worsen insomnia, which can create a negative feedback effect on a person’s overall mental health. For example, nearly 75% of depressed patients report difficulty falling or staying asleep, and this probably plays at least some role in reinforcing some of the symptoms of mood disorders .
Sleep deprivation has been reported to interfere with the growth and function of the hippocampus, a brain area frequently associated with mood [99, 100]. Sleep deprivation may also cause distorted thoughts and increased emotional reactivity, which are some of the hallmark symptoms of depression and other mood disorders .
Therefore, improving sleep quality can be an important factor when it comes to treating mood-related psychiatric conditions, and most likely also plays a major role in shaping mood in healthy people as well.
In addition to the general importance of sleep to mood and overall mental well-being, some evidence suggests that disruption of the circadian rhythm — the natural daily rhythm that governs our sleep-wake cycle and many other important bodily functions — can also have a significant impact on mood.
For example, depressed individuals are often reported to have a disrupted circadian rhythm, which is believed to play at least some role in contributing to the mood-related symptoms of depression .
Therapy involving total sleep deprivation, sleep phase advance, and bright light therapy (called “triple chronotherapy”) has been reported to reduce depression symptoms relatively quickly and sustainably .
Compared to daily exercise, triple chronotherapy reportedly provided immediate relief and greater response and recovery in a study (RCT) of 75 adults with major depression .
Sleep deprivation is also believed to increase the short-term activity of serotonin, dopamine, and norepinephrine — some of the major neurotransmitters involved in the regulation of mood .
One study reported that triple chronotherapy restored the normal circadian rhythm of serotonin and dopamine activity in the brain, which are believed to often be disturbed in depression .
Chronotherapy is actually a somewhat complex process, and is best done with the aid and supervision of a trained medical professional. Therefore, we don’t recommend or endorse doing this casually on your own!
If you’re interested in trying it out, you should at least discuss it with your doctor first, as going through sleep deprivation can come with its own set of potential risks, and could have unpredictable effects on your physical and mental health that only a doctor can help you to manage.
That being said, the process of “triple chronotherapy” typically involves at least one initial day of total sleep deprivation, followed by up to 5 additional days where the patient moves their bedtime earlier and earlier in the evening. Light exposure (such as by using a “light device”) is also often included in the procedure to help the body’s circadian rhythm adjust to its new sleep schedule. In theory, this procedure results in a more stable and regular circadian rhythm after about a week, after which it is generally easier to maintain in the long term .
Surprisingly, some evidence suggests that getting massaged can have noticeable effects on a person’s mood.
Massages have also been reported to :
- lower depression and anxiety symptoms
- increase dopamine and serotonin levels, two important neurotransmitters for mood and overall mental functioning
- lower cortisol and norepinephrine levels, two compounds that are believed to play a role in stress and emotional reactivity
However, it’s possible that at least some of these supposed “benefits” are not necessarily specific to massage, but might instead just be general benefits associated with touch and physical contact — and more research will be needed to tease these two possibilities apart.
Although acupuncture is not a highly-studied topic among scientists, there are a few preliminary studies that suggest that it might have some noticeable effects on mood.
However, while this early evidence is somewhat promising, a lot more research will be needed to figure out for sure what the potential effects of acupuncture might be on mood in healthy humans.
Also, similar to the reported effects of massage on mood, it’s possible that the acupuncture effects reported by some of the above studies might simply be due to the physical touch and social contact that is involved in acupuncture — so future studies on acupuncture will also have to disentangle these two possibilities in order to make any solid conclusions about the benefits of acupuncture techniques specifically.
The vagus nerve plays a central role in the “rest-and-digest” (parasympathetic) nervous system.
However, the research behind this is still in a very early stage, and should be taken with a grain of salt. A lot more studies will have to be done — especially in healthy human populations — to determine the exact effects and potential benefits of vague nerve stimulation.
With that in mind, here are a few preliminary results that may point the way towards potential uses of vagus nerve stimulation, which will hopefully be followed up on by more studies in the future:
According to one study, stimulating the vague nerve was reported to improve depression symptoms and outcomes (such as antidepressant treatment response and likelihood of remission) in 85 patients [115, 116].
According to another study, vagus nerve stimulation was reported to increase blood flow to various brain regions — some of which have been associated with depression, especially when optimal blood flow to them is lacking .
Some of the mental effects of vagus nerve stimulation may be due to increased levels of the neurotransmitters norepinephrine and serotonin — although this is only one of many potential mechanisms that may account for some of these early findings, and so more research will still be needed .
In expressive writing, individuals write deeply about a troubling or emotional event .
As you can probably imagine, this can often be pretty unpleasant in short term! However, the idea is that even though it can be upsetting in moment, writing about feelings in this way may help a person’s ability to cope with their negative emotions, and may possibly lead to noticeable long-term improvements in their mood and general mental well-being.
In fact, because emotions aren’t “just in your brain”, but rather can affect your entire body, some early evidence even suggests that this approach to writing about feelings may even have effects on some aspects of your “physical” health as well.
According to one study (RCT) in 40 depression patients, writing about deep thoughts related to an emotional event for 20 minutes over 3 consecutive days was reported to reduce depression symptoms .
In another study (RCT) of 102 chronic pain patients, individuals who wrote letters expressing their anger were reported to experience improvements in their ability to control some of their symptoms of depression .
Neurofeedback training provides participants real-time information on the activity of certain brain regions.
In theory, neurofeedback training teaches people to self-control their brain activity, although this idea is still quite controversial, and the overall scientific evidence is quite mixed.
However, these are only two studies with relatively small sample sizes, and a lot more research will be needed to confirm whether or not neurofeedback training has any significant benefits in treating mood-related symptoms or issues.
Additionally, neurofeedback training typically requires expensive equipment, and can generally only be done with the help and supervision of trained professionals. For this reason, it’s often not feasible or recommended to try these techniques at home on your own. If you’re interested in giving neurofeedback a shot, the safest thing to do is to look around to see if there are qualified licensed professionals in your area who can administer it to you.
Some early evidence suggests that exposing the body to extreme cold temperatures may stimulate some physical processes that could, in turn, affect a person’s mood.
Cold exposure also reportedly increases blood- and brain levels of norepinephrine and endorphins, two brain compounds which are believed to play a role in mood, stress, and other factors involved in mental well-being [128, 129, 130].
In theory, the idea is that infrared light stimulates neurogenesis, inhibits brain oxidative stress and inflammation, and increases brain energy utilization — all of which are processes that are potentially involved in mood .
Similar to the theory behind “cryotherapy”, there is some preliminary evidence that exposure to very hot and humid temperatures may have some mental effects as well.
For example, a single session of heat therapy was reported to improve depression symptoms in a study of 10 cancer patients .
However, much more research will still be needed to confirm these effects and their possible mechanisms.