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: 

Hypnosis

Meditation

Mindfulness-based stress reduction (MBSR)

Music therapy

Psychosocial approaches including cognitive behavioral therapy, relaxation training, imagery/visualization, psychoeducation, and behavioral approaches

Tai chi or qigong

Yoga

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)

Two guidelines address different types of therapies.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. neurostimulation
treatments ›

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.

First-line therapies

Repetitive transcranial magnetic stimulation (rTMS) for patients who have failed at least 1 antidepressant)

Physical activity 

St. John’s wort

Light therapy for seasonal depression (seasonal affective disorder/SAD)

Second-line therapies

Omega-3 fatty acids

SAMe

Yoga

Light therapy

Third-line therapies

Transcranial direct current stimulation (tDCS)

Vagus nerve stimulation (VNS)

Acetyl-L-carnitine

Saffron (Crocus sativus)

DHEA

Folate

Lavender (Lavandula)

Acupuncture

Sleep deprivation

Investigational therapies

Deep brain stimulation (DBS)

Magnetic seizure therapy (MST)

Not recommended

Inositol

Tryptophan

Rhodiola rosea (roseroot)

Management recommendations:

  • 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.

Society for Integrative Oncology

Two guidelines discuss managing depression among people with cancer.

Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals ›

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): 

  • Hypnosis
  • Meditation
  • Music therapy
  • Other forms of expressive arts therapies 
  • Relaxation techniques
  • Tai chi
  • Yoga

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)
  • Relaxation

High certainty that the net benefit is moderate; offer or provide this modality:

  • Massage
  • Music therapy
  • Stress management
  • Yoga

Moderate certainty that the net benefit is small; offer or provide this modality for selected patients, depending on individual circumstances:

  • Acupuncture
  • 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
  • Biofeedback
  • Energy healing
  • Light therapy
  • Massage
  • Melatonin
  • Nutritional interventions
  • Psilocybin
  • Reflexology
  • 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

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.

Traditional medicine

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 ›

Other assessments

Integrative Oncology, Second Edition ›

By Donald Abrams, MD, and Andrew Weil, MD

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.

Helpful link

Authors

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Maria Williams

Research and Communications Consultant
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Maria Williams is a research and communications consultant who brings over 15 years’ experience in research, consumer education, and science communication to CancerChoices. She has worked primarily in public health and environmental health.

Maria Williams Research and Communications Consultant

Last update: January 8, 2024

Last full literature review: November 2021

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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