With the increasing prevalence of depression in adolescents, screening requirements increasingly fall on pediatric primary care providers, who encounter more at-risk patients. A new review of the literature in Harvard Journal of Psychiatry highlights evidence that non-traditional so-called lifestyle interventions can help providers meet the growing need for depression management in young people. The journal is published in Wolters Kluwer’s Lippincott portfolio.
The article reviews studies of lifestyle medicine interventions related to physical activity, sleep, nutrition, substance use, social connections, and stress management and provides recommendations of clinical practice. “Having additional and more comprehensive detail about these lifestyle recommendations could help clinicians incorporate specific guidance into anticipatory referral, management, and treatment plans,” suggest Talia S. Benheim, BA , and colleagues at Massachusetts General Hospital, as well as Michelle Dalal, MD. , from the University of Massachusetts Chan Medical School and Daniel Hosker, MD, in the September/October issue of Harvard Journal of Psychiatry.
Lifestyle medicine interventions can alleviate lack of access to traditional mental health treatments
Depression in adolescents is strongly associated with negative educational, occupational and health outcomes well into adulthood, and studies highlight the importance of early and timely access to mental health interventions. Yet the inaccessibility of mental health services persists, especially among marginalized populations.
The usefulness, versatility and cost-effectiveness of lifestyle interventions are well known. They can be used by both licensed and unlicensed vendors; implemented on its own or as part of a larger treatment plan; administered in person or virtually, with a single patient or in a group; and are often more cost-effective and adaptable to unique patient cultural situations.
The article reviews the evidence for lifestyle interventions in physical activity, sleep, nutrition, substance use, social connections, and stress, demonstrating the effectiveness or feasibility of reducing depressive symptoms in adolescents. The studies included clinical trials, quantitative studies, and qualitative studies, as well as the authors’ own clinical experience.
Whether physical activity is considered light or vigorous, many studies demonstrate the effectiveness of physical activity in reducing symptoms of depression. For example, one found that a two-hour decrease in sedentary activity in patients aged 12 to 16 reduced depression scores by 16% to 22% at age 18. .
Sleep problems in adolescents persist into adulthood and have been associated with a lack of response to depressive treatment and are even a risk factor for suicide. Yet one study showed that simple, specific guidelines for healthy sleep habits improved depressive symptoms. Bedtime routines such as journaling or maintaining relaxation activities, as well as cognitive behavioral therapy for insomnia, are also important.
Nutritional studies demonstrate that a healthy plant-based and whole-food diet can alleviate or reduce depressive symptoms. The authors suggest a number of simple intervention approaches, such as tip sheets or recipes, the engagement of professional nutritionists, and advice on so-called mindful or intuitive eating.
Cannabis, alcohol, and nicotine are also associated with depression in adolescents and can interfere with effective treatment of both. Studies show that early intervention is essential. An online program in Australia showed that increased knowledge of substances, depression and anxiety reduced the likelihood of drinking.
In adolescents, loneliness is correlated with depression and the lack of social connections is a predictor of suicidal ideation. One study found that increasing connectivity over time had corresponding reductions in adolescent suicidal ideation. Many forms of connection; for example, through extracurricular activities such as clubs and sports; have been shown to be effective in reducing depressive symptoms and may overlap with other lifestyle interventions.
Finally, interventions aimed at helping patients cope with and manage stress can favorably influence the onset, maintenance and severity of depression. Successful interventions include deep breathing, meditation, muscle relaxation techniques, and mindfulness-based cognitive therapy.
The authors warn that interventions involving significant behavior change can be difficult, especially without social, financial or cultural support. Despite the paucity of randomized controlled trials of interventions that promote psychological and health behaviors (eg, physical activity), Benheim, Dalal and colleagues believe that these interventions can help meet the growing need for mental health services and empower teens and families with the knowledge, skills and habits to fight depression.
Benheim, TS, et al. (2022) Back to Basics: Lifestyle Interventions for Depression in Adolescents. Harvard Review of Psychiatry. doi.org/10.1097/HRP.0000000000000343.