"The premise of this is great," says Earric Lee, a physiologist with the Montreal Heart Institute, who was not involved in the study but has led sauna studies since completing his doctoral research in Finland. "Trying to move away from pharmacology is a good thing." More than 250 million people worldwide have major depressive disorder, and tens of millions of people don't respond to any available treatment.
Such a small study doesn't prove that sauna therapy can treat depression. "Single-arm studies have meaningful weaknesses," Mason admits. The cohort was too small to test multiple scenarios, such as varying degrees of heating, CBT without heat, or an attempt at a placebo. (Tricking people into thinking they've had heat treatment when they haven't is difficult, but not impossible-the 2016 study into hyperthermia had a placebo arm that subjected people to mild heat, and convinced 72 percent of participants that they were receiving the actual treatment.)
But these results harden Mason's hunch that heat sessions may ease debilitating symptoms of depression, and that this is an avenue that needs to be better explored. Eight weeks of CBT alone shouldn't achieve such high remission rates.
Adam Chekroud, an adjunct assistant professor of psychiatry at Yale University, appreciates the potential benefit of the hyperthermia routine, but remains skeptical about why Mason's study produced the results reported. For one, some of the participants completed weekly sauna sessions in Mason's study while others completed fortnightly sessions; Chekroud believes that the benefit of receiving a "higher dose" of heat would manifest itself if the intervention were as strong as effective antidepressants. "The placebo effect is powerful in mental health," he says.
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