Manual therapy modalities and depression: a systematic review

Depression and other mood disorders have a significant impact on patients, affecting their daily functioning, physical health, and emotional well-being. While psychopharmacological medications and psychotherapy are the most common evidence-based treatments (supported by a significant amount of scientific research), there is growing research that supports the use of complementary therapies (nonmainstream approaches utilized together with conventional medicine), including manipulative or manual therapies.

This systematic review contributes to the existing literature by evaluating published studies on the effectiveness of various manual-therapy modalities in reducing depression symptoms, and it provides a comparative examination of these modalities as complementary treatment options for depression and related mood disorders.

A comprehensive literature search was conducted from January to April 2025 utilizing PubMed, Embase, and Google Scholar. Search results were uploaded to DistillerSR to assist with the screening phase. The study selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria required studies to be to be peer-reviewed, published in English, assessed mood disorder symptoms as a primary variable, utilized validated depression measures pre- and postintervention, and involved manual therapies administered by qualified professionals. Selected articles were independently evaluated by authors with two metrics: a level of evidence (LOE) table and a screening criterion incorporating specific elements from the search process. The Strength of Recommendation Taxonomy (SORT) was utilized to assess the quality of the studies.

The literature search gathered 6,661 articles that were uploaded to DistillerSR. Then 717 duplicates were removed, so 5,944 articles were screened. Ultimately, 5,810 articles were excluded during title and abstract screening. Full-text analysis was conducted on 132 articles, of which 97 met the inclusion criteria. The following modalities were studied: acupressure, acupoint massage, bone setting, chiropractic manipulation, craniosacral therapy, energetic and light touch therapies, manual therapy, osteopathic manipulative treatment/therapy (OMT/OMTh), foot reflexology, massage therapy, and other soft tissue therapies. Each modality was assigned a "B" rating based on SORT. Seventeen studies in the review included patients with specific psychiatric diagnoses, such as major depressive disorder (MDD), depression, adjustment disorder, and seasonal affective disorder, in which manipulative therapies were evaluated for their impact on managing depressive symptoms. Out of these 17 studies, 15 (88.2 %) reported that manipulative therapy led to a significant reduction in depression symptoms. The results of each modality demonstrating beneficial effects in treating depression symptoms are as follows: 6/6 (100 %) acupressure; 5/6 (83.3 %) chiropractic manipulation; 3/3 (100 %) craniosacral therapy; 8/9 (88.9 %) energetic therapies and light-touch therapies; 9/14 (64 %) manual therapy; 5/10 (50 %) OMT/OMTh; 2/3 (66.7 %) foot reflexology; 32/45 (71.1 %) massage therapy; and 2/5 (40 %) other soft tissue therapies.

This systematic review evaluates the current literature indicating that manual therapy may be effective in reducing symptoms of depression as a complementary treatment. Research demonstrates that acupressure, craniosacral therapy, and massage therapy are consistently associated with improvements in depressive symptoms; however, further investigation into other modalities, particularly within psychiatric populations, is necessary. Ultimately, additional research is needed to substantiate the efficacy of manual therapies for individuals with psychiatric disorders.