A Breathing-Based Meditation Intervention for Patients With Major Depressive Disorder Following Inadequate Response to Antidepressants

Abstract

Objective To evaluate feasibility, efficacy and tolerability of Sudarshan Kriya yoga (SKY) as an adjunctive intervention in patients with major depressive disorder (MDD) with inadequate response to antidepressant treatment. Method Patients with MDD (defined by DSM-IV-TR) depressed despite ≥8 weeks of antidepressant treatment were randomized to SKY or a waitlist control (delayed yoga) arm for 8 weeks. The primary efficacy end point was change in 17-item Hamilton Depression Rating Scale (HDRS-17) total score from baseline to 2 months. The key secondary efficacy end points were change in Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) total scores. Analyses of the intent-to-treat (ITT) and completer sample were performed. The study was conducted at the University of Pennsylvania between October 2014 and December 2015. Results In the ITT sample (n=25), the SKY arm (n=13) showed a greater improvement in HDRS-17 total score compared to waitlist control (n=12)(−9.77 vs. 0.50, P =.0032). SKY also showed greater reduction in BDI total score versus waitlist control (−17.23 vs. −1.75, P = .0101). Mean changes in Beck Anxiety Inventory (BAI) total score from baseline were significantly greater for SKY than waitlist (ITT mean difference: −5.19; 95% CI −0.93 to −9.34; P = .0097; completer mean difference: −6.23; 95% CI −1.39 to −11.07; P = .0005). No adverse events were reported. Conclusion Results of this randomized, waitlist-controlled pilot study suggest the feasibility and promise of an adjunctive SKY-based intervention for patients with MDD who have not responded to antidepressants. Trial Registration ClinicalTrials.gov identifier: NCT02616549

Group Yoga Therapy Impacts Mood States of Adolescents in a Psychiatric Hospital Setting

“…This kind of yoga customized for individual needs and limitations is called yoga therapy, and is defined by the International Association of Yoga Therapists (http://www.iayt.org/) as "the process of empowering individuals to progress toward improved health and well-being through the application of the philosophy and practice of Yoga. " Several recent studies of outpatient adults with major depression documented that yoga therapy substantially and significantly reduced depression scores on standardized measures [7][8][9]. We chose to include yoga therapy for acutely ill teens with psychiatric disorders in the hopes that it would provide them with strategies to calm themselves, develop increased self-efficacy, and improved affect.…”

Commentary: A Breathing-Based Meditation Intervention for Patients with Major Depressive Disorder Following Inadequate Response to Antidepressants: A Randomized Pilot Study

“…The answer may be forthcoming. An article by Sharma et al (2) on non-pharmacological treatment of drug-resistant depression is a welcoming addition to growing clinical research on adjunct therapies where pharmaceutical drugs may produce inadequate responses. Developing adjunct therapies that incorporate non-pharmacological and self-management practices offers means not only to improve therapy outcomes but also to maintain health-related quality of life after reaching remission.…”

“…Developing adjunct therapies that incorporate non-pharmacological and self-management practices offers means not only to improve therapy outcomes but also to maintain health-related quality of life after reaching remission. Since chronically ill patients, caregivers, and health-care providers embrace challenges of refractory medical conditions, medication non-adherence, and increasing treatment costs, clinical findings related to the drug-resistant depression described in Sharma et al (2) have a broader impact on treatments of chronic diseases.…”

“…The Sharma et al article (2) reports clinical efficacy of the breathing-based practice called the Sudarshan Kriya Yoga (SKY) in patients with major depressive disorder (MDD) who did not respond to antidepressant drugs. SKY is a breathing-based meditative technique of slow, medium, and fast rhythmic breathing cycles, and it does not require meditation experience.…”

“…There are two broader aspects of the work of Sharma et al (2), namely: (1) growing number of clinical studies of diverse non-pharmacological modalities as adjunct treatments of CNS disorders and (2) developing non-pharmacological therapies as digital therapeutics using the “software-as-medical-device” strategy (Figure 1). With respect to the first aspect, nutrition and physical activity are promising adjunct therapies.…”