How do integrative experts manage depression?
Both medical groups and integrative experts provide recommendations for managing depression. Learn more about the approaches and meanings of recommendations. See Integrative Oncology Programs and Expert Guidelines ›
Clinical practice guidelines
2013 clinical practice guidelines from the American College of Chest Physicians make these weak recommendations with moderate quality evidence for managing depression.
Mind-body approaches as part of a multidisciplinary approach:
Mindfulness-based stress reduction (MBSR)
Psychosocial approaches including cognitive behavioral therapy, relaxation training, imagery/visualization, psychoeducation, and behavioral approaches
Tai chi or qigong
Moderate-intensity aerobic training performed three times per week and for at least 12 weeks or twice weekly combined aerobic plus resistance training lasting 6 to 12 weeks can significantly reduce depressive symptoms in cancer survivors during and after treatment.
Based on sufficient evidence, resistance training alone does not seem to be effective for this outcome.
ASCO recommends that “all patients with cancer be evaluated for symptoms of depression and anxiety at periodic times across the trajectory of care…Failure to identify and treat anxiety and depression increases the risk for poor quality of life and potential disease-related morbidity and mortality.”1American Society of Clinical Oncology (ASCO). Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults With Cancer Guideline Adaptation. April 14, 2014. Viewed June 7, 2021.
Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 5. complementary and alternative medicine treatments ›
2016 clinical guidelines for the management of adults with major depressive disorder Sections 4 (neurostimulation treatments) and 5 (complementary and alternative medicine treatments) include these therapies for mild to moderate major depressive disorder (MDD). These guidelines are not specific to people with cancer.
Repetitive transcranial magnetic stimulation (rTMS) for patients who have failed at least 1 antidepressant)
St. John’s wort
Light therapy for seasonal depression (seasonal affective disorder/SAD)
Omega-3 fatty acids
Transcranial direct current stimulation (tDCS)
Vagus nerve stimulation (VNS)
Saffron (Crocus sativus)
Deep brain stimulation (DBS)
Magnetic seizure therapy (MST)
Rhodiola rosea (roseroot)
- Patients with cancer who are diagnosed with major depression may benefit from pharmacologic or psychosocial interventions either alone or in combination.
- Low-intensity psychosocial interventions include structured group physical activity programs, group-based peer support or self-help programs, and guided self-help programs based on cognitive behavioral therapy (CBT), behavioral activation, or problem-solving techniques.
- High-intensity psychosocial interventions include individual or group CBT, behavioral couples’ therapy, and individual or group supportive-expressive psychotherapies.
The 2017 NCCN Guidelines® on Survivorship include a recommendation to develop a plan for regular physical activity and healthy nutrition as part of management and treatment of anxiety, depression, and distress.
The 2009 guidelines for complementary therapies and botanicals provide these recommendations for managing mood disturbance with cancer.
Mind-body: support and psychotherapy approaches as part of a multidisciplinary approach (strong recommendation, high-quality evidence):
- Cognitive-behavioral therapy
- Cognitive-behavioral stress management (CBSM)
- Support groups
- Supportive/expressive therapy
Mind-body approaches as part of multimodality treatment (strong recommendation, moderate-quality evidence):
- Music therapy
- Other forms of expressive arts therapies
- Relaxation techniques
- Tai chi
Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment › This set of guidelines has been endorsed by the American Society of Clinical Oncology (ASCO).2Lyman GH, Greenlee H et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology. 2018 Sep 1;36(25):2647-2655.
The 2017 Society for Integrative Oncology clinical practice guidelines regarding people with breast cancer provide these recommendations to professionals for managing depressive symptoms or mood disturbance during and after treatment for breast cancer.
High certainty that the net benefit is substantial: offer or provide this modality:
- Mindfulness-based stress reduction (MBSR)
High certainty that the net benefit is moderate; offer or provide this modality:
- Music therapy
- Stress management
Moderate certainty that the net benefit is small; offer or provide this modality for selected patients, depending on individual circumstances:
- Healing touch
This 2023 guideline makes recommendations for managing depression symptoms among people with cancer.
Recommended both during and after cancer treatment
Mindfulness-based interventions (MBIs) (strong evidence)
Yoga among people with breast cancer (moderate evidence, but only weak evidence regarding other types of cancer)
Recommended during cancer treatment
Music therapy or music-based interventions (moderate evidence)
Reflexology (weak evidence)
Relaxation therapies (weak evidence)
Recommended after cancer treatment
Tai chi and/or qigong among people with breast cancer (weak evidence)
Inconclusive evidence to make recommendations for or against use
- Autogenica relaxation technique which involves a series of attention-focusing exercises designed to induce relaxation and enhance the body's self-healing powers training
- Energy healing
- Light therapy
- Nutritional interventions
- Other natural products and supplements
Published programs and protocols
These protocolsa package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care, programs, and approaches by leaders in integrative cancer care provide guidance for managing depression.
We do not recommend specific integrative protocols or programs but provide information for you to evaluate with your healthcare team.
Lise Alschuler, ND, FABNO, and Karolyn Gazella
Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010
Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions including depression.
Gerald M. Lemole, MD; Pallav K. Mehta, MD; and Dwight L. McKee, MD
Lemole GM, Mehta PK, McKee DL. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
These doctors present easy-to-incorporate lifestyle changes to help you “turn on” hundreds of genes that fight cancer, and “turn off” the ones that encourage cancer, while recommending lifestyle approaches to address each type.
Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO
Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Medicatrix Holdings Ltd. 2020.
This book provides information on the treatment of 24 cancers, plus the most effective treatments of the most common symptoms affecting cancer patients while they undergo chemotherapy, radiotherapy, or surgery.
Practitioners of traditional traditional Chinese medicine and Ayurveda offer therapies and approaches to reduce depression.
Learn more about traditional medicine and how to find practitioners: Finding Integrative Oncologists and Other Practitioners ›
This 2014 book by integrative medicine experts and CancerChoices advisors Donald Abrams, MD, and Andrew Weil, MD, desribes a wide variety of complementary interventions to conventional cancer care, including a chapter from the perspective of a cancer patient.
This book mentions interventions that can be helpful in managing depression, including mind-body interventions, cannabis, and—with caution about use with some chemotherapy drugs—St. John’s wort.