Depression

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: 

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 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.

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.

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.

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.

This 2023 guideline makes recommendations for managing depression symptoms among people with cancer.

Recommended both during and after cancer treatment

Recommended during cancer treatment

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:

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

Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO

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

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