Lifestyle interventions as adjuvant treatments for depression: An umbrella review of systematic reviews and meta-analyses

BACKGROUND: Depression is a high-prevalent mental health disorder that significantly affects quality of life and remains a leading global contributor to disability. Although pharmacological and psychological interventions are effective, many patients fail to achieve complete remission of depressive symptoms. Current evidence suggests that lifestyle-based interventions may offer a promising strategy as an adjuvant treatment for depression. OBJECTIVE: To evaluate the effectiveness of lifestyle-based interventions as adjuvant treatments for reducing depressive symptoms in adults. METHODS: We conducted an umbrella review of systematic reviews and meta-analyses of randomized controlled trials (RCTs) evaluating lifestyle-based interventions for adults with depression. Searches were performed in Medline/PubMed, PsycINFO, Web of Science, Cochrane Library, and Scopus from inception to March 2025. The review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD42024420246). Two reviewers independently screened studies, extracted data, and assessed methodological quality using AMSTAR-2, with discrepancies resolved through discussion with a third author. Findings were synthesised narratively. RESULTS: Forty-six systematic reviews were included. Exercise interventions showed the most consistent antidepressant effects, particularly supervised moderate-intensity aerobic and resistance training. Mind-body therapies demonstrated moderate-to-large benefits, especially in older adults. Dietary interventions showed small-to-moderate benefits and multicomponent interventions yielded small short-term effects, although their effectiveness was limited by heterogeneity and follow-up decline. The methodological quality was predominantly low in the included reviews. CONCLUSIONS: Lifestyle-based adjuvant interventions show relevant antidepressant effects, particularly supervised moderate aerobic exercise and mind-body therapies. However, heterogeneity and low methodological quality limit conclusions, highlighting the need for robust trials to define optimal dosing, durability, and effectiveness.