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Depression and anxiety disorders are among the most common psychiatric conditions, with an estimated 19.1% of U.S. adults experiencing anxiety and 10% experiencing depression in the past year.1 Nearly one-half of people diagnosed with depression will also experience comorbid anxiety. In addition, many will have symptoms that are distressing, but that do not meet duration or intensity criteria to enable a clinical diagnosis. Complementary and integrative therapies (e.g., exercise, meditation, tai chi, qi gong, yoga) are often sought by patients experiencing these conditions. This article provides a concise overview of the evidence on the effectiveness of complementary therapies in treating these conditions.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| Exercise can be a modestly beneficial adjunctive treatment option for depressive and anxiety disorders, especially treatment-resistant depression, unipolar depression, and posttraumatic stress disorder. | B | Several systematic reviews and meta-analyses show positive effects of exercise on depressive5-10 and anxiety disorders,11-13 but the strength of these effects varies. General health benefits justify its use as an adjunctive intervention for depression and anxiety disorders. |
| Yoga is a therapeutic option for depression and has positive effects in people with anxiety disorders, particularly panic disorder. | B | Yoga can be suggested as a monotherapy for depression, but it is preferred as an adjunctive treatment for depression and anxiety.22,26,27,31 The optimal frequency and duration are not clear, but studies have shown symptom reduction with one 60-minute session per week.16,29 |
| Tai chi and qi gong have inconsistent effectiveness as complementary treatments for depression and anxiety. | B | Tai chi and qi gong have shown inconsistent effects on anxiety and depression in several small studies. In studies that demonstrate benefits, their effect on depressive and anxiety symptoms is small.34-36 |
| Mindfulness-based interventions are effective as adjunctive treatment for depression, with positive effects persisting through follow-up. Their effects on anxiety disorders also seem to be positive. | B | There is limited support for mindfulness-based interventions as a monotherapy for depression or anxiety disorders, although they may be effective for preventing relapse or as an adjunctive treatment.28,38,44 Until further adequately powered trials are conducted, physicians should use caution in recommending these interventions as a first-line treatment for anxiety or depressive disorders. |
A = consistent, good-quality patient-oriented evidence; B =...