Dr Sam Manger

Dr Sam Manger is a General Practitioner with a focus on lifestyle medicine and mental health. He is the Academic Lead and Senior Lecturer of the postgraduate suite (Master, Graduate Diploma, and Graduate Certificate) in Lifestyle Medicine at James Cook University College of Medicine and Dentistry, as well as the Immediate Past-President of the Australasian Society of Lifestyle Medicine. He is an ambassador for Equally Well Australia, Advisory Group Member of the RACGP Shaping a Healthy Australia project, hosts The GP Show podcast for health professionals and was awarded the RACGP QLD GP of the Year in 2021.


Title: Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder

Author(s): Wolfgang Marx , Sam H. Manger , Mark Blencowe, Greg Murray , Fiona Yan-Yee Ho , Sharon Lawn , James A. Blumenthal , Felipe Schuch , Brendon Stubbs , Anu Ruusunen , Hanna Demelash Desyibelew, Timothy G. Dinan , Felice Jacka , Arun Ravindran, Michael Berk and Adrienne O’Neil

Introduction: The Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder, developed by an international taskforce for the World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce, were designed to provide a global audience of clinicians with a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD).

Method:The taskforce consisted of researchers, including lived experience researchers, and clinicians from nine different countries, with representation from high-, mid-, and low-income countries. Recommendations were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. These guidelines focused on eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria.

Results & Findings: Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and the need to deliver interventions using a biopsychosocial-cultural framework.

Discussion:Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with MDD, where other evidence-based therapies can be added or used in combination. The recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches where data are limited. Further work is also needed to develop innovative models of care, and to support the training of health professionals regarding lifestyle-based mental health care.