Yoga as a Treatment for Depression

Abstract

Yoga-based practices have been shown to decrease depressive symptoms. This chapter will begin with a case vignette discussing some of the aspects to be considered when assessing whether yoga-based practices should be incorporated into a treatment plan. The case presented shows the benefit of adding of a twice-weekly yoga-based practice to a 12-week treatment plan where pharmacotherapy did not adequately treat symptoms of depression and anxiety. The rest of the chapter will review clinical considerations, as well as the literature examining the application of yoga for depression and associated comorbidities.

FAQs: Common Questions and Answers

• Q1. Who generally practices yoga?

• A1. Large-scale studies have demonstrated that yoga users are more likely to be female, Caucasian, younger, and college-educated [16, 70, 71]. A study of chronic low back pain in low income minority participants found that yoga was perceived as effective for pain relief, mood improvement, and stress management; however, the lack of time represented the greatest barrier to practice [72]. Given the increased burden of disease found in lower socioeconomic populations [73], this study highlighted the need to make yoga-based interventions accessible to lower income populations, especially in ways that may reduce time barriers – e.g., integrated childcare and convenient studio locations. Clinicians and leaders in mental health organizations could consider making yoga classes available by incorporating them into their offerings, by including yoga-based practices as part of various group therapies. Mental health practitioners need to be aware of the potential barriers to entry for lower socioeconomic populations , including less leisure time and access to a yoga studio (both financially and geographically). The demands of working long hours or multiple jobs and childcare/family responsibilities, including travel time to and from work, can significantly limit entry into and maintenance of a yoga practice.

• Q2. What kind of yoga should a patient practice?

• A2. There have been no studies to support one form of yoga as better than any other. In a systematic review of 306 RCTs comparing positive versus not positive trial outcomes of different forms of yoga for any condition, 91% (277/306) of the RCTs were positive for the condition they explored and no differences emerged for the 53 types of yoga interventions studied [74], suggesting that positive outcomes were not related to any particular form or modality of yoga. These findings provided little evidence to guide physicians in referring individuals to specific forms of yoga.

• Q3. Heated vs. non-heated yoga: What’s the difference?

• A3. There are no head-to-head studies comparing heated vs. non-heated yoga for mental health symptoms. In fact, there are no controlled or uncontrolled studies of heated yoga for depression. The potential benefit of adding heat to a yoga practice is supported by the theory that the thermoregulatory system is impaired in depression such that heat has medicinal value, demonstrated by recent studies on whole-body hyperthermia [59, 61]. One of the key components of yoga postures is the stretching of the muscles and fascia. It is postulated that stretching is therapeutic, as it encourages lymphatic circulation and may be related to the immune marker changes associated with yoga practices [75, 76]. Heated yoga may facilitate stretching.

• Q4. Does yoga have benefits over exercise for depression?

• A4. Decreased concentration can be a component of depression, which could make meditation or mindfulness a challenge. It may be easier for some individuals to engage in a series of yoga postures, as the physical movement of yoga may provide a concrete focus for attention. There is evidence that exercise is effective for reducing symptoms of depression in a sample of patients with MDD who did not achieve remission with initial interventions [77, 78] and for increasing positive affect in treatment nonresponders [79]. A review of 12 RCTs comparing yoga to conventional exercise (i.e., running, walking, cycling) indicated that long-term yoga interventions appeared to be equal or superior to exercise in nearly every outcome measured, in both healthy and ill populations [80].