In support of Mental Health Awareness Week, guest blogger, Cornelia Libal gives her thoughts on the current treatment of depression and the role that exercise and specifically yoga can play in achieving good mental health.
Depression on the rise
According to a report published by the Mental Health Foundation in 2016 (1), a fifth of all adults in the UK showed symptoms of depression and anxiety, and nearly a half of all adults think that they have had a diagnosable mental health condition at some point in their life. According to the report, these numbers had increased from prior year’s surveys, demonstrating the increasing issue of depression in our society.
The role of medication
Treatment of depression almost always includes antidepressant medication (2). A report published by NHS Digital8 in 2017 revealed that the number antidepressants prescribed more than doubled between 2006 and 2016. In addition, this class of medications experienced the highest numeric rise in prescriptions for the fourth consecutive year.
Exercise as a treatment for depression
Since the 1990’s scientific papers have been published evaluating large numbers of trials assessing the effectiveness of exercise for the treatment of depression.
One study (3) evaluated 82 participants who took part in a 12-week aerobic fitness program with a one year follow up. The researchers found physiological and psychological improvements at 12 weeks which were then maintained after one year. Thereby demonstrating both the short- and long-term benefits of exercise on mental health.
A recent meta-analysis (4) systematically evaluated 15 different studies on the impact of exercise on depression symptoms. This was the seventh meta-analysis on this topic and it should be noted that all results pointed in the same direction; physical exercise as a treatment for depression has a moderate to large effect. In addition, psychological therapies, such as cognitive behavioural therapy, are also effective strategies. However, medications are of limited value with many negative side effects.
An even more recent meta-analysis (5) with 25 studies concluded that exercise may be even more effective than previously found due to a publication bias and found a large anti-depressant impact of exercise. According to the authors, physical exercise can be considered an evidence-based treatment of depression.
Yet despite these studies, exercise remains an underused treatment option.
Yoga’s role in managing depression
Now that we’ve seen that exercise in general improves depression, what about yoga specifically?
A 2017 publication (6) was the first study to evaluate yoga as monotherapy (e.g. yoga was the only treatment) in patients with mild-to-moderate major depression outside of India. Whilst it was a relatively small sample size with 38 adults, it did have a control group who attended attention control education groups. The intervention group, i.e. the yoga group, did a twice weekly 90-minute hatha yoga class for 8 weeks. The researchers found that the yoga participants were more likely to achieve remission and yoga practice resulted in a statistically and clinically significant improvement in depression severity.
Medication versus exercise
The positive findings of exercise in general and yoga specifically on depression symptoms are in contrast to the moderate efficacy and side effect profile of antidepressants. Fluoxetine, a commonly prescribed antidepressant, has a long list of adverse effects (7). This includes, but is not limited to, anxiety, restlessness, sleep disorders, nightmares, hallucinations, panic attacks, tremor, memory impairment, decreased appetite, blurred vision, cardiac arrhythmias, and suicide.
On the other hand, exercise, including yoga, is well documented as an effective antidepressant which has no adverse side effects.
It’s important to point out that treatment options are not mutually exclusive and may well be combined, e.g. cognitive behavioural therapy and exercise. In addition, the risks and benefits of all the different treatment options should be weighed up against each other. However, exercise and, specifically yoga, should build one of the foundation blocks for both treatment and prevention of depression.
About the author:
As well being a regular Sweaty, Cornelia Libal is a pharmacist and former synchronised swimmer turned personal health consultant and founder of Optimia Health. Cornelia’s goal is to inspire people to become informed consumers of health care and recognise the power of lifestyle changes. She focuses on the role that nutrition and exercise play in your health to balance out an overemphasis on the role of medications and supplements.
Want to learn more?
You can sign up to Cornelia’s mailing list here (http://eepurl.com/giGgMT). As a “thank you” she’ll send you a link to a free eBook about common barriers to optimum health and how to overcome them. You can find Cornelia on Facebook (fb.me/optimiahealth) or YouTube, where you can subscribe to her channel.
(1) https://www.mentalhealth.org.uk/file/2518/download?token=RU6lzcSK, accessed 20th February 2019
(2) NICE Clinical Guideline 90, https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#care-of-all-people-with-depression, accessed 20th February 2019
(3) DiLorenzo T, Bargman E, and Stucky-Ropp R. et al. “Long-term effects of aerobic exercise on psychological outcomes.” Prev Med. 1999 Jan;28(1):75–85
(4) Josefsson T, Lindwall M, Archer T. Physical exercise intervention in depressive disorders: Meta-analysis and systematic review. Scand J Med Sci Sports 2014: 24: 259–272
(5) Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression: A meta-analysis adjusting for publication bias.J Psychiatr Res. 2016 Jun;77:42-51
(6) Prathakanti S, Rivera R, Cochran A, Tungol JG, Fayazmanesh N, Weinman E (2017). Treating major depression with yoga: A prospective, randomized, controlled pilot trial. PLoS ONE 12(3):e0173869
(7) Summary of Product Characteristics for Fluoxetine 20mg capsules, https://www.medicines.org.uk/emc/product/6013/smpc#UNDESIRABLE_EFFECTS, accessed 22nd February 2019
(8) https://digital.nhs.uk/news-and-events/news-archive/2017-news-archive/antidepressants-were-the-area-with-largest-increase-in-prescription-items-in-2016, accessed 22nd February 2019