Tuesday, May 4, 2010

Yoga and Depression:
The Possibility of Yoga as a Supplemental Treatment for Depression

Margret Hall

Yoga: Theory, Culture, and Practice
Professor Laura Douglass
May 3, 2010

Depression is a common disorder in the United States; nearly 7 percent of the population over the age of 18 is diagnosed with a major depressive disorder every year (NIMH, 2010). For those who seek treatment, allopathic medicine generally treats depression with medication and/or counseling. Due to the adrenaline and endorphins released, exercising is well known to improve mood and promote an overall sense of well-being, but exercise alone is often not enough for one who is seriously depressed. Yoga, having been popularized in the United States as a workout practice for toning and strengthening, might have benefits beyond physical. New research links yoga with the relief of symptoms of depression in many individuals (Morgan, 2008). The combination of practicing pranayama, asanas, and restorative yoga can treat the physical effects of depression as well as the emotional and mental effects.
While the classical goal of yoga is to lose all sense of “I” and transcend to enlightenment, the Western appreciation of yoga has mainly been of its physical effects. Few yoga classes in the United States teach yoga for the purpose of enlightenment. Learning yoga is often a rigorous practice in more traditional schools, with great emphasis placed on the teacher-student relationship (Chapman, 1996), whereas in the Western practice it is a large group class that only touches upon the intensive practices of Hatha Yoga. Is it admirable for Americans to even be getting this small insight in yoga and the yogic doctrine, or would we, as a society as well as individuals, be better benefited by more in depth teachings that explore the spiritual parts of yoga in addition to the physical? As most people need gradual change, it is an important step for yoga to be gaining in popularity in the U.S. and in researching the psychological effects of yoga I believe Americans are getting closer to understanding and appreciating the traditional benefits of yoga, though in an adapted way. These adaptations align with the history of yoga in that each yogi teaches their own type of yoga, and practices are tailored to each individual.
Yogic Theories of Depression
Just as there in many different types of yoga being practiced around the world, there are many different explanations of what yoga can achieve. Yoga teacher Arthur Kilmurray focuses on the classic Vedenta teaching of innate wholeness. Reaching a state in life where one has both “a mature and integrated self sense, [and] knowing the infinite depths of Being and the infinite possibilities of our life’s unfolding” is the goal of yogic practice for Kilmurray (“Wholeness and Healing,” 2008, p. 32). The individual is already whole, he just needs to reconnect with and invest in this belief. This acceptance is a form of taking responsibility for one’s life and releases the individual from struggle with himself or herself. Kilmurray also states that the body and mind are in constant flux, and this can be a form of stress to the individual until he or she learns to release the need for stability in an impermanent world (p. 32).
Amy Weintraub, creator of Life Force Yoga, teaches that in yogic theory, depression comes from a mistaken feeling of separation from the world. The spiritual side of yoga focuses on an interconnectedness within everything in the Universe, and, again, the acceptance of wholeness within oneself. (2009). Reconnecting to the world and ending self-imposed isolation, be it physical or mental, promotes a sense of unity. This unity with the flow of life and the universe can relieve the negative feelings that accompany depression (“Wholeness…,” p. 32). Negative feelings lead to suffering which shuts down the individual makes them defensive, rather than promoting introspection and problem solving. Suffering tends to overtake one’s whole being and becomes the defining characteristic of their identity. Kilmurray sees the solution for this problem in yoga’s teaching of acknowledgement of these negative emotions rather than giving them the power to consume one’s being. This witnessing approach is an important facet in yogic practice and will be investigated further in this paper.
Along similar lines as Weintraub, Dr. Swami Vivekananda Saraswati states that what is missing from most treatments for depression is the spiritual element. Saraswati’s own personal experience with depression led him to God after many years of studying psychiatry. If a person is spiritual, “…there is a power in words and there is energy that comes out from the person and, according to the degree of energy and power that person has, the recipient of the words will improve” (“Yogic Treatment of Mental Illness,” 1995). The spiritual person has positive life force energy (“prana” in yogic terms), which can be healing for those around them, and inspire them to improve their own life force energy.
Western Theories of Depression
Symptoms of depression are greatly varied and changeable for each person. For some people, depression may manifest itself as being very tired all of time, but being unable to sleep. For others, sleeping too much is an important symptom. Generally, the most common symptoms are being in a low mood, seemingly unprompted crying spells, mood swings, inability to deal with stress and make decisions, suicidal thoughts, feelings of hopelessness and worthlessness, and changing in weight and eating habits (National Institute of Mental Health, 2009). Individually these symptoms can be managed, but they effect every facet of a depressed persons life and suddenly everything is overwhelming and there is no way to sort it out by one’s self. Most cases of depression are undiagnosed and never treated (NIMH, 2009), so it is probable that many people suffer their whole lives thinking, “This is just the way I am.” Even if one acknowledges that they might be depressed, it can take a long time for them to seek help by themselves because depression makes it hard to motivate. There also seems to be a general feeling that depression is something to be ashamed of, and that it’s something one should be able to control themselves when really there are legitimate scientific reasons for most cases of depression. This mindset is changing as depression gets more and more press, but it is still difficult thing to talk about openly for most people.
Depression is believed to come from any of a number or sources, including but not limited to traumatic life events, genes, biochemical imbalances, and hormonal changes, and stress. There can be a genetic predisposition to depression in a family, but depressive ways of behaving can also be learned, according to Michael Yapko in an article for Psychology Today. Experiences are as influential as genes when it comes to neurochemistry, affecting the way one problem-solves, goes about making decisions, and their attitudes about themselves. These two factors can compliment each other, or exacerbate each other. The causes of depression are completely individual and difficult to pin down from person to person, and thus the treatment of depression is variable and involves a lot of trial and error. The National Institute of Mental Health cites four specific antidepressants that can be used to help alleviate the symptoms of depression, but acknowledges that the medications affect each individual differently and also are accompanied by many side effects. From personal experience I know that while doctors make educated decisions about which medication to prescribe for someone, sometimes the medication can exacerbate the symptoms of depression rather than helping them. Anti-depressants usually need to be taken for four to six weeks before the real effects of them can be ascertained (NIMH, 2009), making the process of finding the right medication for an individual and lengthy and often exhausting one.
Another popular method of treating depression is psychotherapy. A therapist can provide an unbiased opinion and help the patient work through ways to manage their symptoms, as well as figuring out what might be influencing their depression. While family and friends can be great support systems, they usually do not carry the backgrounds that trained professional therapists do so it is important to seek outside help of some kind. Often, psychotherapy is paired with medication as the treatment plan, and duration of treatment is recommended as at least one year (NIMH, 2009). It can take a long time to start feeling relief from depression no matter what treatment plan is chosen, but effective tools can be learned in psychotherapy that may help one not only overcome their depression, but successfully manage bouts of depression in their future without outside help.
Yoga as Supplemental Therapy
They physical benefits of yoga are well known in the United States. Most people know yoga through classes offered at gyms or yoga studios in their area, thanks to its current popularity in our culture as a strengthening and toning exercise, but this only scratches the surface of the possibilities of benefits from regular yoga practice. Yoga has only fairly recently begun to be researched in conjunction to depression; due to the many variables in depression and the difficulty to finding a way to qualitatively explain results, reputable studies are hard to find. Still, those studies that have been done generally conclude that there are possible benefits from yoga for depressed individuals (Morgan, 2008). To understand more exactly how yoga can be used as a treatment for depression, it needs to be broken up into the different facets of practice: asanas, pranayama, meditaion and mindfulness, sutras, and sanskara. Each part of yoga has a specific purpose in the history of yoga, and American practitioners would benefit from researching these more in depth. At first, Americans may react negatively to parts of a classic yoga practice, such as chanting, meditation, cleansing rituals, etc, but given the existing malleability of yoga, it can be adapted so that slowly, more and more facets of classical yoga are integrated into American practice.
Pranayama and Asana
Pranayama are the breathing techniques in yoga. In yogic theory, the breath is what allows the life force energy to enter into the body (Mohan, 2006). Ancient yogis learned that through control of inhalation and exhalation, one could learn to control the mind (McCall, 2007). The breath is completely integral to the practice of yoga; it allows you to deepen your poses, stay focused, and is key to access the relaxation effects of yoga. Bo Forbes, in an article about yoga for anxiety and depression published in the International Journal of Yoga Therapy, states that different breath ratios can be used to different effects, depending on the state of the practitioner. Exhaling twice as long as inhaling is good for an anxious body and mind, and calms the practicioner. To enliven the mind, she suggests an equal ratio of exhalation to inhalation (2008)
One of the most dynamic breathing practices is bhastrika, or the “bellows” breath. When practiced correctly, this breath stimulates blood circulation by rhythmic pumping of the diaphragm and lungs (Muktibodhananda, 1985, p. 257). This particular breath also accelerates pranic movement, especially in the thoracic and brain centers (p. 258). The forceful exhalation empties the lungs of air, readying them for a burst of fresh new oxygen, which invigorates the organs and the mind. I have found that this breathing practice in particular clears my mind while awakening it, and relieves me (if only for a few moments) of the overwhelming emotions and thoughts of depression. In general, focusing on controlling the breath calms an anxious mind, but with extensive pranayama practice, yogis believe it can do much more than that.
Asanas, the postures, also have healing and cleansing effects on the body. Each posture specifically benefits a particular organ or muscle group. Life Force yoga creator Amy Weintraub has selected specific postures, breathing exercises, mantras, etc and ordered them into a routine to help relieve the symptoms of depression. She cites many physiological benefits of her routine (and yoga in general), including a decrease in cortisol, which is a stress hormone, improved oxygen absorption and carbon dioxide elimination, increased alpha and theta waves, and regulation of the hypothalamus. All of these testable factors theoretically can relieve depression symptoms, but if one does not stick with the practice they will probably not experience results. Still, yoga seems to have more immediate effects than mediation and therapy, so it is likely that if a person goes once, they may go back again and again.
Samskara, Yoga Sutras, and Mindfulness
Repetition is a key component of yoga. Through repetition, one learns more about one’s body and, once a series of postures is learned, will eventually be able to focus purely on the mind when practicing. Repetition of pranayama allows one to practice more advanced pranayama techniques, while improving lung capacity and affecting the way one breathes every day. These repetitions go beyond the way one breathes and moves, however; actions in life and modes of thinking become habits, bad or good. Ancient yogis called this habits samskaras, and believed that every time one thinks or does something, they increase the likelihood that they will think or do it again (McCall, 2007, p. 20). These habits can eventually be looked upon as one’s nature, but they can be unlearned with work, just as they were learned.
The Yoga Sutras of Patañjali serve as a sort of code for yogis (or aspiring yogis) to live by. The sutras are positive thoughts and actions to focus on to counter negative ones. Many of the sutras speak of the wholeness of oneself, and what exactly the teachings of yoga are. In sutras II.1-II.10, I see a direct link to the mindfulness needed to understand and overcome depression: “[The] purposes of [yogic action] are to disarm the causes of suffering and achieve integration. The causes of suffering are not seeing things as they are, the sense of ‘I’, attachment, aversion, and clinging to life,” (Hartranft, 2003, pp. 21-23). Sutras II.4-II.10 go on to elaborate on why those particular focuses cause suffering, which makes me introspective about my own attachments and obsessions, and whether or not I could let them go in order to be happier. Much of these types of yogic teachings are counterintuitive to the American Capitalist way of life, but perhaps that is why we are such a depressed and unhappy culture.
Mindfulness of oneself and acting as a witness to what one is experiencing during yoga is essential to proper yoga practice. One must listen to their body and their mind, act as an observer and dissect why they are feeling the way they are. Negative thought patterns must be analyzed and disrupted in order to change them (Saraswati, 1995). This approach is similar to psychotherapy in that through speaking about oneself and explaining problems to another person, they can help one reflect on their actions and emotions, hopefully realizing where they should try to change. In a personal yoga practice, one must rely on themselves for this feedback, but this also teaches self-reliance which can lead to self-confidence and alleviate depression.
Each facet of yoga promotes wellbeing and wholeness, which our culture in the United States could use more of. With so much negativity, even in how we think about ourselves, it is not surprising that there are so many people suffering from depression. As I have shown in my research, yoga serves as a useful compliment to psychotherapy and/or medication. Classical yogic practice is very foreign in the United States, each small acceptance of a facet of it brings us closer to the entirety of it. Having been raised in a Western culture make sit truly difficult to unlearn consumer culture, egoism, and capitalism, and learn the non-harming, non-stealing, truthfulness, celibacy, and unacquisitive ways of yoga. Luckily, there exists a constant exchange of influence on yoga from both the East and West. Yogis do not force yoga on others, and let others interpret it however they like—guiding, but letting each find his own path. Yoga is an individual practice that brings people in touch with themselves, and then past that self-connectedness to an understanding of universality. Most Westerners are not seeking enlightenedness to this degree, but is it enough to only accept what we have? I think that most yogis would agree that incorporating any part of yogic practices into our lives is opening a door to a more spiritual experience. Even a purely physical practice brings us more in touch with our bodies (and in a new way) and even just that is useful in the treatment of depression.

Works Cited
Forbes, B., Akturk, C., Cummer-Nacco, C., Gaither, P., Gotz, J., Harper, A., et al. (2008). Using Integrative Yoga Therapeutics in the Treatment of Comorbid Anxiety and Depression. International Journal of Yoga Therapy, (18), 87-95. Retrieved from Alt HealthWatch database.
Hartranft, C. (2003) “The Yoga-Sûtra of Patañjali.” Unpublished manuscript.
McCall, T. (2007). Introduction. In: Yoga as Medicine. New York: Bantam Books. P. 3- 25
Mohan, G. (2006). Exploring yoga as therapy. International Journal of Yoga Therapy, (16), 13-19. Retrieved from Alt HealthWatch database.
Morgan, A. J., Jorm, A. F. (2008). Self-help interventions for depressive disorders and depressive symptoms: a systematic review. Annals of General Psychaitry. 7(13). Retrived from BioMed Central database.
Muktibodhananda, S. (1985) Hatha Yoga Pradipika. New Delhi: Bihar School of Yoga.
National Institute of Mental Health. (2009, September 23). Depression. Retrieved from http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml
Saraswati, V. (1995, July). Yogic Treatment of Mental Illness. Yoga Magazine. Retrieved from http://www.yogamag.net/archives/1995/djuly95/illness.shtml
Uebelacker, L., Epstein-Lubow, G., Gaudiano, B., Tremont, G., Battle, C., & Miller, I. (2010).Hatha yoga for depression: critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. Journal Of Psychiatric Practice, 16(1), 22-33. Retrieved from MEDLINE database.
Weintraub, A. (2009) Life Force Yoga. Retrieved from http://yogafordepression.com
Wholeness and healing: an interview with Arthur Kilmurry. (2008, Fall). Integral Yoga Magazine. 32-34.
Yapko, M. (2003, July 1). What causes depression? Psychology Today. Retrieved May 2, 2010, from http://www.psychologytoday.com/articles/200307/what-causes- depression


  1. Maggie,

    I thought that your paper on Yoga and depression was very interesting. I appreciated that you gave a lot of background information on what depression is as well as the common western ways of treating it. I think that the part I found most interesting was that there are different ways of thinking that yoga can help depression. For example, you stated that Kilmurray talks about how yoga is about innate wholeness and the integrated self, while others focus more on the spiritual aspects. I like learning about Kilmurray's view point because it caused me to think of depression in a different way and that new way of thinking made yoga as a treatment for depression more realistic and acceptable to someone with a westernized view point.

  2. I enjoyed reading your paper, my paper focused on the same topic as yours and you did a great job finding your research information. Much like yourself i also found it extremely interesting the positive feedback people have had using yoga for depression considering to how difficult to treat depression.

  3. I really enjoyed reading this article because it held a similar subject matter to the article I wrote on Yoga and Anxiety. I was glad that right off the bat, Maggie compared yoga and exercising. Exercise helps symptoms of depression, but exercise alone cannot cure these symptoms. Something else is needed in order for the illness to diminish. This is where yoga can help!
    Reading about the different theories of depression really put this paper topic into perspective for me. This led me to thinking that along with the physical aspect of yoga, the theories and ideas behind it could hold the answers or the "cure". I think comparing yogic theories of depression along with western theories was a great way to dissect this illness and try to come up with a solution for individuals. Depression is different in each person that it affects and there is no set treatment for everyone. It is important for people to do research and find what the right treatment is for them.
    Yoga is a great outlet for depression but is not an easy cure. Yoga can help the body physically rid tension and stress and if practiced in-depth, can help bring a sense of enlightenment. Since depression is a disease where it affects everyone differently, it is a harder subject to research and find an ultimate cure for.

    -Liz Affa