OU R N AL O F DISORDERS ELSEVIER Journal of Affective Disorders 89 (2005)13-24 www.elsevier.com/locate/jad Review Yoga for depression:The research evidence Karen Pilkington*,Graham Kirkwood,Hagen Rampes,Janet Richardsond Research Council for Complementary Medicine,London.UK School of Integrated Health.University of Westminster.115 New Cavendish Street.London WIW 6UW.UK Barnet,Enfield and Haringey Mental Health NHS Trust Northwest Community Mental Health Team.Edgware.Middlesex.UK Health and Social Work.University of Plymouth and Research Council for Complementary Medicine,London.UK Received 8 April 2005;received in revised form 31 August 2005;accepted 31 August 2005 Available online 26 September 2005 Abstract Background:Yoga-based interventions may prove to be an attractive option for the treatment of depression.The aim of this study is to systematically review the research evidence on the effectiveness of yoga for this indication. Methods:Searches of the major biomedical databases including MEDLINE,EMBASE,CINAHL,PsycINFO and the Cochrane Library were conducted.Specialist complementary and alternative medicine (CAM)and the IndMED databases were also searched and efforts made to identify unpublished and ongoing research.Searches were conducted between January and June 2004.Relevant research was categorised by study type and appraised.Clinical commentaries were obtained for studies reporting clinical outcomes. Results:Five randomised controlled trials were located,each of which utilised different forms of yoga interventions and in which the severity of the condition ranged from mild to severe.All trials reported positive findings but methodological details such as method of randomisation,compliance and attrition rates were missing.No adverse effects were reported with the exception of fatigue and breathlessness in participants in one study. Limitations:No language restrictions were imposed on the searches conducted but no searches of databases in languages other than English were included. Conclusions:Overall,the initial indications are of potentially beneficial effects of yoga interventions on depressive disorders. Variation in interventions,severity and reporting of trial methodology suggests that the findings must be interpreted with caution.Several of the interventions may not be feasible in those with reduced or impaired mobility.Nevertheless,further investigation of yoga as a therapeutic intervention is warranted. 2005 Elsevier B.V.All rights reserved. Keywords:Yoga;Depression;Depressive disorder;Systematic review Corresponding author.School of Integrated Health,University of Westminster,115 New Cavendish Street,London WIW 6UW.United Kingdom.Tel.:+442079115000x3920. E-mail address:k.pilkington@westminster.ac.uk (K.Pilkington). Now Health Services Research Department,Institute of Psychiatry,London,UK. 0165-0327/S-see front matter 2005 Elsevier B.V.All rights reserved. doi:10.1016M.jad.2005.08.013
Review Yoga for depression: The research evidence Karen Pilkington a,b, *, Graham Kirkwood a,1 , Hagen Rampes c , Janet Richardson a,d a Research Council for Complementary Medicine, London, UK b School of Integrated Health, University of Westminster, 115 New Cavendish Street, London W1W 6UW, UK c Barnet, Enfield and Haringey Mental Health NHS Trust, Northwest Community Mental Health Team, Edgware, Middlesex, UK d Health and Social Work, University of Plymouth and Research Council for Complementary Medicine, London, UK Received 8 April 2005; received in revised form 31 August 2005; accepted 31 August 2005 Available online 26 September 2005 Abstract Background: Yoga-based interventions may prove to be an attractive option for the treatment of depression. The aim of this study is to systematically review the research evidence on the effectiveness of yoga for this indication. Methods: Searches of the major biomedical databases including MEDLINE, EMBASE, ClNAHL, PsycINFO and the Cochrane Library were conducted. Specialist complementary and alternative medicine (CAM) and the IndMED databases were also searched and efforts made to identify unpublished and ongoing research. Searches were conducted between January and June 2004. Relevant research was categorised by study type and appraised. Clinical commentaries were obtained for studies reporting clinical outcomes. Results: Five randomised controlled trials were located, each of which utilised different forms of yoga interventions and in which the severity of the condition ranged from mild to severe. All trials reported positive findings but methodological details such as method of randomisation, compliance and attrition rates were missing. No adverse effects were reported with the exception of fatigue and breathlessness in participants in one study. Limitations: No language restrictions were imposed on the searches conducted but no searches of databases in languages other than English were included. Conclusions: Overall, the initial indications are of potentially beneficial effects of yoga interventions on depressive disorders. Variation in interventions, severity and reporting of trial methodology suggests that the findings must be interpreted with caution. Several of the interventions may not be feasible in those with reduced or impaired mobility. Nevertheless, further investigation of yoga as a therapeutic intervention is warranted. D 2005 Elsevier B.V. All rights reserved. Keywords: Yoga; Depression; Depressive disorder; Systematic review 0165-0327/$ - see front matter D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2005.08.013 * Corresponding author. School of Integrated Health, University of Westminster, 115 New Cavendish Street, London W1W 6UW, United Kingdom. Tel.: +44 207 911 5000x3920. E-mail address: k.pilkington@westminster.ac.uk (K. Pilkington). 1 Now Health Services Research Department, Institute of Psychiatry, London, UK. Journal of Affective Disorders 89 (2005) 13 – 24 www.elsevier.com/locate/jad
14 K.Pilkington et al.Journal of Affective Disorders 89 (2005)13-24 Contents 1. Introduction 4 2. Yoga.·· 15 3. Aim and objectives......·· 15 4. Methods.-.········ 4.1. Summary of the search strategy 15 4.2. Databases searched......... 5. Search terms.,,....,··· 18 6. Filtering...········ 18 7. Selection criteria.·· 18 7.1. Types of studies 7.2. Types of participants.. 18 7.3. Types of intervention. 18 7.4. Types of outcome measures 18 8. Data collection and analysis.... 8 9. Clinical commentaries..··· 9 10. Main results........... 19 11. Summary of the studies. 19 12. Conclusions.····· Acknowledgements 2 References.···· 22 1.Introduction in the USA to examine the relationship between mental disorders and the use of complementary therapies.The Mental health problems such as depression,anxiety sample of 14,985 included those reporting psychologi- and insomnia are amongst the most common reasons cal distress or mental health service use in addition to for individuals to seek treatment with complementary non-distressed nonusers.Analysis of the 9585 com- therapies.Consequently.several surveys have been pleted interviews indicated a high rate of use of com- conducted which focus on this area. plementary therapies in adults who met criteria for Davidson and colleagues carried out a study to common psychiatric disorders.22.4%of respondents determine the frequency of psychiatric disorders in who met the criteria for major depression had used patients receiving complementary medical care in the complementary and alternative medicine during the UK and the USA (Davidson et al.,1998).The authors past 12 months.A similar survey of a nationally repre- found that psychiatric disorders were relatively fre- sentative sample of 2055 respondents revealed that 7.2% quent.Based on rates of lifetime psychiatric diag- reported suffering from"severe depression"(Kessler et noses,a total of 74%of the British patients and al.,2001).A total of 53.6%of those with severe 60.6%of the American patients had a diagnosis. depression reported using complementary and alterna- Major depression(52%of UK and 33.3%of USA) tive medicine for treatment in the past 12 months. and any anxiety disorders(50%of UK and 33.3%of A trend towards increasing use of complementary USA)were the commonest lifetime diagnoses.Rates therapies among people with major depression was of current psychiatric disorder were 46%of the UK demonstrated by a study conducted in Canada (Wang patients and 30.3%of the USA patients.Six percent et al.,2001).Analysis of data from the National of the total suffered from major depression and 25.3% Population Health Surveys indicated that the preva- of the total met the criteria for at least one anxiety lence of use in those with major depression was 7.8% disorder. (19.4%including chiropractic)in 1994-1995 and Unutzer et al.(2000)used data from a national 12.9%(23.8%including chiropractic)in 1996-1997 household telephone survey conducted in 1997-1998 Finally,the findings of a recent Australian postal
Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2. Yoga. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 3. Aim and objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.1. Summary of the search strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.2. Databases searched . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 5. Search terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 6. Filtering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 7. Selection criteria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 7.1. Types of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 7.2. Types of participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 7.3. Types of intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 7.4. Types of outcome measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 8. Data collection and analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 9. Clinical commentaries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 10. Main results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 11. Summary of the studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 12. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 1. Introduction Mental health problems such as depression, anxiety and insomnia are amongst the most common reasons for individuals to seek treatment with complementary therapies. Consequently, several surveys have been conducted which focus on this area. Davidson and colleagues carried out a study to determine the frequency of psychiatric disorders in patients receiving complementary medical care in the UK and the USA (Davidson et al., 1998). The authors found that psychiatric disorders were relatively frequent. Based on rates of lifetime psychiatric diagnoses, a total of 74% of the British patients and 60.6% of the American patients had a diagnosis. Major depression (52% of UK and 33.3% of USA) and any anxiety disorders (50% of UK and 33.3% of USA) were the commonest lifetime diagnoses. Rates of current psychiatric disorder were 46% of the UK patients and 30.3% of the USA patients. Six percent of the total suffered from major depression and 25.3% of the total met the criteria for at least one anxiety disorder. Unutzer et al. (2000) used data from a national household telephone survey conducted in 1997–1998 in the USA to examine the relationship between mental disorders and the use of complementary therapies. The sample of 14,985 included those reporting psychological distress or mental health service use in addition to non-distressed nonusers. Analysis of the 9585 completed interviews indicated a high rate of use of complementary therapies in adults who met criteria for common psychiatric disorders. 22.4% of respondents who met the criteria for major depression had used complementary and alternative medicine during the past 12 months. A similar survey of a nationally representative sample of 2055 respondents revealed that 7.2% reported suffering from bsevere depressionQ (Kessler et al., 2001). A total of 53.6% of those with severe depression reported using complementary and alternative medicine for treatment in the past 12 months. A trend towards increasing use of complementary therapies among people with major depression was demonstrated by a study conducted in Canada (Wang et al., 2001). Analysis of data from the National Population Health Surveys indicated that the prevalence of use in those with major depression was 7.8% (19.4% including chiropractic) in 1994–1995 and 12.9% (23.8% including chiropractic) in 1996–1997. Finally, the findings of a recent Australian postal 14 K. Pilkington et al. / Journal of Affective Disorders 89 (2005) 13–24
K.Pilkington et al.Journal of Affective Disorders 89 (2005)13-24 15 survey of 6618 randomly selected adults suggested Additionally,many of the trials of yoga are small that self-help strategies including complementary and the results difficult to generalise therapies were very commonly used to cope with However,a recent bibliometric analysis has demon- depression,particularly in mild-moderate psychologi- strated an increase in publication frequency of research cal distress (Jorm et al.,2004). on the clinical application of yoga and growing use of A range of therapeutic approaches is available for randomised controlled trials (Khalsa,2004).Clinical the management of depressive disorders but patients trials were located on the use of yoga for depression, may turn to complementary therapies due to adverse anxiety,cardiovascular conditions (e.g.hypertension, effects of medication,lack of response or simply heart disease),respiratory problems(e.g.asthma),dia- preference for the complementary approach. betes and a variety of others.Systematic reviews of these trials have not yet been conducted although a systematic review of trials of yoga in epilepsy(Ramar- 2.Yoga atnam and Sridharan,2000)concluded that insufficient robust evidence was available.No systematic reviews Yoga has its origins in Indian culture and in its of yoga in depression have been published. original form consisted of a complex system of spiritual,moral and physical practices aimed at attaining 'self-awareness'.Hatha yoga,the system 3.Aim and objectives on which much of Western yoga is based,has 3 basic components,asanas (postures),pranayama The aim of this study was to evaluate the evidence (breathing exercises)and dhyana (meditation).The on the effectiveness of yoga for the treatment of postures involve standing,bending,twisting and bal- depression. ancing the body and consequently improve flexibility and strength.The controlled breathing helps to focus the mind and achieve relaxation while meditation 4.Methods aims to calm the mind (Riley,2004).Although yoga has its origins in Indian religion,it can be 4.1.Summary of the search strategy practised secularly and has been used clinically as a therapeutic intervention.Several explanations based A comprehensive search for clinical research was on Western physiology have been proposed to carried out.Systematic searches were conducted on a account for potential effects of yoga in the treatment range of databases,citations were sought from rele- of various conditions.These can be summarised as vant reviews and several websites were also included modulation of autonomic nervous tone and conse- in the search,including those of MIND and the Men- quent reduction in sympathetic tone,activation of tal Health Foundation. antagonistic neuromuscular systems,which may increase the relaxation response in the neuromuscular 4.2.Databases searched system,and stimulation of the limbic system primar- ily by meditation(Riley,2004). General databases: A national survey conducted in the US demon- CINAHL,Cochrane Central Register of Con- strated that 7.5%of respondents had used yoga at trolled Trials (CENTRAL),Cochrane Database least once in their lifetime and 3.8%had used it in of Systematic Reviews,Database of Abstracts the previous year.Users were more likely to be of Reviews of Effects,EMBASE,IndMED female,college educated and urban dwellers and use (Indian Medlars Centre),MEDLINE (and was for both wellness and specific health conditions PubMed),PsycINFO. (Saper et al.,2004).The authors point out that despite Specialist CAM and condition based databases: greater prevalence of use than other CAM therapies AMED,CISCOM,Cochrane Depression,Anxi- such as acupuncture and homeopathy,yoga receives ety and Neurosis (CCDAN)Review Group less coverage in the Western biomedical literature. register
survey of 6618 randomly selected adults suggested that self-help strategies including complementary therapies were very commonly used to cope with depression, particularly in mild–moderate psychological distress (Jorm et al., 2004). A range of therapeutic approaches is available for the management of depressive disorders but patients may turn to complementary therapies due to adverse effects of medication, lack of response or simply preference for the complementary approach. 2. Yoga Yoga has its origins in Indian culture and in its original form consisted of a complex system of spiritual, moral and physical practices aimed at attaining dself-awarenessT. Hatha yoga, the system on which much of Western yoga is based, has 3 basic components, asanas (postures), pranayama (breathing exercises) and dhyana (meditation). The postures involve standing, bending, twisting and balancing the body and consequently improve flexibility and strength. The controlled breathing helps to focus the mind and achieve relaxation while meditation aims to calm the mind (Riley, 2004). Although yoga has its origins in Indian religion, it can be practised secularly and has been used clinically as a therapeutic intervention. Several explanations based on Western physiology have been proposed to account for potential effects of yoga in the treatment of various conditions. These can be summarised as modulation of autonomic nervous tone and consequent reduction in sympathetic tone, activation of antagonistic neuromuscular systems, which may increase the relaxation response in the neuromuscular system, and stimulation of the limbic system primarily by meditation (Riley, 2004). A national survey conducted in the US demonstrated that 7.5% of respondents had used yoga at least once in their lifetime and 3.8% had used it in the previous year. Users were more likely to be female, college educated and urban dwellers and use was for both wellness and specific health conditions (Saper et al., 2004). The authors point out that despite greater prevalence of use than other CAM therapies such as acupuncture and homeopathy, yoga receives less coverage in the Western biomedical literature. Additionally, many of the trials of yoga are small and the results difficult to generalise. However, a recent bibliometric analysis has demonstrated an increase in publication frequency of research on the clinical application of yoga and growing use of randomised controlled trials (Khalsa, 2004). Clinical trials were located on the use of yoga for depression, anxiety, cardiovascular conditions (e.g. hypertension, heart disease), respiratory problems (e.g. asthma), diabetes and a variety of others. Systematic reviews of these trials have not yet been conducted although a systematic review of trials of yoga in epilepsy (Ramaratnam and Sridharan, 2000) concluded that insufficient robust evidence was available. No systematic reviews of yoga in depression have been published. 3. Aim and objectives The aim of this study was to evaluate the evidence on the effectiveness of yoga for the treatment of depression. 4. Methods 4.1. Summary of the search strategy A comprehensive search for clinical research was carried out. Systematic searches were conducted on a range of databases, citations were sought from relevant reviews and several websites were also included in the search, including those of MIND and the Mental Health Foundation. 4.2. Databases searched General databases: ClNAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, EMBASE, IndMED (Indian Medlars Centre), MEDLINE (and PubMed), PsycINFO. Specialist CAM and condition based databases: AMED, CISCOM, Cochrane Depression, Anxiety and Neurosis (CCDAN) Review Group register. K. Pilkington et al. / Journal of Affective Disorders 89 (2005) 13–24 15
云 Table 1 Randomised controled trials of yoga for depression Pilkington Study Sample Inclusion criteria Yoga intervention Control/comparison Outcome measure(s) Results Methodological appraisal Clinical comments 色 Broota and 30 outpaticnts Clinical diagnosis of Treatment 1:Broota's Tretmerd 2:Iacobson's Symptom checklist一 Percentage reduction Randomisation,concealment Intervention appropriate, Dhir.1990 depression(mainly Relaxation Technique Progressive Relaxation 26 common symptoms in symptoms significant of allocation and blinding Adjunxct to'chemotherapy', by psychiatrist neurtic-depressive or (BRT:4 exercises (PR)for 20 min of depression taken (p<0.05)for BRT and of assessors:unknown Are 3 sessions sufficient 10 per group reactive-depressive) adapted from yoga一 Control:No treatment from DSM-Ⅲand PK compared韩th Baseline characteristics: for an effect?Presertod Age:19-48 yrs Medication for (to narrate present ICD.9 and fiom control (BRT more comparison of groups global symptom <I year,no asana,raising the complaints patient responses efective than jpr bu时 not reported reduction-would hive ECTp向ysical legx,cycling combined and state of mind) in a pilot study no significance given) been helpful to know if disability or with autosuggestion Measures taken pre Tiredness and any specific sympiom neurological and post cach session breathlessness after BRT was affected Affective damage 20 min on 3 if no previous exercise Compliance:unknown consecutive days Attrition:】in each treatment group. reasons not given Disorders Janakiramaiah DSM-IV diagnosis of SKY (Sudarshan Kriya ECT-modified ECT BDI 17.item HRSD Significant reductions in Randomisation. Intervention appropriate 名 et al.,2000 recmaited melncholic depression Yogal:3 soquential 3 times weckly At baseline and BDI and HRSD scores concealment of allocation: (moderately depressed consecutively (score of 17+on HRSD) components of thythmic MN((imipramine:一 weekly for 4 weeks unknown assessors not patients),Outcomes (2005) 15 per group Untreated for current hyperventilation Imipramine 150 mg for all 3 groups.ECT blinded appropriate and measured Age:mean (SDc episode,medically fit interspersed with nommal orally at night group had lowest mean Baseline characteristics using appropriate methods, sKY36.07.8). breathing followed by scores at wecks 3 and 4. reported as comparable Adequate dose of ECT36.72.5), 10-15 min relaxation 45 Remission rates:SKI cmg巴，sex,illness antidepressant used,ECT MN43.411.9 min in total 10(67%,ECT14(93%. duration and severity given 3 times weckly Once daily,6也ysa IMN II (73%)at 4 weeks wreek for 4 weeks No clinically significant Compliance:not side effects observed mentiooed for IMN Attrition:unknown Khumar et al.N-50 students in Severe depression Yoga (Shavasana) No intervention Zung Depression Randomisation,concealment 50 cases of'severe 1993 university hostels diagnosed by Amritsar basod primarily on Self Rating Scale and pre-post depression scores of allocation and blinding depression but 25 in each group Depression Inventory. thythmic breathing Personal Interview for yoga group. of assessors:unkcnown authors have not Zung Depression and relacation Schedule,All Significant differences Baseline characteristics:no given any cut-off scores Self Rating Scale 30 min daily ore-treatment.Zung between treatment and comparison except similar for 30 days cale only after 15 control group at mid and scores at baseline Age:20-25 yrs No medical coodition, and 30 days post treatment (p-001)
Table 1 Randomised controlled trials of yoga for depression Study Sample Inclusion criteria Yoga intervention Control/comparison Outcome measure(s) Results Methodological appraisal Clinical comments Broota and Dhir, 1990 30 outpatients selected by psychiatrist Clinical diagnosis of depression (mainly neurotic-depressive or reactive-depressive) Treatment 1: Broota’s Relaxation Technique (BRT): 4 exercises adapted from yoga — deep breathing, bow asana, raising the legs, cycling combined with autosuggestion Treatment 2: Jacobson’s Progressive Relaxation (JPR) for 20 min Symptom checklist — 26 common symptoms of depression taken from DSM-III and ICD-9 and from patient responses in a pilot study Percentage reduction in symptoms significant ( p b0.05) for BRT and JPR compared with control (BRT more effective than JPR but no significance given) Randomisation, concealment of allocation and blinding of assessors: unknown Intervention appropriate, Adjunct to dchemotherapyT, Are 3 sessions sufficient for an effect? Presented global symptom reduction — would have been helpful to know if any specific symptom was affected 10 per group Medication for b1 year, no ECT, physical disability or neurological damage 20 min on 3 consecutive days Control: No treatment (to narrate present complaints and state of mind) Measures taken pre and post each session Tiredness and breathlessness after BRT if no previous exercise Baseline characteristics: comparison of groups not reported Age: 19–48 yrs Compliance: unknown Attrition: 1 in each treatment group, reasons not given Janakiramaiah et al., 2000 45 patients recruited consecutively 15 per group Age: mean (SD): SKY 36.0 (7.8), ECT 36.7 (2.5), IMN 43.4 (11.9) DSM-IV diagnosis of melancholic depression (score of 17+ on HRSD) Untreated for current episode, medically fit SKY (Sudarshan Kriya Yoga): 3 sequential components of rhythmic hyperventilation interspersed with normal breathing followed by 10–15 min relaxation 45 min in total Once daily, 6 days a week for 4 weeks ECT — modified ECT 3 times weekly IMN (imipramine): — Imipramine 150 mg orally at night BDI 17-item HRSD At baseline and weekly for 4 weeks Significant reductions in BDI and HRSD scores on successive occasions for all 3 groups. ECT group had lowest mean scores at weeks 3 and 4. Remission rates: SKY 10 (67%), ECT 14 (93%), IMN 11 (73%) at 4 weeks No clinically significant side effects observed Randomisation, concealment of allocation: unknown assessors not blinded Baseline characteristics reported as comparable on age, sex, illness duration and severity Compliance: not mentioned for IMN Attrition: unknown Intervention appropriate (moderately depressed patients), Outcomes appropriate and measured using appropriate methods, Adequate dose of antidepressant used, ECT given 3 times weekly Khumar et al., 1993 N = 50 students in university hostels 25 in each group Age: 20–25 yrs Severe depression diagnosed by Amritsar Depression Inventory, Zung Depression Self Rating Scale and interviews No medical condition, Yoga (Shavasana) based primarily on rhythmic breathing and relaxation 30 min daily for 30 days No intervention Zung Depression Self Rating Scale and Personal Interview Schedule, All pre-treatment, Zung scale only after 15 and 30 days Significant differences in pre–post depression scores for yoga group. Significant differences between treatment and control group at mid and post treatment ( p = 0.01) Randomisation, concealment of allocation and blinding of assessors: unknown Baseline characteristics: no comparison except similar scores at baseline 50 cases of dsevere depressionT but authors have not given any cut-off scores K. Pilkington et al. / Journal of Affective Disorders 89 (2005) 13–24 16
no other treatment, Compliance:unknown duration of depression Attrition:unknown 2-3 months Rohini et al 30 consecutive Major depressive Full SKY Partial SKY BDI BAI Total scores reduced for Randomisation unknown, No specific comments 2000 patients attending disorder (DSM-IV) (as described above) (full SKY without both groups.No significant Concealment of allocation, psychiatric services cyclical breathing) difference between groups blinding of assessors:adequate 15 in each group ≥18 on HRSD, Onae山ily in the At baseline then 12 full SKY and 7 partial Baseline characteristics: Age:mean (SD) drug free moming for 4 weeks weckly SKY responded,based on Full SKY:29.5 50%or greater redaction duration (longer in full (82)Partial in BDI total scores SKY group) sKY:34.2(11.7) Compliance:unknown Attritio工anknown 28 volunteers Mild depression Yoga (lyeng一 Waiting list, BDI Pre-test,mid Significant reduction in Mild depression,Beck et aL,2004 via a variety (10-15 on BDI) back bends,standing no active course and post-dest) BDI and STAl tor of allocation,blinding of depression inventory of strategies poses and inversions intervention STAI (pre and post) yoga group but not for assessors,unknown is not a diagnostic Yoga group I王， diagnosts or t杠eatment. followed by POMS (pre and post cca山ooup Baseline characteristics: instrument,its purpase Pilkington Waiting list, no medical relaxation postures 60 Ist,5th and lst class) Significant changes in age/sex reported is to assess the severity control 15 min in the moming. Also cortisol POMS pre to post class but no group comparison of depression Age:18-29 yrs Same asanas for all Compliance:unknown (mean 21.5) (no inversions for menstruating women). Twice a week for 5 wks (practice at home not encouraged) Attrition:3 yoga,2 control but no reasons given of Affective STAI-State-Trait Anciety Inventory,POMS-Profile of Moods Scale,BDI-Beck Depression Inventory.HRSD-Hamilton Rating Scale for Depression,BAl-Beck Amxiety Inventory 老 2005
no other treatment, duration of depression 2–3 months Compliance: unknown Attrition: unknown Rohini et al., 2000 30 consecutive patients attending psychiatric services Major depressive disorder (DSM-IV) Full SKY (as described above) Partial SKY (full SKY without cyclical breathing) BDI BAI Total scores reduced for both groups. No significant difference between groups Randomisation unknown, Concealment of allocation, blinding of assessors: adequate No specific comments 15 in each group Age: mean (SD) Full SKY: 29.5 (8.2) Partial SKY: 34.2 (11.7) z18 on HRSD, drug free Once daily in the morning for 4 weeks At baseline then weekly 12 full SKY and 7 partial SKY responded, based on 50% or greater reduction in BDI total scores Baseline characteristics: similar except for illness duration (longer in full SKY group) Compliance: unknown Attrition: unknown Woolery et al., 2004 28 volunteers via a variety of strategies Yoga group 13, Waiting list, control 15 Age: 18–29 yrs (mean 21.5) Mild depression (10–15 on BDI) No current psychiatric diagnosis or treatment, no medical contraindications Yoga (Iyengar) — back bends, standing poses and inversions followed by relaxation postures 60 min in the morning. Same asanas for all (no inversions for menstruating women). Waiting list, no active intervention BDI Pre-test, mid course and post-test), STAI (pre and post), POMS (pre and post 1st, 5th and last class) Also cortisol Significant reduction in BDI and STAI for yoga group but not for control group Significant changes in POMS pre to post class Randomisation, concealment of allocation, blinding of assessors, unknown Baseline characteristics: age/sex reported but no group comparison Compliance: unknown Mild depression, Beck depression inventory is not a diagnostic instrument, its purpose is to assess the severity of depression Twice a week for 5 wks (practice at home not encouraged) Attrition: 3 yoga, 2 control but no reasons given STAI — State-Trait Anxiety Inventory, POMS — Profile of Moods Scale, BDI — Beck Depression Inventory, HRSD — Hamilton Rating Scale for Depression, BAI — Beck Anxiety Inventory. K. Pilkington et al. / Journal of Affective Disorders 89 (2005) 13–24 17