Benefits of controlled breathing

A type of controlled breathing with roots in traditional yoga shows promise in providing relief for depression. The program, called Sudarshan Kriya yoga (SKY), involves several types of cyclical breathing patterns, ranging from slow and calming to rapid and stimulating, and is taught by the nonprofit Art of Living Foundation.

One study compared 30 minutes of SKY breathing, done six days a week, to bilateral electroconvulsive therapy and the tricyclic antidepressant imipramine in 45 people hospitalized for depression. After four weeks of treatment, 93% of those receiving electroconvulsive therapy, 73% of those taking imipramine, and 67% of those using the breathing technique had achieved remission.

Another study examined the effects of SKY on depressive symptoms in 60 alcohol-dependent men. After a week of a standard detoxification program at a mental health center in Bangalore, India, participants were randomly assigned to two weeks of SKY or a standard alcoholism treatment control. After the full three weeks, scores on a standard depression inventory dropped 75% in the SKY group, as compared with 60% in the standard treatment group. Levels of two stress hormones, cortisol and corticotropin, also dropped in the SKY group, but not in the control group. The authors suggest that SKY might be a beneficial treatment for depression in the early stages of recovery from alcoholism.

Potential help for PTSD

Since evidence suggests that yoga can tone down maladaptive nervous system arousal, researchers are exploring whether or not yoga can be a helpful practice for patients with post-traumatic stress disorder (PTSD).

One randomized controlled study examined the effects of yoga and a breathing program in disabled Australian Vietnam veterans diagnosed with severe PTSD. The veterans were heavy daily drinkers, and all were taking at least one antidepressant. The five-day course included breathing techniques (see above), yoga asanas, education about stress reduction, and guided meditation. Participants were evaluated at the beginning of the study using the Clinician Administered PTSD Scale (CAPS), which ranks symptom severity on an 80-point scale.

Six weeks after the study began, the yoga and breathing group had dropped their CAPS scores from averages of 57 (moderate to severe symptoms) to 42 (mild to moderate). These improvements persisted at a six-month follow-up. The control group, consisting of veterans on a waiting list, showed no improvement.

About 20% of war veterans who served in Afghanistan or Iraq suffer from PTSD, according to one estimate. Experts treating this population suggest that yoga can be a useful addition to the treatment program.

Researchers at the Walter Reed Army Medical Center in Washington, D.C., are offering a yogic method of deep relaxation to veterans returning from combat in Iraq and Afghanistan. Dr. Kristie Gore, a psychologist at Walter Reed, says the military hopes that yoga-based treatments will be more acceptable to the soldiers and less stigmatizing than traditional psychotherapy. The center now uses yoga and yogic relaxation in post-deployment PTSD awareness courses, and plans to conduct a controlled trial of their effectiveness in the future.

Cautions and encouragement

Although many forms of yoga practice are safe, some are strenuous and may not be appropriate for everyone. In particular, elderly patients or those with mobility problems may want to check first with a clinician before choosing yoga as a treatment option.

But for many patients dealing with depression, anxiety, or stress, yoga may be a very appealing way to better manage symptoms. Indeed, the scientific study of yoga demonstrates that mental and physical health are not just closely allied, but are essentially equivalent. The evidence is growing that yoga practice is a relatively low-risk, high-yield approach to improving overall health.

Brown RP, et al. “Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part I — Neurophysiologic Model,” Journal of Alternative and Complementary Medicine (Feb. 2005): Vol. 11, No. 1, pp. 189–201.

Brown RP, et al. “Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part II — Clinical Applications and Guidelines,” Journal of Alternative and Complementary Medicine (Aug. 2005): Vol. 11, No. 4, pp. 711–17.

Janakiramaiah N, et al. “Antidepressant Efficacy of Sudarshan Kriya Yoga (SKY) in Melancholia: A Randomized Comparison with Electroconvulsive Therapy (ECT) and Imipramine,” Journal of Affective Disorders (Jan.–March 2000): Vol. 57, No. 1–3, pp. 255–59.

Khalsa SB. “Yoga as a Therapeutic Intervention: A Bibliometric Analysis of Published Research Studies,” Indian Journal of Physiology and Pharmacology (July 2004): Vol. 48, No. 3, pp. 269–85.

Kirkwood G, et al. “Yoga for Anxiety: A Systematic Review of the Research,” British Journal of Sports Medicine (Dec. 2005): Vol. 39, No. 12, pp. 884–91.

Pilkington K, et al. “Yoga for Depression: The Research Evidence,” Journal of Affective Disorders (Dec. 2005): Vol. 89, No. 1–3, pp. 13–24.

Saper RB, et al. “Prevalence and Patterns of Adult Yoga Use in the United States: Results of a National Survey,” Alternative Therapies in Health and Medicine (March–April 2004): Vol. 10, No. 2, pp. 44–49.

For more references, please see www.health.harvard.edu/mentalextra.