Antidepressant medication is considered a primary treatment for major depression, but the drugs fail to fully work for more than half of Americans who use them. Now, researchers suggest a way to boost their effectiveness: breathing-based yoga.
In a pilot study published in the Journal of Clinical Psychiatry, researchers reveal how 8 weeks of Sudarshan Kriya yoga improved symptoms of anxiety and depression in patients with major depressive disorder (MDD) who were not responding to antidepressants.
According to the Anxiety and Depression Association of America, depression is the most common mental illness in the United States. In 2014, around 15.7 million adults experienced at least one major depressive episode in the past 12 months.
Symptoms of depression may include persistent sadness, feelings of hopelessness, pessimism, guilt or worthlessness, fatigue, loss of interest in activities, reduced appetite, weight loss, and insomnia.
An individual is usually diagnosed with MDD if they experience at least five of these symptoms for at least 2 weeks, and such depressive episodes may commonly occur after a traumatic event, such as the death of a loved one or a medical illness.
Antidepressants - such as selective serotonin reuptake inhibitors (SSRIs) - are often the first port of call when it comes to treatment for MDD, but patients do not always respond to the drugs. While additional medication may be offered, this can lead to unpleasant side effects that cause patients to stop treatment completely, making relapses more likely.
Now, Dr. Anup Sharma, a neuropsychiatry research fellow at the Department of Psychiatry at the University of Pennsylvania's Perelman School of Medicine, and team suggest Sudarshan Kriya yoga may be an effective, low-cost, non-drug approach to help patients who do not respond to antidepressants.
Investigating how yoga might benefit patients with MDD
Sudarshan Kriya yoga is a meditation technique that focuses on rhythmic breathing exercises, with the aim of placing the mind into a deep, restful state.
"Sudarshan Kriya yoga gives people an active method to experience a deep meditative state that's easy to learn and incorporate in diverse settings," notes Dr. Sharma.
While previous research has suggested Sudarshan Kriya yoga to be beneficial for patients with MDD, Dr. Sharma and colleagues say there have been no clinical studies assessing whether the practice is beneficial in outpatient settings.
What is more, the researchers note that there has been a lack of well-designed studies investigating the possible benefits of yoga for depression, despite a significant rise in the number of Americans taking up the practice.
For their study, the team enrolled 25 adults who had been diagnosed with MDD. All patients had been taking antidepressants for at least 8 weeks but had seen no significant improvement in symptoms.
Patients were randomized to one of two groups for 8 weeks: a Sudarshan Kriya yoga group or a "waitlist" group.
Subjects in the yoga group were required to take part in a six-session program in the first week, which incorporated Sudarshan Kriya yoga exercises, yoga postures, sitting medication, and stress education. For the remaining 7 weeks, participants were asked to attend a once-weekly Sudarshan Kriya yoga follow-up session, as well as complete a practice session at home.
Subjects in the waitlist group - acting as the control group - were offered the yoga intervention at the end of the 8 weeks. Both groups continued with their antidepressant therapy during the study period.
Yoga improved symptoms of anxiety, depression
At study baseline and after the 8 weeks, participants' symptoms of anxiety and depression were measured using the 17-item Hamilton Depression Rating Scale (HDRS-17). Subjects' mean score at baseline was 22.0, representing severe depression.
After the 8-week study period, participants in the Sudarshan Kriya yoga group saw their HDRS-17 score improve by an average of 10.27 points, while the control group showed no significant improvement.
As a secondary measure, the researchers monitored participants' anxiety and depression symptoms using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).
Again, the control group showed no major improvement over the 8 weeks, while the Sudarshan Kriya yoga group showed an average 15.48-point improvement in BDI score and a 5.19-point improvement in BAI score.
Based on their results, Dr. Sharma and team say Sudarshan Kriya yoga may be a promising add-on therapy for patients with MDD for whom antidepressants are ineffective.
"With such a large portion of patients who do not fully respond to antidepressants, it's important we find new avenues that work best for each person to beat their depression. Here, we have a promising, lower-cost therapy that could potentially serve as an effective, non-drug approach for patients battling this disease."
Dr. Anup Sharma
The researchers now plan to assess the effects of Sudarshan Kriya yoga in a larger group of patients with depression, with a particular focus on how the practice affects brain structure and function.