4 Things That Help Depression More Than You May Think

In the 1990s, we often heard the mantra: Depression is a chemical imbalance to be managed with pills. The culprit was thought to be serotonin. The serotonin theory of depression gave the public a simple and optimistic message, with a clear mandate: Take your pills.

We now know that the serotonin theory is false, and we’re becoming increasingly aware of the side effects and discontinuation symptoms of antidepressants such as selective serotonin reuptake inhibitors (SSRIs). Yet prescriptions for antidepressants have continued to skyrocket. In 2000, about one in ten Americans were on antidepressants; today, it’s about one in six.

In May, the journal Lancet—among the most prestigious medical journals in the world—published new guidelines for treating depression. The recommendations were drawn from a vast body of scientific literature. The review identifies four practices, other than medication, for healing depression.

These recommendations don’t just reflect the opinions of a small group of mental health professionals. They reflect an emerging consensus within the profession about what the future of depression treatment should look like.

Four Pillars

New research is converging on four pillars for healing depression.

Source: Nesrin art / Pexels

The first pillar is exercise, which ranks as one of the most effective known lifestyle interventions for depression. These include aerobic exercises, walking, jogging, strength training, and yoga. Intriguingly, evidence suggests that strength training is slightly more effective for women and younger adults, and yoga for men and older adults.

Exercise isn’t just about shedding calories. It improves inflammation, metabolism, sleep, and the body’s response to stress—precisely the factors that tend to go awry in depression. In fact, the review authors note, some studies have shown that exercise is even more effective than SSRIs for mild to moderate depression (for example, here).

Sleep is the second pillar in treating depression. Experts hold that the average adult should get between 7 and 9 hours of sleep a night. A growing body of evidence shows that sleep isn’t optional for positive mental health; it’s essential.

When we don’t sleep well, our ability to regulate mood plunges via effects on the amygdala, the prefrontal cortex, and stress hormones. Any of us who’ve gotten a bad night of sleep knows this firsthand. A few bad nights of sleep in a row can feel extremely debilitating.

The problem, of course, is that one of the defining symptoms of depression is sleep disturbance: difficulty falling asleep, difficulty staying asleep, or waking too early. Telling a depressed person to “get more sleep” is hardly useful advice.

This is why the review emphasizes that the first‑line treatment for insomnia is cognitive behavioral therapy for insomnia (CBT-I), not sleeping pills. CBT‑I is more effective than medication and can even be administered through structured online programs over a period of weeks, not months or years.

The third pillar is diet. What we eat is one of the primary ways we modify our brain function. Yet diet has, until recently, been relatively overlooked in the treatment of depression.

Diet matters because it’s tied to a healthy gut-brain axis, the regulation of stress hormones, and the production of brain neurotrophins. To take just one of these pathways, consider the gut-brain axis. (Keep in mind that about 90 percent of the body’s serotonin is stored in the gut, not the brain.) A healthy gut-brain connection depends largely on having the right gut microbiome—the community of microbes that thrive in our digestive tracts.

That community can become impoverished through, among other things, a reliance on ultra‑processed foods and refined sugars. An impoverished microbiome can result in inflammation, digestive problems, poor immune response, and increased stress hormones—all risk factors for depression.

In particular, the review points to evidence that a Mediterranean‑style diet—one rich in fruits and vegetables, whole grains and legumes, and healthy fats like olive oil and nuts—can mitigate depression.

The fourth pillar is psychotherapy. One of the core insights lost in the “Prozac revolution” of the 1990s was the value of a therapeutic relationship for navigating crisis—a safe place to talk through one’s problems with a trusted counselor.

The review lists a number of effective, evidence‑based therapies, including:

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• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Acceptance and commitment therapy (ACT)
• Psychodynamic therapy
• Mindfulness-based therapies

Intriguingly, there’s little evidence that one therapeutic approach is generally superior to another. Any of these approaches can help change the patterns of thinking, feeling, and action that precipitate and sustain depression.

Perhaps the most surprising aspect of the review is how relatively little weight is given to antidepressants. The authors note that SSRIs can help, but they work best in the context of a therapeutic relationship. Moreover, they emphasize that SSRIs are not for everyone. Antidepressants can come with negative side effects, such as sexual dysfunction, insomnia, and in some cases, increased suicidal ideation, as well as discontinuation symptoms, such as dizziness, “brain zaps,” and anxiety. These make SSRIs far from ideal for many.

These four pillars of sleep, diet, exercise, and psychotherapy may sound like common sense, but now, they’re backed by our best current research. What’s striking is not that these practices can help depression, but that they’ve been neglected in medical practice for so long.

Why This Shift Matters

For decades, the dominant narrative has been that depression is a brain disease that can be reversed, or at least managed, with antidepressants. Historically, a number of factors explain why this narrow biomedical view came to dominate the field, as I describe in my recent book.

One factor was that doctors and advocacy groups believed that the biological view would help alleviate the stigma and shame associated with depression. If depression is “kind of like diabetes,” then I shouldn’t be blamed for it, the thinking went.

Unfortunately, research carried out over the last decade shows that the biological view of depression can actually increase stigma and other harms. For example, those who believe their depression stems from a biological cause tend to be more pessimistic about getting better, they tend to think medication is superior to therapy, and they tend to stay on antidepressants for longer.

The upshot isn’t that we should never use medication. What it means is asking different questions in the doctor’s office:

• What are we doing about my sleep?
• How are we addressing movement and exercise?
• What changes should I make to my diet?
• Which type of psychotherapy might I benefit from?

The newer recommendations for depression aren’t just a matter of supplementing the status quo. They point toward a shift that is likely to transform how we think about and treat depression.