Integrative Treatments for Depression: A Review of the Evidence

The most popular treatments for depression include psychological and pharmacological treatments. In terms of psychological therapies, the most commonly-used form is cognitive behaviour therapy (CBT) while the most popular antidepressants are selective serotonin reuptake inhibitors (SSRIs) such as Prozac® (fluoxetine), Zoloft® (sertraline) and Lexapro® (escitalopram).

While these treatments can be helpful for many people, there are a significant portion of people who do not benefit from them. In fact, research indicates that approximately 60% of people continue to experience symptoms of depression despite receiving psychological or pharmacological treatments. Efforts have been directed at improving treatment outcomes by creating new psychological therapies and/or pharmaceutical antidepressants. Unfortunately, outcomes are simply not improving.

In a paper that I recently published in the journal Medical Hypotheses, I argue that treatments outcomes are only likely to improve when we take a more integrative (or holistic) approach. Research confirms that depression can be caused many factors which psychological therapy and antidepressants simply do not target. For example, depression can be caused by:

• Lifestyle and environmental factors e.g., poor sleep, lack of physical activity, high stress, and environmental toxins
• Diet and nutrition e.g., unhealthy dietary patterns, nutritional deficiencies, pro-inflammatory foods, and food allergies/intolerances
• Psychology and coping skills. This is targeted by psychological therapies.
• Social relationship and spiritual health. Spirituality is about having purpose and meaning. This may or may not be associated with religion.
• Medical and physical factors e.g., comorbid medical diseases, poor gut health, and hormonal imbalances. It is believed that pharmaceutical medications target hormones/neurotransmitters associated with mood such as serotonin and dopamine. However, they do not treat other medical/physical factors.

Given the multifactorial causes associated with depression, an integrative approach is essential. Interestingly, there is an increasing body of evidence confirming the benefits of several interventions that target many of the areas described above. The figure below is included in the article I published which summarises the many different treatment options available. I comprehensively review the research examining the efficacy of these different treatments in the article.

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References

1. Lopresti, A.L. (2019) It is Time to Investigate Integrative Approaches to Enhance Treatment Outcomes for Depression? Medical Hypotheses. Link to article