A recent study published in the Journal of Psychiatric Practice offered yet another piece of compelling evidence that yoga may be an effective treatment option for depressed patients (Scott, T). In the study, 30 participants were separated into two groups. One received three 90-minute yoga classes and four homework sessions per week, and the second received two 90-minute yoga classes and three homework sessions each week. The duration of the study was 12 weeks. Both groups showed promising results: an increase in feelings of positivity, a reduction in anxiety, improved sleep, and a decrease in depressive symptoms.
I have already shared some of my thoughts about the study here, and I believe that any tool at our disposal that may help fight depression and improve quality of life should be given serious consideration. But perhaps what I like most about this particular study is that participants taking antidepressants were required to have maintained a stable dose of their medication for at least three months prior to enrolling. This makes it difficult to attribute any positive results to a medication effect only.
I am a psychiatrist with a busy outpatient practice. I help patients overcome depression and anxiety, and I listen to stories of heartache, resiliency, and hope. I offer guidance, and sometimes medication. I also talk to patients about nutrition, the importance of moving their bodies, and finding joy in the journey of discovering true purpose.
But I am also as much a yogi as I am a psychiatrist.
Every day, at least once, I bring my attention to my breath and I find time for stillness. If I am lucky, this takes place at one of the many yoga studios in Austin–after I leave work, with my wife by my side and surrounded by familiar faces. Other busy professionals/modern yogis carve out time for a 60-minute vinyasa, or if they are feeling particularly bold, a yoga sculpt class (a fusion cardio sequence with free weights). When life gets busy, stillness tends to happen in the confines of my office. I shut the door, kick off my shoes and sit on the floor. Usually I only have about five minutes, which is generally enough time to clear my mind.
I discovered yoga during college and didn’t look back. For me, yoga was never really about the snazzy studios, top-10 playlists, or designer apparel. Yoga offered an hour of respite, 60 minutes of life contorting my body in weird shapes in a hot room and allowing my breath to guide me through the experience of simply being present.
Early on, I saw yoga as an escape; sure, there is a demanding physical aspect, but ultimately yoga is about learning to appreciate the connection between the physical body and the mind.
I learned to push my body to a place where I was able to find physical balance, and then to appreciate that the only thing lost in failure was ego, which I quickly learned to leave outside the studio. In time, I became keen on focusing on my breath, settling into crow pose, or warrior two. And then I would forget, even if just for a second, that the room was so hot. The entire process can offer a sense of agency and accomplishment. An added plus is that it feels really good.
Studies on yoga and yogic breath (prana) have supported that breathing with intention can activate our parasympathetic nervous system, increase inhibitory neurotransmitters like GABA, reduce salivary cortisol (a marker of stress), and increase alpha waves in our brain prompting a state of blissful relaxation (Sengupta, P). Translated, this means that science supports that yoga can prompt positive physical changes in our body, even at a neurochemical level.
It is important to point out that when we talk about yoga, there are several different types. The authors of the study highlighted Iyengar yoga, which focuses on gradual progression through various asanas (postures), and usually utilizes prompts in the process. But there are other forms of yoga: vinyasa, hot yoga, and modern yoga sequences like cardio-sculpt that may also offer benefits of combining physical activity with a mindfulness-based practice, which in turn could potentially help improve depression and anxiety.
Yoga’s utilization as medicine appreciates an increasing interest behind educating clinicians in trauma-informed yoga, which incorporates meditative movements with trauma-processing therapy. Other forms of yoga, like yoga nidra, have been found as a useful treatment for insomnia. Yin yoga offers a potential remedy for anxiety, and notable improvements in ADHD symptoms have been observed in children who are enrolled in a yoga practice (Mehta, S). The common thread that ties various forms of yoga together is the notion of attention to breath.
In my clinical practice, it is not uncommon for me sit in stillness with patients and begin visits with a sequence of 4-7-8 breathing. Like any other psychiatrist's office, there’s a couch and table for discussion, but sometimes being seated on meditation cushions offers a physical dimension of being grounded and relaxed. Almost unequivocally, patients feel better with 60 seconds of breath work. That’s faster than a Xanax, and I’d argue more sustainable.
Ayurveda, the science of life, offers yoga as a lifestyle therapy. This approach is especially important when it comes to mental health care. Shifting our focus from disease to wellness, how can we learn to navigate life with intention? How can we employ the yogic ethical principle of aparigraha (letting go of thoughts, feelings or behaviors that don’t serve us)? Or learning to explore and hold onto the idea of santosha (contentment)?
It comes as no surprise that more studies are supporting that yoga is not only therapeutic but is therapy at its essence—a true treatment that offers a range of physical and emotional health benefits).
While critics would suggest that these studies are too small and conclusive results can’t be drawn, I would offer that by looking at ways to support the benefits of yoga with evidence (often required for any treatment to become standard of care), we provide hope and most importantly options for people struggling with depression. As a growing body of research emerges, and the renaissance of yoga as the medicine it was intended to be becomes front and center, we can further appreciate yoga’s potential to catalyze recovery and healing.
1. Scott, T, et. al. Psychological Function, Iyengar Yoga, and Coherent Breathing: A Randomized Controlled Dosing Study. Journal of Psychiatric Practice: November 2019 - Volume 25 - Issue 6 - p 437–450
2. Sengupta, P. Health Impacts of Yoga and Pranayama: A State-of-the-Art Review. Int J Prev Med. 2012 Jul; 3(7): 444–458
3. Mehta, S. et al. Peer-Mediated Multimodal Intervention Program for the Treatment of Children with ADHD in India: One-Year Follow-up. ISRN Pediatr. December 2012.