Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation

 

Am Fam Physician. 2019 May 15;99(10):620-627.

  Patient information: See related handout on exercise, yoga, and meditation for anxiety and depression.

Author disclosure: No relevant financial affiliations.

Many people with depression or anxiety turn to nonpharmacologic and nonconventional interventions, including exercise, yoga, meditation, tai chi, or qi gong. Meta-analyses and systematic reviews have shown that these interventions can improve symptoms of depression and anxiety disorders. As an adjunctive treatment, exercise seems most helpful for treatment-resistant depression, unipolar depression, and posttraumatic stress disorder. Yoga as monotherapy or adjunctive therapy shows positive effects, particularly for depression. As an adjunctive therapy, it facilitates treatment of anxiety disorders, particularly panic disorder. Tai chi and qi gong may be helpful as adjunctive therapies for depression, but effects are inconsistent. As monotherapy or an adjunctive therapy, mindfulness-based meditation has positive effects on depression, and its effects can last for six months or more. Although positive findings are less common in people with anxiety disorders, the evidence supports adjunctive use. There are no apparent negative effects of mindfulness-based interventions, and their general health benefits justify their use as adjunctive therapy for patients with depression and anxiety disorders.

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.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

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 depressive510 and anxiety disorders,1113 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.3436

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 = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

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 depressive510 and anxiety disorders,1113 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 tr

The Authors

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SY ATEZAZ SAEED, MD, is professor and chairman of the Department of Psychiatry and Behavioral Medicine at East Carolina University Brody School of Medicine, Greenville, N.C., and executive director of behavioral health service line for Vidant Health, Greenville....

KARLENE CUNNINGHAM, PhD, is clinical assistant professor in the Department of Psychiatry and Behavioral Medicine at East Carolina University Brody School of Medicine.

RICHARD M. BLOCH, PhD, is professor emeritus in the Department of Psychiatry and Behavioral Medicine at East Carolina University Brody School of Medicine.

Address correspondence to Sy Atezaz Saeed, MD, Brody School of Medicine, East Carolina University, 600 Moye Blvd., Ste. 4E-100, Greenville, NC 27834 (e-mail: saeeds@ecu.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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