Yoga and its use for depression

By Amulya Sajja, MS4 and Samuel Mathis, M.D.

Depression is a common diagnosis that is seen in almost all medical practices. It is characterized by feelings of sadness or guilt and changes in sleep, energy, appetite, concentration. In severe cases, it can also cause psychomotor symptoms and suicidal ideations. Prompt and appropriate treatment is vital to improving patient quality of life and for safety. With the increased stress of Covid-19, cases of depression and anxiety have significantly increased in the US and many patients are seeking both treatment and alternative therapies to help with their symptoms. One potential integrative therapy that can provide significant assistance in the treatment of depression is the practice of yoga.

Yoga originated from Hinduism and Buddhism, is a mind-body intervention that involves movement, breathing, mindfulness, meditation, mantras, and/or rituals with the intent to unify the mind, body, and spirit. It has been practiced by individuals for over 5,000 years and has numerous subsets and variations in types of movements performed or settings of practice. In addition to its health benefits of improved flexibility, improved strength, and a decrease in a number of pain syndromes, research has shown the use of yoga helps decrease symptoms of depression. In addition, it is thought that the mindfulness part of yoga provides a focus that helps suppress ruminative thoughts (commonly seen in depression).

Positive physiological effects have been observed with yoga in terms of autonomic responses and inflammation. Yogic practices stimulate parasympathetic responses such as decreased heart rate, improved heart rate variability, and decreased blood pressure. The parasympathetic response is enhanced further when combined with the deep breathing practices associated with the movements. The deep breathing exercises improve oxygen levels as well as activation of the Vagus nerve through the diaphragmatic movement to create the parasympathetic response. Studies have shown that C-reactive protein levels and other inflammatory markers, including cortisol, decrease with yoga practice. Furthermore, elevations in several hormones, including GABA, serotonin, and dopamine, which function as natural “anti-depressants,” have been observed in individuals who practice yoga. When coupled with an SSRI, the added effect of both increased production and decreased reuptake of serotonin can cause a significant improvement in mood. Regular yoga practice also improves sleep through its increase in the natural production of melatonin in practitioners.¹ Improved sleep plays a vital role in improving depressive symptoms as the sleep/wake cycle is often compromised in patients with depression.

Several studies demonstrate an improvement in levels of hormones in individuals with depressive symptoms who practice yoga. One study found a 27% increase in GABA levels just after one 60-minute yoga session². This increase in GABA can cause decreased feelings of anxiety and improved focus and concentration. In addition, a study comparing medication-only therapy, yoga-only therapy, and combined therapy (yoga and medication) in patients with clinical depression found a significant decrease in cortisol levels in the yoga-only group and combined group, as compared to the medication-only group.¹

Studies conducted on individuals with depressive disorder or depressive symptoms demonstrated an improvement in symptoms after they practiced yoga. A systematic review looking at the efficacy of yoga in managing depression described positive effects, after practicing yoga, in many specific subset groups of individuals who have had depressive symptoms. These groups included pregnant women, patients with chronic low back pain, breast cancer patients, caregivers, and patients diagnosed with major depressive disorder.³ Each group reported decreased symptoms of depression as well as improvement in mood. Multiple other studies have shown statistically significant improvement in depressive symptoms in patients who are on anti-depressants as well as not on any medication.

While yoga does not replace the standard therapy for depression, there is growing support for the use of yoga towards improving stress and stress-related psychological conditions associated with depression. Strong evidence exists for the implementation of yoga as a complementary therapy for patients with depressive disorders. It is useful to discuss the known evidence-based benefits of yoga with patients and to ask those with depression if they are interested in this mind-body practice. Given its health and psychological benefits, yoga is an excellent addition to the standard of care in patients with depression.

 

References

1. Stephens I. (2017). Medical Yoga Therapy. Children (Basel, Switzerland), 4(2), 12. https://doi.org/10.3390/children4020012
2. Cavaliere, PhD, C. (2020, October 12). Yoga and GABA: New Insights from the Science. Iris Publishers. https://irispublishers.com/wjypr/fulltext/yoga-and-gaba-new-insights-from-the-science.ID.000541.php.
3. Bridges, L., & Sharma, M. (2017). The Efficacy of Yoga as a Form of Treatment for Depression. Journal of evidence-based complementary & alternative medicine, 22(4), 1017–1028. https://doi.org/10.1177/2156587217715927