Lifestyle Interventions for Major Depressive Disorder (MDD): An Expert Consensus Statement From the American College of Lifestyle Medicine

Objective: To identify statements of consensus on integrating lifestyle medicine (LM) into treating major depressive disorder (MDD) in adults to improve quality of care and patient health outcomes. Methods: Experts in MDD, primary care, and behavioral health followed an a priori protocol for developing consensus statements. Using an iterative, online Delphi process, panel members reported levels of agreement, and statements were classified as consensus, near consensus, or no consensus. Results: The panel identified 102 candidate statements addressing: (1) MDD and Lifestyle Risk: Assessment and Treatment, (2) Evaluation, Diagnosis, and Special Populations, (3) Nutrition and Gut Health, (4) Physical Activity, (5) Sleep, (6) Connectedness, (7) Substances and Environmental Factors, (8) Adherence to Treatment and Optimizing Treatment. After 3 iterations of an online Delphi survey, revisions, and removal of duplicative statements, 71 statements met criteria for consensus, 10 for near consensus, and 21 for no consensus. Consensus was reached on key topics that included the importance of lifestyle interventions for treatment and prevention of MDD, strategies for adoption, and benefits for health outcomes and treatment success. Conclusion: Using lifestyle interventions for treating MDD can be strengthened by applying these statements to improve quality of care, inform policy, and identify areas for future research.