Yoga as an Adjunct Therapy for Depression

Maureen Ryan

CSOCS 3452 Yoga: Theory, Culture and Practice

Lesley College

Spring 2011

Final Paper

May 2, 2011

Yoga As an Adjunct Treatment for Depression

Introduction

Major Depressive Disorder is an illness that affects 14.8 million American adults each year and is the leading cause of disability for people ages 15-44. (National Institutes of Health. The Numbers Count: Mental disorders in America. NIH, 2008) Most people who suffer with depression are offered antidepressants and other prescriptions drugs as the primary treatment. The use of these medications has steadily increased since their inception. In its study, the U.S. Centers for Disease Control and Prevention looked at 2.4 billion drugs prescribed in visits to doctors and hospitals in 2005. Of those, 118 million were for antidepressants. Adult use of antidepressants almost tripled between the periods 1988-1994 and 1999-2000. Between 1995 and 2002, the most recent year for which statistics are available, the use of these drugs rose 48%, the CDC reported (National Center for Health Statistics. Anti-depressant Use. NCHS, 2007). Even with this increase of the use of drugs, a five-year study conducted by the World Heath Organization cites suicide from depression as the fourth leading cause of death worldwide, and by 2020 it is expected to be the second. When Eli Lilly introduced Prozac the first Selective Serotonin-Reuptake Inhibitor (SSRI) in 1987 it was going to revolutionize the treatment of depression. Millions of people worldwide take this antidepressant medication or one of the newer SSRIs yet the number of suicides continues to mount (Weintraub 2004, p. 7-8). According to a recent report published by the University of Washington’s Kids Count, mental health problems have now surpassed injuries as the single most common reason for hospitalizations among children five to nineteen in the State of Washington. And currently nationwide suicide is the third biggest killer of young people between the ages of 15 and 24 (Weintraub 2004, p. 8).

Antidepressant medications do not work for everyone and they can have serious side effects such as body temperature changes, difficulty in breathing, increased heartbeat and suicide. Even when they do give relief, they tend to loose their effectiveness over time and the strength of the prescription has to be increased to get the same effect. Hence the chance of experiencing side effects also increases. Exploring adjunct treatments for prescription drugs expands the choices for treatment and is an important factor in promoting health. Recent studies have provided insight into the effectiveness of yoga as an adjunct therapy for depression. This paper will explore the effectiveness of yoga as an adjunct therapy in the treatment of depression.

What brought me to the topic?

My first yoga class came during a stressful time in my life, where I probably would have been prescribed medication if I had sought medical help. Instead I found a yoga class, which helped me through that period. The Hatha Yoga class I attended was offered at my place of work during lunch hour, three days a week. It provided me with the opportunity to begin to breath through my problems and to stretch my tense, stiff body. Yoga calmed my mind and allowed me to relax my physical body enough to dissipate the physical and mental stress I was experiencing. As I continued my new yoga practice, I felt my depression slowly lifting. Not much had changed in my life but I felt better after each class. I found that the grass was definitely “greener” on the other side of the yoga class. Recently I have returned to a regular yoga practice and although I am not suffering from the same level of stress and depression I did then, I still experience a positive effect on my mood and a reduction in my stress level.

Yoga is effective as a treatment for depression. It has been found to have a positive effect on the neurotransmitters in the brain that effect mood. One study conducted at Benares Hindu University in Varanasi, India found that three and six month practices of yoga improved the functioning and mood of people with clinical depression. In a study of eighty people, half were treated with the tricyclic antidepressant imipramine and half with yoga. After six months of practice 60% of those treated with yoga showed improvement in their subjectively rated symptoms, e.g. sleep patterns, digestive symptoms, social interactions and overall mood (McCall 2007, p. 265-66). The drug group’s improvement in this area was less but researchers did not quantify them. Both groups had similar improvements in neurotransmitter levels (McCall 2007, p. 266). The yoga practice resulted in a significant rise in serotonin levels and a decrease in monoamine oxidase levels both of which cause a boost in mood. Also the Cortisol levels and levels of other stress hormones in the blood declined significantly (McCall 2007, p. 266).

Comparison of Western and Eastern Views of Depression

I found that Western medicine’s view of depression and the Eastern Yogic view of depression to be different. According to Western Medicine, depression is the result of an imbalance in neurotransmitters dopamine and serotonin in the brain (National Institutes of Health. The Numbers Count: Mental disorders in America. NIH 2008). The stress hormone cortisol is usually found in excess in the bloodstream of those suffering with depression because the fight or flight response is always turned on (National Institutes of Health. The Numbers Count: Mental disorders in America. NIH, 2008). Yogic philosophy views depression differently, stating that the separation of people from one another and from “their selves” causes suffering and ignorance of themselves as part of the universal whole. When we forget that we belong to each other and to the universe, that we are deeply connected to all living beings, we feel separate and alone. “The pain of depression is the result of a false identification with our external selves and experiences. Through the practice of yoga, the sense of separation, which is the literal sources of depression, is diminished, and the sense of connection to oneself and others is enhanced. Yoga can also shift the physiological imbalances in the body that create depressed or anxious moods. Yoga asana, pranayama, and meditation reintegrate the self and help the person go inside and connect to the deeper knowledge of who they are” (National Institutes of Health. The Numbers Count: Mental disorders in America. NIH, 2008).

Biomedical View of Yoga for Depression

Today there are more research studies that support the use of yoga for depression as well as anecdotal evidence that people suffering from depression have found yoga to be beneficial (National Institutes of Health. The Numbers Count: Mental disorders in America. NIH, 2008). In fact yoga was found to be more effective than walking or other forms of exercise in the treatment of depression (Streeter, et al. 2010). Studies found that while physical activity did improve serotonin levels in the brain, yoga did a better job in raising the levels of serotonin in the brain (Streeter, et al. 2010). Practicing yoga lowers levels of the major stress hormone cortisol and boosts levels of the brain's main neurotransmitter responsible for communication between the cells and neurons known as GABA. Low levels of GABA are associated with both depression and anxiety.

In studies of the use of yoga for depression there are some findings that it increases the levels of GABA. One study in particular found that in experienced yoga practitioners, brain GABA levels increased by 27% after a 1-hour session of yoga and also recommends that the practice of yoga should be explored and compared to other exercise modalities as a treatment or adjunctive treatment for disorders associated with low GABA states (Streeter, et al. 2007). The development of an inexpensive (compared with medications), widely available intervention such as yoga, with few side effects, that is effective in alleviating the symptoms of depression and other disorders associated with low GABA states has many health advantages.

Yogic Perspective on Depression

The personal accounts that I found of those who practiced yoga and found relief from depression were that of yoga teachers Patricia Walden and Amy Weintraub. Patricia Walden is one of two senior advanced teachers of Iyengar yoga in the United States, she experienced depression in her twenties and early thirties. Her treatment ran the gamut from private and group psychotherapy, hypnosis to medication. She felt that all of these treatments helped to a degree but that they left her with a feeling of emptiness, a sense that there must be something more (McCall 2007, p. 261). When Patricia met Mr. Iyengar in 1977 she made a connection to his style of yoga and found that “something more.” The feeling of emptiness she had felt before meeting Mr. Iyengar changed during that yoga class. His philosophy was one that she immediately connected to. Iyengar said “if you keep your armpits open you will never be depressed” (McCall 2007, p. 261). According to Patricia, he was referring to her posture, which was the posture of a depressed person with a sunken chest. Open the armpits refer to the space between the armpit and the chest growing wider and more lifted. This lifts the lungs and the heart allowing you to breath more deeply. The thoracic spine begins to elongate. All of these things have a positive effect on your mental state (McCall 2007, p. 264). It was at this time Patricia began to realize how the physical body could affect the mind. She developed her yoga practice as a way of helping her deal with her depression.

In Iyengar yoga there are sequences of yoga asanas that are usually specific to those suffering from depression, i.e. back bends, vigorous standing asanas, and inversions. Patricia Walden characterizes two different types of depression rajasic or tramasic and designs the type of asana, pranayama and meditation practices that would be most beneficial for each. The characteristics of these types of depression are different with rajasic being characterized by agitation, anxiety, and rapid breathing. The most beneficial type of asana practice for rajasic would be calming, cooling and able to help the mind slow down. People with tamasic depression are lethargic, apathetic, and lacking energy. Their breath tends to be shallow, with a short inhalation. Tamasic depression is best alleviated with more active and energizing practice. (McCall, p. 267) Vigorous standing poses and challenging vinyasas help to increase energy flow in the body. Yoga practice can be more specifically designed to each individual’s symptoms of depression. I don’t believe prescription medications for depression can be customized for each individual in the same way.

In Amy Weintraub’s book Yoga for Depression: A Compassionate Guide to Relieve Suffering Through Yoga (2004) she gives her experience of yoga and how it helped her heal her own depression. Amy suffered for sixteen years with depression. She describes that depression for her was “as Emily Dickinson describes it, an element of blank. I moved as though through a fog” (Weintraub 2004, p. 2). During a therapy session her therapist told her “you’re one of those people who will always have empty pockets.” Amy visualized herself “like Virginia Woolf, filling those empty pockets with stones and stepping into the river” (Weintraub 2004, p. 2). The naming of her as one of those with “empty pockets” and the medication she took for depression felt like a “life sentence” to her. However, while collecting the mail for a friend of hers who was away she came upon a Kripalu catalog. The description of yoga practice caught her attention and shortly thereafter she went to Kripalu for a Rest and Renewal trip. It was there that Amy experienced her first yoga class. Her experience at Kripalu opened doors to a new path for healing her depression. “In that first class, the instructor had us place our hands in prayer position in front of our hearts. Take a deep breath in, she said, and fill your heart with light. Hold the breath and feel the light as healing energy expand through your chest and through your whole body. Exhale and open your palms to receive. Stay empty. God loves your empty hands” (Weintraub 2004, p. 3). Amy found that “empty pockets” wasn’t a curse but a blessing. Her new insight didn’t “blow the fog of depression” it simply “opened a window through which I felt the possibility of feeling better” (Weintraub 2004, p. 3). In the moments after her yoga class she felt “alive”. “Every cell felt awake and in a state of awe, a state beyond happiness in which I felt connected to all beings” (Weintraub 2004, p. 3).

After her experience at Kripalu she began to get up a little earlier in the morning to practice yoga. She experimented with yoga postures, went back to Kripalu, and took yoga classes. She developed a sequence of postures and breathing exercises she could do on her own at home. As time passed she began to feel better and her good days outnumbered the bad ones. Just months later with the supervision of her psychiatrist she slowly weaned herself off the medication for depression. She has been off her medication since 1989 and has “not had need of medication since” (Weinbraub 2004, p. 5).

Conclusion

I have come to some conclusions from my research on yoga as adjunct therapy for depression. Yoga can play just as important a role as medications in improving the health and recovery of those suffering with depression. It is not a quick fix but certainly is safer than long-term use of antidepressants. As I look back on my own struggle with depression, I can see that by using the tools yoga offered me, I was able to help my not only my emotional body, but my physical and spiritual body. Today, even though I might not always be actively practicing yoga, I can always utilized some of the tools that I learned through yoga to help reduce my stress level and bring peace to my physical, spiritual and emotional bodies. Prescription medication may be needed at times to reduce the desperation and suicidality that a depressed person feels but as a long-term solution it does not restore health and connection to the self. It is expensive and has serious side effects. Yoga can touch the whole being. Yoga can effectively relieve depression and bring out the “feelings of joy and love inside all of us” (Weintraub 2004, p. xvi).