What is the clinical evidence from this study?

Study design: Observational. Population: Major depression (n=76). Intervention: Yoga (alone or with antidepressants) vs. Antidepressant medication alone. Primary outcome: Change in serum cortisol level at 3 months (p=0.006).

January 1, 2013Indian Journal of Psychiatry166 citationsOpen Access

Cortisol and antidepressant effects of yoga

JTJagadisha ThirthalliNational Institute of Mental Health and Neurosciences GNGH NaveenChettinad Academy of Research and Education MRMG RaoNational Institute of Mental Health and Neurosciences

Key Result

Yoga therapy, either alone or with antidepressants, significantly reduced serum cortisol levels from 111.9 to 91.7 ng/ml (p=0.006) over 3 months, with cortisol reductions correlating with antidepressant response.

Study Design

Type

Observational (n=76)

Blinding

Open-label (rater-blinded for HDRS)

Randomization

None

Multicenter

Structured PICO

Does yoga reduce serum cortisol levels and improve depression scores in out-patient depressives?

Population

54 outpatients with major depression and 18 healthy controls, followed for 3 months to assess the effects of yoga and/or antidepressants on serum cortisol and depression scores.

Intervention

Yoga module taught over a month and practiced at home daily, either alone (n=19) or along with antidepressant medication (n=19)

Comparator

Antidepressant medication alone (n=16)

Outcome

Hamilton Depression Rating Scale (HDRS) score and serum cortisol measurements at 3 monthssurrogate

Yoga may serve as an effective adjunctive or standalone therapy for depression by reducing serum cortisol levels.

Main Result

Absolute Event Rate: 91.7% vs 113%

p-value: p=0.006

Limitations

Lack of randomization as patients chose their own treatment
Little control over the antidepressant medication subtypes or their doses
Potential confounding of cortisol response by acute effects of certain antidepressant medications

Abstract

CONTEXT: Hypercortisolemia is well-known in depression and yoga has been demonstrated earlier to reduce the parameters of stress, including cortisol levels. AIM: We aimed to find the role of yoga as an antidepressant as well as its action on lowering the serum cortisol levels. SETTINGS AND DESIGN: An open-labeled study consisting of three groups (yoga alone, yoga along with antidepressant medication and antidepressant medication alone) was conducted at a tertiary care psychiatry hospital. METHODOLOGY: Out-patient depressives who were not suicidal were offered yoga as a possible antidepressant therapy. A validated yoga module was used as therapy taught over a month and to be practiced at home daily. Patients were free to choose the drugs if their psychiatrist advised. Patients (n=54) were rated on Hamilton Depression Rating Scale (HDRS) with serum cortisol measurements at baseline and after 3 months. In 54 patients, assessments and blood test results were both available. 19 each received yoga alone or with drugs and 16 received drugs only. Healthy comparison subjects (n=18) too underwent morning cortisol measurements once. RESULTS: Serum cortisol was higher in depressives compared with controls. In the total sample, the cortisol level dropped significantly at the end of treatment. More patients in the yoga groups had a drop in cortisol levels as compared to drug-only group. In the yoga-only group, the cortisol drop correlated with the drop in HDRS score (antidepressant effect). CONCLUSION: The findings support that yoga may act at the level of the hypothalamus by its 'anti-stress' effects (reducing the cortisol), to bring about relief in depression.

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