Standardized Heated Hatha Yoga for Depression Treatment Study

A randomized controlled trial was conducted to investigate the effects of heated Hatha yoga on depressive symptoms compared to a waitlist control group. The study involved 80 patients aged 21 to 60, with completion rates of 55% and 65% for the immediate yoga group and waitlist group, respectively. Results of the trial showed promise for heated yoga in reducing depressive symptoms.

• Yoga
• Depression
• Research
• Mental Health
• Treatment

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1. A Randomized Controlled Trial of Standardized Heated Hatha Yoga for the Treatment of Depression M. Nyer1, 2, M. Nagaswami1, S. Tuchman1, L. Hopkins3, F. Jain1, 2, C. Streeter2, 4, M. Fava1, 2, D. Mischoulon1, 2 1. Depression Clinical and Research Program (DCRP), Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA;2. Harvard Medical School, Department of Psychiatry, Boston, MA, USA; 3. Addiction Research Program, Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; 4. Department of Psychiatry and Neurology, Boston University School of Medicine, Boston, MA Disclosures: Dr. Fava has received funding/sponsorship from the following sources: https://connects.catalyst.harvard.edu/Profiles/profile/1243272 Dr. Mischoulon has recieved research support from Nordic Naturals. He has provided unpaid consulting for Pharmavite, LLC and Gnosis USA, Inc. He has recieved honoraria from the Massachusetts General Hospital Psychiatry Academy, Harvard Blog, PeerPoint Medical Education Institute LLC, and Blackmores. He has recieved royalties from Lippincott Williams & Wilkins for published book, Natural Medications for Psychiatric Disorders: Considering the Alternatives . All other authors have no competing financial interests. Corresponding Author: Maren Nyer, PhD Email: MNYER@mgh.harvard.edu

2. Background Independent randomized controlled trial (RCT)-level evidence indicates that non-heated yoga and whole-body hyperthermia hold promise for treating depressive symptoms.1-4 There is no published RCT-level evidence testing heated yoga s ability to treat depressive symptoms. Bikram yoga is a common, standardized form of heated Hatha yoga (105 ).5

3. Objectives Aim: to conduct an RCT to test the effects of heated Hatha yoga (HY) vs. a waitlist control (WL) on depressive symptoms. Hypothesis: HY will significantly reduce depressive symptoms when compared to a WL in individuals with clinically significant symptoms of depression.

4. Methodology Randomized patients to either: A) Immediate HY group (IYG) 8 weeks of HY; recommended at least 2 classes/week B) Waitlist control group (WL) 8 weeks of waitlist followed by 8 weeks of HY HY classes: 90-minute standard Bikram yoga classes Two partnering community yoga studios in the Boston-area

5. Methodology (continued) Outcome Measures: PRIMARY: Inventory of Depressive Symptomatology (IDS-CR)6 30 items; given every 2 weeks during yoga and waitlist arms Hamilton Depression Rating Scale (HAMD)7 28 items; given at baseline and endpoint for each study arm

6. Results Eighty patients were randomized, ranging from 21 to 60 years old (M = 32.5, SD = 11.33). Completion rates: 22/40 IYG (55%) 26/40 WL (65%). Mean Attendance (of those attending yoga:) IYG = 10.1 classes WL = 10.4 classes

7. Results (continued) IYG had significantly greater improvements in depression severity on the IDS-CR vs. the WL (b=-1.58, t=-5.25, p<.0001, 95% CI [-2.18, -0.99], dGLMM=1.61). Fifty percent (N=16) of the IYG achieved response (IDS-C > %50 decrease in IDS-CR symptoms), whereas only 7.7% (N=3) of the WL were responders. Collapsing across conditions (IYG + WL), more frequent HY was associated with greater IDS-CR reduction over time (b=-0.07, t=-2.58, p=.011, 95% CI [-1.95, -1.20]), suggestive of a dose response.

8. Results (continued) Linear modeling indicated that, on average, a frequency of once weekly practice showed a decrease of 10.4 points on the IDS from Baseline to Week 8 (b=-1.58, t=-8.22, p<.0001, dGLMM= 0.79); whereas practicing weekly practice decreased by 12.6 points (b=-2.12, t=-9.74, p<.0001, dGLMM= 1.06). Practicing three times weekly showed a 14.8-point reduction (b=-2.67, t=-6.94, p<.0001, dGLMM=1.34). The model predicted practicing once per week resulted in a 32.0% symptom reduction, twice-weekly a 39.3% reduction, and thrice-weekly a 46.9% reduction.

9. Conclusions HY demonstrated large antidepressant effects vs. a WL in those with clinically elevated depressive symptoms. More frequent of attendance was associated with greater antidepressant effects. Strengths: novel; RCT; blinded assessors using gold-standard metrics. Limitations: WL was inactive; lower than expected class attendance rate; high attrition rate. Future research: utilize adaptive trial design to identify adherence- boosting components; replication with active control; testing heated vs. non-heated yoga

10. References 1. 2. 3. 4. 5. 6. 7. Cramer H. A systematic review of yoga for major depressive disorder. J Affect Disord. 2017;213:70-77. doi:10.1016/j.jad.2017.02.006 Uebelacker LA, Tremont G, Gillette LT, et al. Adjunctive yoga v. health education for persistent major depression: a randomized controlled trial. Psychol Med. 2017;47(12):2130-2142. doi:10.1017/S0033291717000575 Janssen CW, Lowry CA, Mehl MR, et al. Whole-Body Hyperthermia for the Treatment of Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2016;73(8):789-795. doi:10.1001/jamapsychiatry.2016.1031 Koltyn KF, Robins HI, Schmitt CL, Cohen JD, Morgan WP. Changes in mood state following whole-body hyperthermia. Int J Hyperth Off J Eur Soc Hyperthermic Oncol North Am Hyperth Group. 1992;8(3):305-307. Choudhury B. Bikram Yoga: The Guru Behind Hot Yoga Shows the Way to Radiant Health and Personal Fulfillment. New York, NY: Harper Collins Publishing; 2017. Rush, A. J., Gullion, C. M., Basco, M. R., Jarrett, R. B., & Trivedi, M. H. (1996). The inventory of depressive symptomatology (IDS): psychometric properties. Psychological medicine, 26(3), 477-486. Williams, J. B. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of general psychiatry, 45(8), 742-747.