Practicing yoga may ease mild to moderate major depression, even in people who aren’t taking antidepressant medication or receiving psychotherapy. That’s the message of a small, but intriguing new study published in the journal PLoS ONE in March. It was the first study in the United States to look at yoga as a standalone treatment for diagnosed depression.
“Prior to our study, the only other clinical trials that had examined yoga as a solo therapy in major depression were conducted in India,” says lead researcher Sudha Prathikanti, M.D., an integrative psychiatrist at the University of California, San Francisco. “While results from those trials were positive, it was suggested that the findings might not apply well to Western populations.” Dr. Prathikanti’s study helps dispel that concern.
What the recent study revealed
The study included 38 adults, who were formally diagnosed with mild to moderate major depression. They weren’t using any other depression treatments, such as antidepressants, psychotherapy, herbs, supplements, or mind-body approaches.
Half were randomly assigned to take 90-minute hatha yoga classes, which met twice weekly for eight weeks. The other half (the control group) spent an equal amount of time in educational classes, where they learned about yoga’s history and philosophy, but didn’t actually do yoga. Over the course of the study, depression symptoms decreased more in the yoga group than in the control group.
Although these results are promising, Dr. Prathikanti says they should be considered preliminary. “They are based on a small number of participants,” she says. “They don’t offer conclusive evidence of yoga’s mood effects, but they do support further, larger-scale studies of yoga in major depression."
Melding the best of both worlds
Dr. Prathikanti’s research was shaped in part by her personal life journey. When she was five years old, her family immigrated to the United States from India. “While my parents embraced Western scientific education, they still had great reverence for many aspects of traditional Indian culture, including the discipline of yoga,” she says.
As a young psychiatrist in San Francisco, Dr. Prathikanti felt increasingly pulled toward those traditions as well. She traveled to India to visit two research centers that were conducting clinical trials on yoga. Upon returning home, she began practicing yoga regularly and studying Ayurveda, an ancient Hindu system of medicine.
Today, Dr. Prathikanti draws upon her training as both a psychiatrist and a certified Ayurveda practitioner to customize integrative treatment plans for her patients. “These treatment plans might incorporate yoga, meditation, herbs, transpersonal psychotherapy, acupuncture, and other complementary/alternative therapies,” she says.
Earlier in her career, Dr. Prathikanti had run into some limitations when using conventional psychiatric techniques alone. “Whether I was using psychotherapy, medications, or behavioral interventions, there seemed to be little scope for addressing the spiritual dimension of my patients’ lives,” she says. “I also noticed an over-reliance on clinical experts to achieve and maintain health.” She believes that an integrative approach to emotional wellness helps overcome these limitations.
The “active ingredients” of yoga
For this study, Dr. Prathikanti focused on hatha yoga, some style of which is taught in most U.S. yoga classes. “Hatha yoga emphasizes physical components — such as body postures, breathing techniques, and relaxation techniques — to achieve a fit body and calm, balanced mind,” she says.
The yoga program she used in the study began with 20 minutes of breathing exercises. Participants then spent 50 minutes performing a sequence of mindful poses and movements, including Cobra Pose, Bow Pose, Shoulder Stand, Fish Pose, Bridge Pose, and Child Pose. Finally, they spent 15 minutes in Corpse Pose, as the instructor guided them into deep relaxation.
“Our yoga intervention can be conceptualized as having several potential therapeutic elements,” says Dr. Prathikanti. “They include the physical activity involved in assuming yoga poses, the regulation of breath in specific patterns, the calm and mindful way of moving through the practices, and the deep relaxation in the final resting pose. Previous clinical trials suggest that each of these yoga elements may comprise an ‘active ingredient’ having its own antidepressant mechanism of action.”
Another study seconds that opinion
The same month as Dr. Prathikanti’s research was published, a separate study from Boston University Medical Center reported similar findings. In that study, 32 people with major depression (some of whom were taking antidepressants) were randomly assigned to either two or three Iyengar yoga classes per week plus home practice. Iyengar yoga is a school of hatha yoga that focuses on detail and precision in postures and breath control. By the end of the 12-week study, depressive symptoms had lessened in both groups.
As encouraging as these recent studies may be, they’re just the beginning. More research is needed to sort out the possible benefits of yoga for depression. Still, one thing the studies clearly show is that having depression doesn’t rule out sticking with a regular yoga routine — and that in itself is a favorable sign.
Individuals with depression vary in how they respond to different antidepressants and psychotherapy techniques. The same is undoubtedly true of yoga classes. “The goal in developing a novel intervention such as yoga is not to replace conventional care that may be highly effective for some individuals,” says Dr. Prathikanti. “Rather, it is to expand therapeutic options so that more people may benefit.”
Prathikanti, S., Rivera, R., Cochran, A., Tungol, J. G., Fayazmanesh, N., & Weinmann, E. (2017). Treating major depression with yoga: A prospective, randomized, controlled pilot trial. PLoS ONE, 12, e0173869.
Streeter, C. C., Gerbarg, P. L., Whitfield, T. H., Owen, L., Johnston, J., Silveri, M. M., . . . Jensen, J. E. (2017). Treatment of major depressive disorder with Iyengar yoga and coherent breathing: A randomized controlled dosing study. Journal of Alternative and Complementary Medicine, 23, 201-207.