Lifestyle interventions for treatment-resistant depression

There are several common circumstances in which treatments outside of the traditional Western Allopathic medical tradition can be useful for patients with treatment-resistant depression. While many patients benefit only partially from maximized medication and psychotherapy and desire additional evidence-based recommendations, a holistic approach has other advantages. First, many patients request alternative and complementary treatments with a goal of avoiding or reducing pharmacological therapies and their side effects. Second, behavioral changes that fall outside of commonly used psychotherapeutic approaches can be addressed via complementary approaches. Finally, patients may come from cultural or personal perspectives that value a mind-body approach which when used adjunctively with traditional treatment can improve engagement and adherence and strengthen the therapeutic alliance. Fortunately, many interventions have sufficient clinical evidence of efficacy and underlying scientific and mechanistic foundation to provide a strong menu of recommendations for mental health professionals. Here, we will review diet, exercise, mindfulness, and closely related interventions, including some that cross domains.