Depression is the leading cause of disability worldwide, and with the limited effectiveness of current treatments such as antidepressants and cognitive behavioral therapy (CBT), there’s a need to find new ways to help.

There is promising evidence that yoga-based interventions (YBIs) could work well on their own or in combination with medication and/or CBT.

However, the majority of these findings are inconsistent in their study design, data reporting and individual components (time frame, methodologies), which makes it challenging to generalize the results.

In a recent article in Complementary Therapies in Medicine, a team of investigators led by Maren Nyer, PhD, from the Depression Clinical and Research Program at Massachusetts General Hospital, and Maya Nauphal, a Boston University graduate student who works with Nyer’s team, identified five key questions that need to be answered to strengthen the case for prescribing yoga as a treatment for depression.

Are Certain Types of Yoga More Effective at Treating Depression Than Others?

Different styles of yoga place varying emphasis on breathing, meditation and/or postures, which makes it difficult to standardize yoga protocols across studies. Even within a particular style, yoga practices can differ based on the teacher and composition of the class.

Breathing, meditation and/or postures could also affect symptoms of depression independent of each other.

Future studies could take a closer look at these individual components to see how each impacts disease symptoms and the likelihood that participants will continue practicing yoga.

What “Dosage” of Yoga Is Needed to Achieve an Antidepressant Effect?

Patients with depression will likely want to know the minimum amount of yoga practice time (session duration and frequency) will be needed to improve their symptoms and achieve remission.

However, there is little data on the dosing effects of yoga practice across depressed populations. Some studies focus on the effects on depression immediately after practice, while others look at the effects over weeks or months.

There is also variability in the way depression symptoms are described and assessed across studies, which makes it difficult to make clear connections between length of yoga practice and symptom relief.

Are Yoga Based Interventions Safe for Depressed Populations?

The lack of reliable safety data across diverse populations is one of the largest limitations of the research to date. Many yoga studies are conducted with younger, fitter patients who may be better able to maintain a regular practice schedule and complete difficult postures with less risk of injury than older or less healthy participants.

Better data on the potential for adverse events (such as injuries) that can occur with yoga practice across diverse populations would provide patients with a better picture of the risks and benefits of YBIs. It could also help in setting realistic treatment expectations.

How Does Yoga Interact with Established Depression Treatments?

Yoga-based interventions do not yet have the evidence base necessary to be prescribed as standalone treatments for depression. They will likely be used in conjunction with other treatment strategies such as antidepressants, cognitive behavior therapy and/or exercise.

Researchers will need to learn more about how yoga can best be combined with these existing treatment strategies to craft personalized treatment plans for patients.

What Are the Barriers to Accessing Yoga-Based Interventions?

If clients are unable to establish or maintain a regular yoga routine, it will likely limit its therapeutic effect. The most commonly cited barriers to accessing YBIs are the time, cost and logistical challenges of attending yoga practice.

The authors also note that the symptoms of depression, such as social withdrawal and low motivation, could be barriers to starting and maintaining a yoga practice.

Home- or video-based YBIs could help address some of the time and logistical issues, and insurance could help to address the cost of yoga classes if insurance companies agree to cover them.

But more work will need to be done to determine what prescriptions or approvals will be needed for individuals to qualify for coverage, and what certifications or training instructors will need to attain to provide yoga at a prescription level.

About the Mass General Research Institute
Research at Massachusetts General Hospital is interwoven through more than 30 different departments, centers and institutes. Our research includes fundamental, lab-based science; clinical trials to test new drugs, devices and diagnostic tools; and community and population-based research to improve health outcomes across populations and eliminate disparities in care.
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