Lifestyle habits such as diet, physical activity and sleep are often discussed in the context of mental health, but guidance on how they fit into clinical depression care has been inconsistent. A new expert consensus statement aims to clarify where the evidence is strongest.
The statement, published by the American College of Lifestyle Medicine, affirms that lifestyle interventions can serve as foundational, primary and adjunctive treatments for adults with major depressive disorder (MDD), alongside psychotherapy and medication. The document was published in the American Journal of Lifestyle Medicine.
Developed by a panel of 12 experts in psychiatry, primary care, behavioral health, cardiology and lifestyle medicine, the statement synthesizes existing research into 71 consensus recommendations covering assessment, treatment and long-term management of depression. The goal was not to replace standard care, but to clarify where experts agree lifestyle approaches are supported by evidence and where gaps remain.
“Despite a growing evidence base, lifestyle interventions remain underutilized in mental health care,” said Gia Merlo, MD, clinical professor of psychiatry at NYU Grossman School of Medicine and lead author of the publication. She said the consensus provides clinicians with clearer guidance on how evidence-based lifestyle strategies can be incorporated into depression care.
The panel concluded that physical activity can be used as a primary therapy for adults with mild MDD and that lifestyle interventions more broadly can support treatment across the full spectrum of disease severity. These approaches include nutrition, regular movement, restorative sleep, stress management, social connectedness and avoidance of risky substances.
Nutrition-related recommendations emphasized whole-food, plant-predominant dietary patterns, which have been associated with better mental health outcomes in observational and intervention studies. At the same time, the panel cautioned against ketogenic and very low-carbohydrate diets for depression due to limited evidence and known health risks.
The statement also highlights the importance of assessing baseline lifestyle habits and recognizing barriers that may affect a person’s ability to make changes. These include trauma, social drivers of health, access to food and safe spaces for activity, and individual readiness for change. Tailoring interventions, rather than applying one-size-fits-all advice, was a consistent theme throughout the recommendations.
Depression remains the leading cause of disability worldwide, affecting more than 300 million people, according to the World Health Organization. Rates of major depressive disorder increased by 18% globally between 2005 and 2015. While psychotherapy and medication are effective for many, only about half of patients achieve full remission with those approaches alone.
“Only half of patients with major depressive disorder achieve remission with psychotherapy and pharmacotherapy, while others improve only partially or not at all,” said Ramaswamy Viswanathan, MD, professor of psychiatry at SUNY Downstate Health Sciences University and a co-author of the statement. He said lifestyle interventions can play an important role in improving outcomes and quality of life when integrated into care.
Because the document is an expert consensus rather than a new clinical trial, the authors stress that recommendations should be applied thoughtfully and in conjunction with established treatments. They also identify areas where stronger evidence is still needed, including how specific dietary patterns affect depression across different populations.
This study was supported by the American College of Lifestyle Medicine.