Treating Depression Successfully Requires a Multi-Pronged Strategy

There are no silver bullets, but these complementary therapies work

This article is part of a Wise & Well Special Report: The United States of Depression.

“Stop telling me to go for a run.”

My friend was saying something I often hear from clients about family and friends who think treating depression is simple: Just go for a run and stop eating so much sugar. Get over it.

Except, my friend already exercised. She already ate well. Telling her to go for a run again when she could barely get out of bed was not helpful.

Exercise and nutrition can play an important role in managing depressive symptoms, but very rarely do they fully replace therapy and medications. Saying that someone with clinical depression can stop using traditional treatment therapies if they move more and eat better food could cause people to not seek treatment when they need it most.

The value of exercise

Exercise is an effective tool to reduce depression risk. People who walk at a brisk pace (fast enough to increase your heart rate while still being able to talk) just 10–20 minutes each day have up to 25% lower risk for depression compared to people who don’t exercise.

While studies like this don’t prove cause-and-effect, the broad body of work is convincing: Regular exercise can help ward off depression and also help manage symptoms when someone is already diagnosed with depression.

However, one workout session is not going to lift someone’s mood and pull them out of a depressive episode.

One of my clients was a busy middle-aged man in a stressful work environment that left little time for self-care. When he could feel his depression worsening, he would dust off his running shoes for a workout. This repeatedly left him tired and worse off than before his exercise. When he finally prioritized regular, low-intensity physical activity in his daily life, along with regular sessions of psychotherapy, he experienced fewer depressive episodes.

We don’t know yet how long someone needs to exercise before their depression symptoms improve. What we do know is that exercise needs to be included earlier as part of mental health therapy, and not only recommended when someone already feels depressed.

When food isn’t medicine

“I failed.”

The client who said this was a sales representative for a nutrition supplement and wellness company. A big part of her sales story was how changing her diet and exercise routine eliminated her need for any other depression therapies. Now she was again experiencing depression and unsure how she could admit this to her own clients.

Scientists continue to show that diet quality plays a big role in decreasing depression risk and managing depression symptoms.

Food preferences and daily diet can affect a person’s depression risk. Eating a diet that includes more dietary fiber from vegetables and healthy fats from fish or nuts, while also eating fewer sugary or ultra-processed foods, reduces both the number and severity of depressive symptoms.

Unfortunately, the association of nutrition with mental health has led some wellness practitioners to declare that eating a “good” diet is a natural form of medicine that allows you to stop using antidepressants.

In reality, 56% of people who stop using antidepressants experience a depression relapse in one year, compared to only 39% of people who kept taking antidepressant medication, a 2021 study concluded.

As a nutrition scientist, I am very excited about potential nutrition-related therapies for mental health. But as a registered dietitian who helps patients, I have heard too many stories from clients who repeatedly experienced major depressive episodes and refused to seek treatment because their wellness guru had convinced them that food was the only medicine they needed.

We need a more balanced approach.

Meaningful mental health care: A holistic approach

Jessi Gold, MD, a psychiatrist, and assistant professor at Washington University School of Medicine, emphasizes the importance of considering all options as part of a full treatment plan.

“It is important to approach treatment holistically,” Gold says, “and understand that in many people therapy plus medication is more beneficial than either alone and that many people need medication to even allow them to get to therapy or get to yoga.”

If you want to incorporate nutrition and exercise practices into your own mental health care, consider some of these strategies.

• Gradually increase the intensity of your exercise. Notice how you feel the day after a workout. Are you energized and engaged in the activities around you? Then try another workout at the same level. Or do you feel more fatigued and anxious? Try exercise again but at a less intense level.
• Slowly add foods with more fiber and healthy fats into your diet. These foods are at the heart of most nutrition plans that improve mental health. But changing your diet over 2–3 weeks, instead of all at once, gives your body time to adjust to a new eating style and to figure out if it is the right eating style for you.
• Do not change your medical treatment plan without involving your doctor. Medical providers can monitor you for any unwanted side effects as you adjust your therapy plan and treat them before any harm is done.
• Change one part of your treatment plan at a time. Don’t decide to reduce your antidepressant use, start exercising, and follow a new diet all in the same week. If you do experience any problems, you won’t know which of those changes caused the issue.
• Monitor other health conditions closely. Exercise and nutrition programs can impact your body size, blood sugar, and blood pressure levels. If medication doses for those conditions are not adjusted in time, your depression may become worse.
• Don’t be afraid to try the therapy approaches you used before your new plan. Your new health behaviors may allow you to use a medicine with fewer side effects, or a lower dose of an older medication.
• Do not become focused on exercise and nutrition to avoid making other important changes in your life. No amount of vegetable-filled dinners or bike rides can fix the wrong job, the wrong relationship, or maladaptive coping strategies.
• Be patient. Exercise. Nutrition. Talk therapy. Antidepressants. The one thing these all have in common is that they take time to work, up to eight weeks in some cases. Give one strategy time to work before moving on to a new approach.

Exercise and nutrition hold amazing promise for mental health care. If you struggle with chronic depression, find nutrition and exercise programs that you can sustain over time and combine them with your existing treatments for mental health.

Exercise or nutrition will not be the one silver bullet that cures depression, but they are vital parts of a holistic, individually tailored mental health care plan.

…

This article is part of a Wise & Well Special Report: The United States of Depression. If you or a loved one is depressed, it’s vital to talk about it. Because depression increases the risk of suicide, consider calling the confidential National Suicide Prevention Lifeline at 1–800–273-TALK (8255) for English, 1–888–628–9454 for Spanish, or call or text 988. Global support in 44 languages is available from Befrienders Worldwide.