Depression is the second most disabling condition in the United States and following successful treatment, many patients will suffer from recurring depressive episodes. A new study published in PLOS ONE investigated the effects of treating major depression with yoga.
The World Health Organization describes major depression, a mental disorder characterized by at least two weeks of consistent low mood, low energy, and loss of interest in normal activities, as the second most disabling condition in the United States. Depression is a contributor to almost 50,000 deaths in the United States each year through suicide. Additionally, depression can influence other medical conditions including coronary artery disease and diabetes.
The most common treatments for depression are antidepressant medications and/or psychological interventions including cognitive behavioural therapy, interpersonal therapy, and supportive group therapy. However, only half of Americans diagnosed with depression will receive any care, and once treatment is initiated, dropout rates are up to 50%. Dropout is influenced by cost, duration of treatment, stigma surrounding mental illness and lack of rapport between the patient and therapist. Additionally, even after successful treatment for depression, more than half of individuals who suffered from one episode of depression will have a recurrent episode within a few years. Thus, it is imperative to develop novel treatments for depression that are affordable and accessible.
The practice of yoga began more than 5000 years ago in India as a method to harmonize body, mind and spirit. Yoga is gaining popularity in the United States where nearly 10% of the population partake in the activity. Yoga exercises are easily adapted for individuals with medical problems or for those who find physical activity difficult. Yoga is appealing for the treatment of depression due to its low cost, ease of access, and high social acceptance.
A number of randomized controlled trials have been conducted to assess the mood benefits of yoga. However, investigation is still at an early stage as the benefits of yoga are subject to publication bias to positive studies. A new study published in PLOS One investigated the mood benefits of hatha yoga as a monotherapy for depression in 38 adults in the United States who met the criteria for depression of mild-to-moderate severity. In this study, participants were randomized to receive either 90-minutes of hatha yoga practice twice weekly for 8 weeks, or to attend a 90-minute attention control education group during the same time period. The primary outcome measured was severity of depression, through Beck Depression Inventory-II (BDI) scoring, a self-report psychometric test used to quantify stages of depression. Secondary outcomes were self-efficacy and self-esteem, measured by two independent scales at baseline and following treatment.
The results of this study showed that yoga participants had a greater decline in BDI scores than the control group, indicating that participating in yoga decreased the severity of their depression symptoms. Additionally, yoga participants were more likely to achieve remission stage. Interestingly, BDI scores did not differ between the two groups until the final measurement point, suggesting that there may be a delay in the onset of yoga-mood benefit that may be related to the time required for individuals to learn the yoga exercises. Additionally, pharmacological treatment for depression usually has a delay of 4 weeks before exerting mood effects, so participating in yoga for even longer periods of time may provide additional mood benefits.
Limitations of this study are that the study group was small, and that an effective ‘dose’ of yoga is not well known. Therefore, it is unknown whether participants would benefit from participating in yoga more often, such as a daily or near-daily basis. Additionally, because a difference between the two treatment groups was only observed in the last measurement point, this difference could be due to chance and not the effect of yoga.
Overall, this study showed that patients may benefit from depression with yoga. Future studies should be aimed at identifying yoga-specific mood effects on depression in larger and more diverse populations for a longer period of time. Additionally, researchers should study if participating in yoga more often is more beneficial to mood. If yoga is validated as providing mood benefits, it could be combined with conventional anti-depressant therapies and provide long-term benefits for patients.
Written By: Neeti Vashi, BSc