Depression is very commonly experienced and for the sufferer can be extremely debilitating. Sufferers struggle on a daily basis to carry out normal tasks and often feel a complete sense of hopelessness. Little pleasure is gained from once enjoyed activities and depressed individuals often become withdrawn, whilst living with a constant sense of physical and mental exhaustion. Despite the wide range of psycho- and pharmacotherapies available to treat depression, epidemiological studies suggest that around 40% of depressed patients do not respond to first-line treatments, including medication and therapies such as CBT. Even those who do respond to initial treatment strategies will likely continue to experience some residual symptoms and have a chance of relapse of 10-60%.
In addition to these poor response rates, many sufferers are concerned about the side effects and addictive properties that such drugs can have; also, many are still greatly affected by the stigma as well as emotional barriers associated with mental health therapies. It is not surprising that Davidson and colleagues discovered in 1998 that 74% of patients receiving complementary therapies in the UK had been diagnosed with a psychiatric illness at some point in their lives. Of these, 52% suffered major depression or anxiety . A number of more recent studies have found that complementary therapies are very commonly used by patients with depression .
Much recent attention has been given to the practice of yoga and its benefits in depression. Results are in the early phases of proving a direct link to improved/reduced depression severity, but there is a strong positive association emerging in the literature to suggest yoga is a very effective means of reducing symptoms of depression and anxiety disorders. Yoga has developed from the original Indian methods that aimed to bring about ‘self-awareness through spiritual, moral and physical practice’ to the version of yoga we use in the West today. Most commonly Hatha yoga, this modern practice is based on postures, breathing exercises and meditation, which together result in strengthening and stretching of the body and calming of the mind. Potential clinical benefits are related to a range of physiological changes that may occur as a result of yoga practice, and which ultimately result in increased whole-body relaxation.
A 2005 systematic review, comparing five randomised control trials, looked at a range of yoga interventions and their impact on severity of patients’ depression. The trials considered suitable included one that found Iyengar yoga (a form of Hatha yoga), when practised for two one-hour sessions per week, significantly reduced depression rating scores compared with the control group who attended no yoga sessions. Two of the studies looked at the effects of Sudarshan Kriya yoga (SKY), one of which showed that the reduction in depression score of patients attending SKY sessions was comparable to that seen in patients receiving drug therapy, with 67% of the SKY group having a reduced symptom severity at the end of the intervention. The second study also showed that SKY reduced depression scores both with and without the breathing aspect of the practice. One trial looked at 50 female university students randomly assigned to either 30 minutes of yoga per day for 30 days or no intervention. There was no difference between the groups at the start of the trial but a statistically significant reduction in depression rating in the yoga group, but not the control group, existed at the midpoint and the end of the trial. The writers of this review conclude that although these studies were carried out mostly in young subjects with varying depression severity and with relatively small subject numbers, there was an overall trend towards yoga-based therapy having beneficial effects on depressive disorders .
In a similar review carried out more recently, Vebelacher and colleagues looked specifically at Hatha yoga interventions and found eight trials that met their inclusion criteria. Their review concluded that, in patients with depression or clinically elevated depressive symptoms, there was scientific support for yoga therapies in improving severity of illness. This study also drew attention to the shortfalls in the current methodologies of yoga intervention studies, but supported the need for further investigation and clarification of the link to improved depression scores. The researchers attribute the observed benefits of yoga interventions to ‘mindfulness’ and exercise, both key aspects of Hatha yoga and other effective depression treatments.
Mindfulness attempts to promote a state in which we are totally present in that moment and in the actions being carried out, thus forcing the mind to focus completely and solely on the current moment. Yoga has also been found to improve cardiopulmonary fitness, strength, endurance and flexibility of muscles, as well as reduce physical ailments, all of which add to improved physical and overall fitness and perception of health. The authors go on to describe a number of proposed mechanisms of action that may be accountable for the mental health benefits of regular yoga practice. These include:
- Reduced HPA axis activation; the complex system of physical and biochemical responses to stress which are thought to play a role in depression. Reduced HPA activity (and, as a result, reduced plasma levels of cortisol, one of the main stress hormones whose levels correlate with depression severity) has been found in yoga intervention trials carried out in cancer patients and alcoholics
- Increased sleep regulation; since insomnia and depression often go hand in hand, the improvements in sleep efficacy and quality seen in insomniacs practising yoga regularly, are likely to be similar in depression patients
- Reduced rumination; the process by which we get stuck in a cycle of negative and debilitating thoughts is often a fundamental and enduring symptom of depression. The ‘mindful’ aspects of yoga are thought to be key in breaking the rumination process by providing an alternative focus. Studies into mindfulness alone have been shown to significantly improve depression after an eight weeks course
In addition to these possible physiological changes that could be accountable for the positive effects of yoga in depressed patients, it may also provide a more convenient, cost effective and socially accepted alternative to traditional therapies such as CBT .
At this time, results are still inconclusive as to the exact cause of the benefits seen from yoga practice. It is also not currently known what ‘dose’ of yoga is effective or most efficacious at providing the greatest benefit. One study, however, looked at the dose impact of yoga on perceived stress and psychological outcomes in a group of 72 distressed women. These women were randomly assigned to either one or two yoga classes per week, for 12 weeks, or were put on a waiting list and attended no yoga classes. The authors concluded that both yoga groups had significantly reduced perception of stress, as well as seeing improvements in anxiety, depression, psychological quality of life and mood, compared with the control groups. Due to the difficulties people had in regularly attending two classes per week, no dose response relationship could be established. Therefore, some yoga, practised on a regular, if not frequent, basis (as little as once a week), appears to be better than none at all for improving a range of mental health issues . Unfortunately the significant effects of yoga on reducing depressive symptoms appear to only occur in those new to yoga, since Elise and Moore found that symptoms of stress, depression and anxiety did not change over a trial period in previously-participating yoga goers. They did not, however, state the levels of the regular yoga attendees’ symptoms in comparison to new attendees and controls prior to the trial, suggesting these people were already at a lower baseline severity before the intervention .
In light of the above preliminary studies there is considerable support for the use of yoga as a cost effective, convenient and flexible alternative to conventional depression therapies and medications. Unlike many medications, it has no negative side effects when practised correctly and under the guidance of a qualified instructor. It is widely accessible to the general public, considerably more socially accepted than most psychotherapies and has proven beneficial effects on physiological function and general fitness. Yoga may therefore provide a real therapeutic alternative to previously unresponsive or relapsed depression patients, as well as providing considerable benefit to all members of the wider public.
1) Davidson, J.R., Rampes, H., Eisen, M., Fisher, P., Smith, R.d., Malik, M., 1998.
Psychiatric disorders in primary care patients receiving complementary medical treatments. Compr. Psychiatry 39 (1),16-20.
2) Wang, J., Patten, S.B., Russell, M.L., 2001. Alternative medicine use by individuals with major depression. Can J Psychiatry 46, 528-533.
3) Jorm, A.F., Griffiths, K.M., Christensen, H., Parslow, R.A., Rogers, B., 2004. Actions taken to cope with depression at different levels of severity: a community survey. Psychol. Med. 34, 293-299.
4) Pilkington, K., Kirkwood, G., Rampes, H., Richardson, J. 2005. Journal of Affective Disorders, 89 (1-3). pp. 13-24.
5) Ueblacker, Epstein-Lubow, Gaudiano, Battle and Miller. 2010. Hatha Yoga for Depression: Critical Review of the Evidence for Efficacy, Plausible Mechanisms of Action and Directions for Future Research. Journal of Psychiatric Practice,16 (1).
6) Michalsen, A., Jeitler, M., Brunnhuber, S., L¨udtke, R., B¨ussing, A. ,Musial, F., Dobos, G., and Kessler, C. 2012. Iyengar Yoga for Distressed Women: A 3-Armed Randomized Controlled Trial Evidence-Based Complementary and Alternative Medicine. Article ID 408727
7) Campbell, D. E. and Moore, K. A. 2004. Yoga as a preventative and treatment for depression, anxiety, and stress. International Journal of Yoga Therapy, 14, pp. 53-58.
Sophie Tully has joined Igennus as Nutrition Technical Advisor. Passionate about health and fitness, she decided to build on her pharmacology and cancer research background and undertake an MSc in clinical nutrition. Sophie is now determined to show people that ‘optimal health’ is not just being disease-free. It is about living a long and happy life without reliance on medication, or suffering ongoing illness. ‘Health’ results from a delicate balance of nutrition, physical fitness and mental wellbeing, specific to each of us. Each aspect is equally important and reliant on the other two – one element alone can shift the balance and impact on health.