Yoga for Depression - Therapy with Yogatherapywithyoga.com/research.pdf · u Sudarshan Kriya Yoga (SKY) – Daily 45 minute sessions once daily for six weeks (breathing based) u ECT

Yoga for Depression

JANIS CARTER & GERARD BYRNEDepartment of PsychiatryUniversity of Queensland

[email protected]@psychiatry.uq.edu.au

Background

u Increasing interest in complementary treatmentsfor depression

u Increasing interest in augmentation ofpharmacological treatments with non-pharmacological ones

u High levels of interest in Yogau Little evidence of the value of Yoga in mental

disorders

RCT: Yoga vs ECT vs Imipramine

u Sudarshan Kriya Yoga (SKY)– Daily 45 minute sessions once daily for six weeks

(breathing based)

u ECT– Modified bilateral ECT three times weekly until

HDRS <7 on two consecutive assessments

u Imipramine– 150mg nocte (no titration)

Janakiramaiah et al., Journal of Affective Disorders, 57: 255-259, 2000

RCT: Yoga vs ECT vs Imipramine

0

5

10

15

20

25

30

Wk 0 Wk 1 Wk 2 Wk3 Wk4

ECTImipramineYoga

HRSD-17

Janakiramaiah et al., Journal of Affective Disorders, 57: 255-259, 2000

N = 45

DSM-IVMDD

BaselineHDRS 24.8

Caveats

u Open labelled studyu No placebo groupu Cultural issues (Bangalore)

Yoga AugmentationFeasibility Study

u N = 8 males war veterans (mainly Vietnam)u Mean age: 60.25 years (range: 53 – 84)u PTSD + MDD (DSM-IV)u All on an SSRI (mainly sertraline)u Open label augmentation with Yogau Baseline self-rated CES-D score: 37 ± 12.39u Baseline clinician-rated HDRS score: 29.9 ± 7.5

Yoga Intervention

u Group Yoga – men onlyu Subjects in good physical healthu Conducted by an accredited Yoga instructoru Classes conducted once a week for an houru Yoga postures derived from instructions of

B.K.S. Iyengar – claimed to be specific fordepression

Upavista Konasana

Ardha Chandrasana

Ustrasana

Baddhakonasana

Viparita Dandasana

Salamba Sarvangasana

Yoga AugmentationIndividual CES-D* Scores over 6 weeks

0

10

20

30

40

50

60

1 2 3 4 5 6

Week*CES-D: Center for Epidemiologic Studies Depression Scale20 items, maximum score 60, > 22 = significant depression

Yoga AugmentationMean Self-Rated CES-D Score

0

5

10

15

20

25

30

3540

1 2 3 4 5 6

Week

Baseline mid-October 2002

Yoga AugmentationIndividual HDRS-17* Scores over 6 weeks

0

10

20

30

40

50

1 3 6Week*HDRS-17: Hamilton Depression Rating Scale17-item version; Maximum score 52

Yoga AugmentationIndividual HDRS-17* Scores over 6 weeks

0

10

20

30

40

50

1 3 6Week*HDRS-17: Hamilton Depression Rating Scale17-item version; Maximum score 52

Longer Term OutcomeContinued Yoga Augmentation

0

10

20

30

40

50

60

1 2 3 4 5 6 14 15 16 17 18 19 22 23 24 25

Gulf War IIEarly Jan 03

Week

Baseline mid-October 2002

CES-D Score

Putative Mechanisms

Diversion & distraction

Self-efficacy

Mastery

Social interaction

Aerobic fitness

Monoamines

Endorphins

Thermogenesis

RCT: Sertraline vs AerobicExercise vs Both

0

5

10

15

20

Sertraline AerobicExercise

Both

Before Treatment

After 16wks ofTreatment

HDRS-17N = 156DSM-IV MDDAge: 57

Blumenthal et al., Arch Intern Med 159: 2349-2356, 1999

F(2,152) = 0.61, p = 0.55

Future Plans

u Six-Week Randomized Controlled Trialu Veterans with PTSD + MDDu Yoga Augmentation of standard

psychiatric treatment (antidepressant +counselling)

u Control condition