Evidence-Based Non-Pharmacological Treatment of Depression in 2024: Comprehensive Guide

Disclaimer: This information is for educational purposes only and does not replace professional medical advice. Always consult with a healthcare provider for personalized treatment options.

Understanding Depression and Its Management

According to the 2024 report by the National Crime Records Bureau (2024), 171,000 individuals have died by suicide in India since 2022. While impulsivity may play a role in someone ending their life, depression is the leading cause of death by suicide. 

Depression is a mental health condition marked by persistent low mood, feelings of hopelessness and helplessness, low self-worth, changes in appetite and sleep, irritability, and loss of interest in pleasurable activities. These symptoms can interfere with one’s daily life and impair relationships and work. In severe cases of depression, small tasks like keeping up with personal hygiene may feel challenging. 

Depression can be managed with proper and timely professional help. If the symptoms are severe, medication can help lift the fog. A lot of the management of depression happens in psychotherapy. Depending on the modality of therapy, one may work on challenging and reframing negative thought patterns, improving relationships, or unlearning long-term patterns learned in childhood that may be contributing to depression.

Lifestyle changes like getting proper nutrition, regular physical activity and seeking social support also help alleviate some of the symptoms of depression. 

What is Non-Pharmacological Management of Mental Health?

Overview: Non-pharmacological management of depression refers to any intervention that does not involve taking medication. Psychotherapy is the most well-researched and popular non-pharmacological treatment for depression. Various modalities of therapy have been thoroughly researched and are regularly used in the mental health profession to treat depression.

Other types of interventions that don’t use medication to treat depression include neurostimulation, mindfulness-based practices and lifestyle changes.

Some alternative practices like meditation and massage therapy may also help alleviate the symptoms of depression. However, it’s important to keep in mind that these are best used as adjuncts to psychotherapy and, where necessary, medication. 

Benefits: The benefit of opting for a non-pharmacological treatment for depression is the absence of side effects. Common side effects of anti-depressants include headaches, nausea, low libido and decreased alertness. By not taking medication, one can avoid the possibility of developing side effects. 

Often, depression occurs due to psychosocial factors such as interpersonal conflict, loss of job or other support systems, death of a loved one, or adverse childhood experiences. By opting for a non-psychopharmacological treatment, in particular, psychotherapy, one can learn to cope with these stressors proactively. 

Having said that, when symptoms of depression are severe, they can interfere with effective therapy and other non-pharmacological interventions. In such cases, it is advisable to take the support of medication. 

5 Evidence-Based - Non-Pharmacological Interventions for Depression

Psychotherapy

Psychotherapy, often referred to as “talk therapy”, is the most effective non-pharmacological depression treatment. Depending on the individual’s history, needs and capacity, different treatment modalities may be effective. Here are some modalities that have been backed by research: 

Cognitive Behavioral Therapy (CBT): CBT, or Cognitive Behavioural Therapy, is a form of therapy which helps identify, challenge and reframe negative thought patterns that may contribute to symptoms of depression. For example, the automatic negative thought, ‘I am a failure’ after a professional setback may plummet one into a depressive episode. Through various techniques, CBT helps the individual learn that this thought is not accurate. 

Interpersonal Therapy (IPT): Interpersonal therapy is a structured, brief therapy that usually lasts around 12 to 16 sessions, and focuses on interpersonal relationships. IPT can be useful in cases where one is facing interpersonal conflict or an interpersonal loss, like the end of a relationship. 

Dialectical Behavior Therapy (DBT): Dialectical Behavioural Therapy focuses on learning emotional regulation skills, mindfulness and distress tolerance. Many times, our inability to tolerate mild discomfort and regulate ourselves can contribute to the symptoms of depression.

For example, if we’re feeling low and want to talk to a friend but they’re not available, we may take that personally and conclude that our friend is ignoring us. This can further dampen our mood. DBT teaches us to separate the emotional reaction from the rational response, which in this case would be to accept that the friend can’t be available at the drop of a hat, and that doesn’t reflect on the quality of their friendship. 

Psychodynamic therapy: Psychodynamic therapy is based on the principle that our childhood experiences impact how we navigate situations as adults. A psychodynamic therapist is interested in the entire personality and personhood of the individual and helps uncover contradictions, fantasies and subconscious fears and hopes.

While psychodynamic therapies are the oldest therapy modality, the evidence of their efficacy has been researched only in the last two decades or so. This is because of the divide between clinical work and research. It is important to note that research is showing that the impact of psychodynamic therapy tends to last longer than most other evidence-based therapies. 

Mindfulness-Based Therapies

Mindfulness-based therapies help the individual increase self-awareness and attention to one’s inner state and outer environment and help reduce stress. There are two popular mindfulness-based therapies used for depression: 

Mindfulness-Based Stress Reduction (MBSR): MBSR is a structured program that usually lasts 8 weeks, and focuses on mindfulness techniques that help cope with stress, anxiety and depression. Some of the benefits of MBSR include improved mood and emotional regulation, better sleep quality and increased self-awareness. When combined with psychotherapy, MBSR can be a useful technique to manage symptoms of depression without medication. 

Mindfulness-Based Cognitive Therapy (MBCT): As the name suggests, MBCT combines mindfulness-based techniques with CBT, and is specifically designed to help individuals with the management of depression. While mindfulness cultivates more self-awareness, CBT techniques help individuals identify and challenge negative thought patterns as they become more aware of them. 

tDCS

Transcranial Direct Current Stimulation or tDCS is an up-and-coming non-invasive neurostimulation technique that delivers low-intensity electrical currents to specific areas in the brain. While research is still ongoing, the technique seems to have promising results for depression. One way that tDCS helps alleviate the symptoms of depression is by enhancing cognitive control during emotion regulation. 

Mave Health’s wearable device ARC delivers tDCS, and is a tested method of relieving symptoms of depression without any side effects. 

Electroconvulsive Therapy (ECT)

ECT is the oldest brain stimulation technique and has primarily been used for cases of severe and treatment-resistant depression. When it was first formulated, ECT was a painful procedure wherein electrical currents would be administered without anaesthesia. For this reason, it was banned in several countries. However, the advancement of technology has allowed for ECT to be administered safely using anaesthesia. This is called modified ECT. 

Tms

Tms or Transmagnetic Stimulation is a technique which uses magnetic fields to influence brain activity. It is a non-invasive procedure in which magnetic coils placed on the scalp deliver pulses. Like other brain stimulation techniques, tms too is used in cases of treatment-resistant depression. 

Lifestyle and Behavioral Interventions

Regular physical activity, a nutritious and balanced diet and adequate sleep are the trifecta of a lifestyle that is conducive to wellbeing. These three play an important role in the management of depression without medication.  

Exercise:

Regular exercise releases endorphins or the ‘feel good’ hormones, which is seen to be helpful for relieving the symptoms of depression. Exercise can also boost our confidence and help release some of the stress and tension from the body. While walking, yoga and strength training are popular forms of exercise with benefits for one’s mental health, when picking a physical activity, it’s important to consider something you enjoy and look forward to doing. 

Diet and Nutrition:

Our gut health and mental health are closely linked via the gut-brain axis. This exaplain why changes in appetite and digestive issues often co-occur with depression and anxiety. Paying attention to what we eat, consuming a nutrition-dense diet and avoiding ultra-processed foods is seen to be helpful for our mental well-being. 

Sleep Hygiene:

Sleep disturbances are commonly seen among individuals struggling with depression. Sleep and mood have a bidirectional relationship wherein deficits in one can impact the other. Maintaining a healthy sleep schedule and getting uninterrupted sleep for 6 to 9 hours can help manage the symptoms of depression. 

Complementary and Alternative Therapies

While depression often indicates a deeper psychosocial concern which is best processed in therapy, some complementary and alternative interventions can help ease the symptoms. These include: 

Acupuncture:

Acupuncture is an ancient Chinese technique which involves inserting needles in specific points to relieve tension and stimulate the nerves. While its efficacy for depression is still being researched, initial studies show that this stimulation may help in the regulation of neurotransmitters that are involved in the symptoms of depression. 

Massage Therapy:

Massage therapy can also be a helpful tool in reducing stress and thereby, improving one’s mood and depressive symptoms. However, not everyone may find massages relaxing or comfortable.

This is an important consideration when opting for any alternative therapy since a lot of its impact depends on the subjective experience of the individual receiving it. In other words, if you don’t enjoy massages, forcing yourself to get one may be counterproductive. However, if you find massages relaxing, it may also help elevate your mood and offer temporary relief from the symptoms of depression.

Aromatherapy:

While not a substitute for professional help, aromatherapy can help one relax and soothe oneself. Aromatherapy can also be a helpful aid for sleep, which is often disturbed in individuals experiencing depression. Lavender, ylang ylang and bergamot are some oils that are commonly used for relaxation and mood enhancement. 

Safety and Regulation:

Given that research about alternative practices is still nascent, it is important to take safety and precautionary measures when opting for these. Try to find professionals who are trained in these therapies, and always consult with your healthcare provider before opting for alternative interventions. 

Creative and Expressive Therapies

Depression can often stifle creative expression, playfulness and joy. Creative and expressive therapies help an individual express difficult emotions and uncover new depths about their experience. Creative and expressive therapies include: 

Art Therapy: Art therapy uses tools like painting, sketching, sculpting, and drawing to express one’s emotions.  This non-verbal method of expression can also help in processing what’s going on and developing coping mechanisms. 

Music Therapy: One may listen to music or make music as a part of music therapy. Many of us turn on a sad song when we’re feeling low. It helps us put into words or make sense of difficult feelings. Making music, on the other hand, can be a helpful creative outlet for what we’re feeling. 

Dance/Movement Therapy: Our body and mind are intricately connected. Dance/movement-based therapies can be a powerful body-based tool to invite some play and creativity into one’s life. While its efficacy for depression is still being researched, there is enough anecdotal information about the therapeutic benefits of dance and movement to say it improves mood and confidence. 

Social and Environmental Interventions

Building a Support System:

Social support and healthy relationships are perhaps the most important factor for our mental health. However, relationships can be complex and sometimes, our primary relationships can be the source of psychological discomfort. Investing in building healthy and supportive relationships is of utmost importance for the management of depression. Work on improving your close relationships (working with a therapist can offer insights about this), and if that doesn’t seem possible, try to find support networks outside of family. You may make new friends, or join support groups or activity-based groups where you can meet like-minded people. 

Environmental Changes:

Many of us spend large chunks of time behind screens. Others don’t step out that often, and those living in cities may get little to no access to nature. Environmental factors have become an area of interest in research on mental health. We are learning that excessive screen time, lack of nature, air pollution and cluttered surroundings can be detrimental to our mental health. Some ways to mitigate this include spending more time outdoors in parks or growing home gardens if you don’t have access to green areas; reducing screen time; and keeping your immediate surroundings clean and free of clutter. 

Self-Compassion and Mindfulness Techniques

Practising Self-Compassion: Our mental health journey is not linear. Often, it may feel like taking two steps forward and one back. Depression may also make basic tasks feel difficult. It’s important to stay compassionate toward oneself as we navigate this journey. We can cultivate self-compassion by learning more about depression, seeking support when we need it and curbing criticism when things become difficult. 

Mindfulness Meditation: Depression may make us feel foggy and disconnected from ourselves. Mindfulness meditation helps us cultivate self-awareness. This self-awareness can help us become more attuned with our mood and needs as well as things that bring us relief or joy. 

Technology-Based Interventions

Online Therapy: If one is unable to see a mental health professional in person, one may consider online therapy. Since COVID, many therapists have begun working online and we have learnt that online sessions are just as effective as in-person sessions. At Mave Health’s Therapy Club, you can find the country’s top mental health professionals who offer online services. 

Virtual Support Groups: Virtual support groups can provide access to support from other individuals who have had similar experiences. There are several support groups one can find, many of which are led by therapists. A support group can not only offer a space to share one’s experiences but also learn from others’ journeys. 

Financial Considerations

Affordable Options: If the cost of individual therapy is unaffordable, one may inquire about sliding scale as many therapists, aware of the high cost, set aside a few sliding scale slots. However, since the primary treatment for depression is psychotherapy and in some cases, depression, it’s advisable to find a professional who is affordable. Many hospitals and group clinics offer low-cost services. One may also discuss financial concerns with the therapist and come to a comfortable arrangement. If individual therapy is not accessible, one may consider joining a support group or a therapy group - these are usually cheaper. 

Warning Signs and When to Seek Help

Recognizing Severe Depression: In severe cases of depression, one may find basic tasks difficult. Some signs of severe depression include excessive sleeping, loss of appetite, not being able to keep up personal hygiene, loss of interest in activities, slow movements or in some cases, agitation and restlessness. In severe depression, one may also have suicidal thoughts or tendencies. If an individual seems to be talking more about death, endings or wrapping things up, this may be a sign that urgent care is needed. 

Frequently Asked Questions (FAQs)

What is Non-Pharmacological Management of Mental Health?

Non-pharmacological management of mental health involves interventions other than medication. The primary non-pharmacological management of mental health is psychotherapy. However, lifestyle modifications, movement-based therapies, body-based activities, and meditation and mindfulness practices are also seen to be helpful for mental health. 

Which of the Following is a Non-Pharmacological Intervention for Depression?

Non-pharmacological interventions for depression include psychotherapy, creative and expressive therapies, mindfulness practices, meditation and lifestyle changes. 

Can Depression be Treated Without Medication?

Mild to moderate depression may be treated without medication. However, in severe depression, medication may be necessary as it helps relieve symptoms so that other forms of intervention may become more useful. 

What are the Pharmacologic Options for Management of Depression?

Commonly used medications for depression include SSRIs, SNRIs, tricyclic antidepressants and monoamine oxidase inhibitors. Antidepressants are prescribed by a psychiatrist, and should be taken under supervision. Psychiatrists decide the dosage and management of medication depending on the frequency and severity of symptoms. 

Conclusion and Call to Action

While medication plays an important role in the management of depression, especially in severe cases, non-pharmacological interventions are necessary for wholesome care. Psychotherapy is recommended in all cases of depression. Lifestyle changes are also extremely helpful, while alternative interventions and creative therapies can help with symptom relief. 

Depression usually has a psychosocial component - like strained relationships or adverse childhood experiences - and for this reason, medication alone is not adequate. At the very least, and regardless of the severity of symptoms, one must consider psychotherapy. Other non-pharmacological interventions can help improve outcomes and offer relief from symptoms. 

To learn more about depression, you can read our blogs here. 

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