Advances in non-pharmacological therapies for depressive disorders: A systematic review

Abstract

Depression is a prevalent mood disorder characterized by persistent dysphoria, anhedonia, feelings of guilt, fatigue, and a spectrum of concomitant emotional and somatic symptoms. As a major public health burden, depression is responsive to both pharmacological and non-pharmacological interventions; however, the clinical utility of these therapeutic strategies is largely undermined by adverse effects and significant interindividual heterogeneity in treatment response. Furthermore, monotherapy with pharmacological agents fails to guarantee adequate clinical efficacy in all patients—a shortcoming that may erode the fragile sense of optimism and motivational drive inherent to this patient population, who are inherently prone to hopelessness due to the core pathophysiological features of depression. Non-pharmacological interventions for depression refer to a set of therapeutic approaches designed to ameliorate the disease, relieve symptoms, alleviate pain, improve function, prolong survival, and facilitate overall health recovery in affected individuals. These interventions, including psychological interventions, medicated food homology-based regimens, dietary therapy, music therapy, acupuncture, and traditional Chinese medicine (TCM) modalities, exert antidepressant effects through multiple mechanistic pathways, such as the attenuation of neuroinflammation, modulation of neurotransmitter release and metabolism, enhancement of neuronal plasticity, and regulation of the gut-brain axis. In light of the aforementioned challenges and potential of non-pharmacological interventions, this review systematically summarizes their clinical applications and mechanistic underpinnings to provide an objective evidence-based evaluation, and further explores the therapeutic efficacy of different non-pharmacological interventions in mitigating depressive symptomatology.