music reading report

Topical Review Article

The Efficacy of Yoga as a Form of Treatment for Depression

Ledetra Bridges, LMSW 1

and Manoj Sharma, MBBS, MCHES, PhD 1

Abstract The purpose of this article was to systematically review yoga interventions aimed at improving depressive symptoms. A total of 23 interventions published between 2011 and May 2016 were evaluated in this review. Three study designs were used: randomized control trials, quasi-experimental, and pretest/posttest, with majority being randomized control trials. Most of the studies were in the United States. Various yoga schools were used, with the most common being Hatha yoga. The number of participants par- ticipating in the studies ranged from 14 to 136, implying that most studies had a small sample. The duration of the intervention period varied greatly, with the majority being 6 weeks or longer. Limitations of the interventions involved the small sample sizes used by the majority of the studies, most studies examining the short-term effect of yoga for depression, and the nonutilization of behavioral theories. Despite the limitations, it can be concluded that the yoga interventions were effective in reducing depression.

Keywords yoga, depression

Received June 7, 2016. Received revised March 10, 2017. Accepted for publication May 19, 2017.

Depression is one of the most common mental illnesses in the

world. It is estimated that there are 350 million people world-

wide who have some form of depression. 1

In the United States,

16 million people had a depressive episode in the past year. 2

A

condition affecting one’s mood and action, depression can

affect one’s life substantially. According to the most recent

World Health Organization, depression is the leading cause

of disability worldwide and is believed to be a major contribu-

tor to the overall global burden of disease. 1

The Diagnostic and Statistical Manual of Mental Disorder,

Fifth Edition, has defined depression as 5 or more of the

following symptoms that are present for 2 or more weeks and

cause significant emotional distress and/or impairment in

functioning. Symptoms are depressed or sad mood, short-

tempered or easily annoyed, loss of interest or enjoyment in

hobbies or activities that was previously enjoyed, feeling of

worthlessness or guilt, thoughts of death or suicide, difficulty

with concentrating or making decisions, feeling tired or fati-

gue, feeling restless or slow, changes in appetite such as over-

eating or loss of appetite, changes in weight such as weight

loss or weight gain, and changes in sleep pattern. 3

According

to the National Institute of Mental Health, depression occurs

due to a combination of genetic, biological, environmental,

and psychological factors. 4

Treatment for depression consists

of participation in psychotherapy, taking antidepressants, or a

combination of both. However, many individuals do not par-

ticipate in psychotherapy or antidepressants due to factors

such as unmet needs, side effects, lack of access/resource, and

personal choice.

Currently, researchers are studying the efficacy and effec-

tiveness of mind-body interventions such as yoga as an alter-

native and complementary treatment for depression. Yoga,

with its origin in ancient India, is recognized as a form of

alternative medicine that implements mind-body practices. The

philosophy of yoga is based on 8 limbs that are better described

as ethical principles for meaningful and purposeful living. 5

While there is no specific definition, yoga has been interpreted

as a process of uniting the body via mind and spirit to promote

physical and mental wellness.

Yoga practices can utilize any or all the 8 limbs. They

generally involve relaxation (shava asana), physical postures

1 Jackson State University, Jackson, MS, USA

Corresponding Author:

Manoj Sharma, MBBS, MCHES, PhD, School of Public Health, Jackson State

University, 350 West Woodrow Wilson Avenue, Jackson, MS 39213, USA.

Email: [email protected]

Journal of Evidence-Based Complementary & Alternative Medicine 2017, Vol. 22(4) 1017-1028 ª The Author(s) 2017 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/2156587217715927 journals.sagepub.com/home/cam

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

(asana), breathing regulation techniques (pranayama), and

meditation (dhyana). While there are different schools of yoga,

some common schools include Ananda, Anusara, Ashtanga,

Bikram, Iyengar, Integral, Kundalani, Kripalu, Power, Prana,

Sivananda, and Vinyasa. Types of yoga include alignment-

oriented yoga, fitness yoga, flow yoga, gentle yoga, hot yoga,

specialty yoga, and spiritual-oriented yoga.

There have been some known benefits of yoga. Per Woo-

dard, 5

yoga improves flexibility, can loosen muscles resulting

in reduced aches and pain, generates balanced energy, reduces

breathing and heart rates, lowers blood pressure and cortisol

levels, increase blood flow, and reduces stress and anxiety due

to calmness. Yoga practices can thus improve preexisting med-

ical conditions such as arthritis, cancer, mental illness symp-

toms, and so on.

There is a body of research supporting the use of yoga to

reduce depression or depressive symptoms. Mehta and

Sharma 6

published a systematic review of literature on yoga

and depression, searching research articles in English from

2005 to June 2010. They reviewed 18 studies describing the

extent to which yoga has been found to be beneficial as a

complementary therapy for depression and depressive symp-

toms. The purpose of this review was to identify newer studies

after 2011 and ascertain the efficacy of yoga on depression.

Based on this review, recommendations for future interven-

tions have been developed.

Methodology

An extensive literature search was conducted to collect studies for

inclusion in this review. Studies were identified through electronic

database searches of Cumulative Index to Nursing and Allied Health

Literature (CINAHL), Google Scholar, Education Resource Informa-

tion Center (ERIC), PsycINFO, and Medline for the time periods of

2011 to May 2016. Keywords (as title and abstract words used to search

for articles) were yoga and depression/depressive disorder, yoga for

depression/depressive disorder, and treating depression through yoga,

yielding 731 articles. There were 138 records after duplicates were

removed from the search results. One hundred and thirty-eight arti-

cles were screened for intervention. Of those 138 articles, 75 articles

were omitted due to not having an intervention or utilizing interven-

tions that did not target depression (n ¼ 42), and consisting of review and discussion articles (n ¼ 16), or studies still in progress (n ¼ 5). The remaining 63 articles were screened using the inclusion and

exclusion criteria. Inclusion criteria for studies in this review were

the following: (1) publications between 2011 and 2015, (2) publica-

tions in the English language, (3) publication of studies that mea-

sured depression or depressive symptoms as an outcome (see Table 1

for outcome measures of each study), (4) publications of studies that

used yoga as an intervention that included the use of one or more of

the 8 limbs, and (5) studies that used a randomized controlled design

or quasi-experimental or pretest/posttest design.

The exclusion criteria were the following: (1) studies that did not

measure depression or depressive symptoms as an outcome; (2) stud-

ies that were incomplete or ongoing; (3) articles that were published

in a journal not indexed in any of the following databases: CINAHL,

Google Scholar, ERIC, PsycINFO, and Medline; and (4) qualitative

studies. Both authors evaluated the articles. After reading and

reviewing the articles, there were 23 studies included in the systema-

tic review. This is further illustrated in Figure 1. PRISMA guidelines

were followed in selection of these articles for inclusion in this

systematic review. Important components of each study that will

be reviewed include original reference, country of the study, the

name and a brief description of the intervention, duration of the

intervention, age of participants, time of assessments, design and

sample, and salient findings.

Results

A total of 23 studies describing interventions that used yoga as a

form of treatment for depression, meeting the inclusion criteria,

were found through literature search. These studies are described

sequentially, in order of their publication by year in Table 2.

Studies were carried out in Australia, 8,29

India, 10,17,18,28

Iran, 7,16

Italy, 26

Taiwan, 22

the United Kingdom, 21

and the United

States. 9,11-15,19,20,23-25,27

Studies focused on the meditative

aspects of yoga while others incorporated exercise and/or gentle

and slow movements and awareness. Types of yoga included

Antenatal, 21

Anusara, 22

combination of Asana and Pra-

nayama, 10,18,23

Hatha, 8,13,19,20

integrated yoga, 17,28

Iyengar, 14

Kirtan Kriya, 15,26

Mindfulness-based meditation (with

yoga), 9,11,27

Tai chi (with yoga), 12

unspecified, 7,16

and

Viniyoga. 24-25,29

Hatha yoga was used most often (4 times)

among the aforementioned interventions. The next most com-

monly used interventions were Asanas and Pranayama, the

mindfulness-based meditation (with yoga), and Viniyoga, which

were each used thrice.

Participants in the studies were all adults. Many of the studies

reported that the participants were age 18 and older. 8,9,13,19-23,29

Other studies reported that participants were between the ages of

18 and 45, 12,17,23,24

18 and 60, 10,11,16,18,26,27

18 and 80, 14

20 and

35, 7,17

20 and 70, 22,26

30 and 70, 28

and 45 and 90. 15

Participants

in the studies included pregnant women, 9,12,17,19,21,23,25

individ-

uals with a depression diagnosis, 13,16,20,29

cancer patients, 22,28

narcotic drug addicts, 7

patients with poststroke hemiparesis, 8

patients with lower back pain, 10

college students, 11

patients with

atrial fibrillation, 14

caregivers, 15,18

postpartum women, 24

anxiety, 26

and low-income patients. 27

Only one study included patients with a Diagnostic and

Statistical Manual of Mental Disorders, Fourth Edition, diag-

nosis of a depressive disorder. 26

Fourteen studies included

adults with elevated levels of depression diagnosed by Beck’s

Depression Inventory-II, 7

Edinburgh Postnatal Depression

Scale, 9

Structural Clinical Interview for Depression, 12,15,25

MINI-International Neuropsychiatric Interview, 13,20

Hamilton

Depression Rating Scale, 16

Patient Health Questionnaire, 23,24

Depression Anxiety Stress Scale, 29

and a clinician. 10,14,27

Five

studies included patients with self-report of depression. 8,19,21-22,28

In 2 studies, the depression criteria were unclear. 17-18

Studies used pretest/posttest, 12,14,16,26

quasi-

experimental, 9,11,23,27

and randomized controlled

trials. 7,8,10,13,15,17-22,24,25,28,29

Sample sizes were small, ranging

in size from 14 to 136 patients. Intervention periods ranged in

length from 1 week to 24 weeks. One study did not specify its

1018 Journal of Evidence-Based Complementary & Alternative Medicine 22(4)

length, but it can possibly be concluded that it took place for up

to 32 weeks. Among the yoga intervention, participants were

encouraged or required to attend yoga classes anywhere from

once a week to daily for 1 or more weeks. The time asked to

practice yoga ranged from 12 minutes to 90 minutes. Majority

of the studies encouraged participants to practice yoga once a

week. The longest duration included 1 hour daily yoga per

16 weeks. Only 4 studies 10,17,22,25

reported the use of power

analysis. This is a limitation of the studies utilizing yoga to

study its effect on depression.

There were 5 studies that did not have a comparison or

control group. 9,11,14,23,27

Ten studies compared yoga to no

specific treatment, including assessment(s) only 7,12,18,19,24

or standard care. 17,21,22,25,29

Two studies compared yoga to

health education. 13,20

One study each compared yoga to aerobic

exercise, 8

physical therapy, 10

instrumental music, 15

pharmaco-

logical treatment, 16

self-help, 26

and social support group. 28

Studies assessed severity of depression using the Beck’s

Depression Inventory, 10,11,27,28

Beck’s Depression Inventory-

II, 7,9

the Hamilton Rating Scale for Depression, 15,16,24,26

the

Geriatric Depression Scale, 8

the Centers for Epidemiological

Studies–Depression Scale, 12,19

Patient Health Question-

naire, 13,20,24

the Zung Depression Self Rating Scale, 14,26

Hos-

pital Anxiety Depression Scale, 17,18

the Edinburgh Postnatal

Depression Scale, 23,25

Inventory of Depression and Anxiety

Symptoms, 24

or Depression Anxiety Stress Scale. 29

The sever-

ity of anxiety or stress was assessed using the State-Trait Anxi-

ety Inventory, 7-8,10,12,13,17,20,25

Perceived Stress Scale, 11,13,20

the Zung Assessment Anxiety Self Rating Scale, 14,26

the

Hamilton Rating Scale for Anxiety, 26,27

Pregnancy Experience

Questionnaire, 17

and the Kessler Psychological Distress

Scale. 29

Health-related quality of life was assessed using the

Medical Outcome Study Health Survey, 15

World Health Orga-

nization Quality of Life–BREF, 18

and the Short Form Health

Survey. 20,29

Mindfulness was assessed using the Five Facet

Mindfulness Questionnaire 9,11,23

and the Self-Compassion

Scale. 27

Maternal-fetal attachment during pregnancy was

assessed via the Maternal Fetal Attachment Scale. 9

Pain or

illness burden was assessed using the Numerical Rating

Scale 10

; hamstring and lower back flexibility were measured

using the Sit and Reach. 10

Worry was assessed using the Penn

State Worry Questionnaire. 11

Rumination or negative think-

ing was assessed via the Rumination Response Scale. 13,20

Interpersonal factors were assessed using the Interpersonal

Sensitivity and Hostility Inventory 13,15

and the Connor-

Davidson Resilience Scale. 29

Fatigue was assessed using the

Brief Fatigue Inventory. 22

Wellness was assessed using the

Perceived Wellness Survey. 27

Table 1. Summary of Measurement Tools.

Study/Year Measurement Tools(s)

Marefat et al, 20117 Beck’s Depression Inventory-II; State-Trait Anxiety Inventory Chan et al, 20128 Geriatric Depression Scale; State-Trait Anxiety Inventory Muzik et al, 20129 Beck’s Depression Inventory-II; Edinberg Postnatal Depression Scale; The Five Facet Mindfulness Questionnaire;

The Maternal Fetal Attachment Scale Tekur et al, 201210 Beck’s Depression Inventory; State-Trait Anxiety Inventory; Numerical Rating Scale; Sit and Reach Eastman-Muller et al,

2013 11

Beck’s Depression Inventory; Perceived Stress Scale; Penn State Worry Questionnaire; The Five Facet Mindfulness Questionnaire

Field et al, 201312 The Center for Epidemiological Studies–Depression Scale; State-Trait Anxiety Inventory Kinser et al, 2013

13 Patient Health Questionnaire-9; Perceived Stress Scale-10; State-Trait Anxiety Inventory; Rumination Response

Scale; Interpersonal Sensitivity and Hostility Inventory Lakkireddy et al, 2013

14 Zung Self-Assessment Depression Score; Zung Self-Assessment Anxiety Score

Lavretsky et al, 201315 Hamilton Rating Scale for Depression; Mini-Mental State Examination; Cumulative Illness Rating Scale; Medical Outcome Study SF Health Survey

Naveen et al, 201316 Hamilton Rating Scale for Depression; Brain-derived Neurotrophic Factor; Clinical Global Impression Satyapriya et al, 2013

17 State-Trait Anxiety Inventory, Hospital Anxiety Depression Scale; Pregnancy Experience Questionnaire

Umadevi et al, 201318 Hospital Anxiety Depression Scale; World Health Organization Quality of Life–BREF Bershadsky et al, 2014

19 Center for Epidemiological Studies–Depression Scale; Cortisol via cotton swabs

Kinser et al, 201420 Patient Health Questionnaire-9; Perceived Stress Scale-10; State-Trait Anxiety Inventory; Short Form Health Survey Newham et al, 2014

21 State-Trait Anxiety Inventory; Edinberg Postnatal Depression Scale

Taso et al, 201622 Profile of Mood States; Brief Fatigue Inventory Battle et al, 2015

23 Edinberg Postnatal Depression Scale; Treatment Response to Antidepressant Questionnaire; Credibility Expectancy

Questionnaire; International Physical Activity Questionnaire; The Five-Facet Mindfulness Questionnaire Buttner et al, 2015

24 Hamilton Depression Rating Scale; Inventory of Depression & Anxiety Symptoms; Patient Health Questionnaire-9

Davis et al, 201525 Edinberg Postnatal Depression Scale; State-Trait Anxiety Inventory Doria et al, 201526 Zung Self-Assessment Anxiety Score; Zung Self-Assessment Depression Score; Hamilton Rating Scale for Depression;

Hamilton Rating Scale for Anxiety Falsafi et al, 201527 Beck Depression Inventory; Hamilton Rating Scale for Anxiety; Self-Compassion Scale; Perceived Wellness Survey Rao et al, 201528 Beck Depression Inventory Manincor et al, 201629 Depression Anxiety Stress Scale-21; Kessler Psychological Distress Scale; Short-Form Health Survey-12; Scale of

Positive and Negative Experience; Flourishing Scale; and Connor-Davidson Resilience Scale

Bridges and Sharma 1019

Study quality was assessed using the Cochrane guidelines

for systematic reviews. Results from the risk of bias assessment

showed that 4 studies had low risk of bias, 8,10,21,22

5 studies had

high risk of bias, 9,11,14,23,26,27

and 14 studies had unclear risk

of bias. 7,12,13,15-20,24,25,28,29

Risk of selection bias was generally

low as 11 studies reported adequate random sequence genera-

tion 8,10,13,15,17,18,20-22,25,29

; and 7 studies reported adequate

allocation concealment. 8,10,18,21,22,28,29

Risk for performance

bias was high as only one study reported blinding of partici-

pants and personnel; 10

and 2 studies reported blinding of out-

come assessment. 8,10

Incomplete outcome data were

adequately addressed in only 6 studies. 7,8,10,12,22,24

Risk for

selective reporting is unclear as only 3 studies had adequate

reporting. 10,21,22

Five articles were nonrandomization studies,

thus have selection bias. 11,14,25-27

Yoga as a complementary form of therapy and treatment was

found to be beneficial in the majority (n ¼ 14) of the interven- tions.

7,9-12,14,15,17-19,23,26,27,29 While in 6 interventions both

groups (yoga and control) showed improvement, 8,16,20,24,25,28

and there were no significant changes in 3 interventions. 13,21,22

One of the studies that reported no significant change con-

cluded that while yoga did not reduce depression, it prevented

an increase in depressive symptoms. 21

Significant effects of

yoga on depression were observed in the yoga group, 11

both

groups, 13,25

and yoga group compared to the control group. 17

In

one study, the yoga group reported less depressive symptoms

during the early pregnancy and postpartum periods. 19

No sig-

nificant effect was found in one study that examined yoga

intervention in reducing depressive symptoms among breast

cancer patients. 22

Discussion

The purpose of this systematic review was to examine the

effectiveness of yoga as an alternative treatment or comple-

mentary form of therapy for depression and depressive symp-

toms. In our search of the English-language peer-reviewed

literature from 4 databases, 23 interventions between 2011 and

May 2016 were evaluated. This number suggests that over the

past 5 years, there was continued interest in examining the

effectiveness of yoga practices for managing depression and

reducing depressive symptoms. This literature review provides

positive findings of yoga interventions in reducing depression

symptoms. Per this review, individuals with elevated depres-

sion levels and/or medical conditions benefited from yoga

treatment. Results also revealed that depression symptoms

improved among caregivers.

Our review found that yoga was effective in reducing

depressive symptoms in pregnant women, 9,12,17,19,21,23,25

among patients experiencing lower back pain, 10

among

patients with atrial fibrillation, 14

among persons with post-

stroke hemiparesis, 8

and addicts. 7

While most of the interven-

tions found yoga to be effective in treating depressive

symptoms, 3 studies, stroke patients, 8

pregnant patients, 21

and

breast cancer patients, 22

found no significant impact. In this

review, there were similar studies that reported a positive effect

of yoga and depression, which differ from some of the non-

significant results. There were 2 studies examining the effect of

yoga in reducing depression symptoms; while one study did not

find a significant impact of depression among breast cancer

patients, 22

the study did find a positive impact. This is also true

for other studies finding a positive impact of yoga in decreasing

depressive symptoms in pregnant women 9,12,17,19,23,25

and

postpartum depression. 18

Some factors that could affect the

results are the difference in geological locations, difference

in the styles of yoga used, sample characteristics, and duration

of yoga intervention. This warrants more research on the effect

of yoga for specific population groups such as depressed

patients with breast cancer to understand the factors that are

associated with the mixed results.

Various yoga methods were used in these studies with Hatha

yoga 8,13,19-20

being the most, followed by asana pra-

nayama, 10,18,23

and the Western adaptation of yoga, mindful-

ness meditation 9,11,17

and Viniyoga. 24,25,29

It was not evident

from the review that any one type/school of yoga was better

than the other. They all reported reductions in depressive symp-

toms among participants in the yoga groups. However, Hatha

yoga has been identified as one of the most commonly used

form of yoga in the United States. 30

Regardless of the length of the intervention, the interven-

tions proved to be efficacious. For example, the shortest yoga

Figure 1. Article selection process to locate articles for review.

1020 Journal of Evidence-Based Complementary & Alternative Medicine 22(4)

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ss io

n w

as si

gn if ic

an t

[F (1

, 7 8 ) ¼

5 .8

5 , P ¼

.0 1 8 ],

w it h

si gn

if ic

an t

d if fe

re n ce

b e tw

e e n

gr o u p s

(P <

.0 0 1 )

D e p re

ss io

n d e cr

e as

e d

in b o th

gr o u p s:

4 7 %

in yo

ga gr

o u p

(P <

.0 0 1 ,e

ff e ct

si ze

[E S ] ¼

0 .9

6 ),

1 9 %

in co

n tr

o l gr

o u p

(P <

.0 0 1 , E S

0 .5

9 )

S p in

al m

o b ili

ty im

p ro

ve d

in yo

ga gr

o u p

(5 0 %

) an

d co

n tr

o l gr

o u p

(3 4 .6

% )

N R

S an

d S A

R gr

o u p �

ti m

e in

te ra

ct io

n w

as si

gn if ic

an t

E as

tm an

-M u lle

r e t

al ,1

1 U

S A

2 0 1 3

Y o ga

-n id

ra —

W e e k ly

: 2

h o u r

cl as

se s

o f

re la

x at

io n

vi a

b o d y

se n si

n g,

b re

at h

aw ar

e n e ss

e x e rc

is e ; si

le n ce

to in

te gr

at e

e x p e ri

e n ce

; w

o rk

w it h

co n fl ic

ti n g

e m

o ti o n s

fo r

8 w

e e k s

1 8 -5

6 B as

e lin

e ; 8

w e e k s

Q u as

i- e x p e ri

m e n ta

l, 6 6

gr ad

u at

e an

d u n d e rg

ra d u at

e st

u d e n ts

e x p e ri

e n ci

n g

st re

ss , an

x ie

ty ,

an d

w o rr

y

T h e re

w as

a st

at is

ti ca

l si

gn if ic

an t

p re

- to

p o st

te st

im p ro

ve m

e n t

in st

re ss

, d e p re

ss io

n , an

d w

o rr

y

F ie

ld e t

al ,1

2 U

S A

2 0 1 3

T ai

ch i/ yo

ga —

W e e k ly

: 2 0 -m

in u te

se ss

io n s

o f

st re

tc h e s

an d

m o d e ra

te ly

ae ro

b ic

e x e rc

is e s

fo r

1 2

w e e k s

C o n tr

o l—

T ai

ch i/ yo

ga at

e n d

o f tr

e at

m e n t

p e ri

o d ; as

se ss

m e n ts

1 8 -3

7 B as

e lin

e ; 1 2

w e e k s

P re

te st

/p o st

te st

, 9 2

cl in

ic al

ly d e p re

ss e d

p re

gn an

t w

o m

e n

(w it h

o n ly

o n e

ch ild

) an

d h av

e n o

m e d ic

al p ro

b le

m s;

n o t

u si

n g

d ru

gs

T ai

ch i/ yo

ga sh

o w

e d

si gn

if ic

an t

gr o u p �

tr e at

m e n t

re d u ct

io n

in an

x ie

ty an

d d e p re

ss io

n (P ¼

.0 1 )

an d

sl e e p

d is

tu rb

an ce

s (P ¼

.0 5 )

(c o n ti n u ed

)

1021

T a b

le 2 .

(c o n ti n u e d )

S tu

d y,

C o u n tr

y Y

e ar

In te

rv e n ti o n

an d

D e sc

ri p ti o n

A ge

T im

e o f

A ss

e ss

m e n t

D e si

gn an

d S am

p le

S iz

e S al

ie n t

F in

d in

gs

K in

se r

e t

al ,1

3 U

S A

2 0 1 3

Y o ga

— W

e e k ly

: 7 5 -m

in u te

H a th

a yo

ga cl

as s;

d ai

ly h o m

e p ra

ct ic

e s

vi a

D V

D ; fo

r 8

w e e k s

A tt

e n ti o n -c

o n tr

o l gr

o u p —

H e al

th e d u ca

ti o n

se ss

io n s

o n

w e e k ly

to p ic

s; re

so u rc

e s

o n

w e e k ly

to p ic

s; fo

r 8

w e e k s

> 1 8

B as

e lin

e ; 2 , 6 , 8

w e e k s

R an

d o m

iz e d ,2

7 w

o m

e n

d ia

gn o se

d w

it h

m aj

o r

d e p re

ss iv

e d is

o rd

e r

(M D

D )

T h e re

w e re

n o

si gn

if ic

an t

gr o u p �

ti m

e d if fe

re n ce

in d e p re

ss io

n sc

o re

b e tw

e e n

th e

yo ga

an d

co n tr

o lg

ro u p s;

th e

tr e n d

in gr

o u p �

ti m

e (P ¼

.0 8 3 )

su gg

e st

s th

at th

e yo

ga gr

o u p

co m

p ar

e d

to th

e co

n tr

o l

gr o u p

h ad

re d u ce

d ru

m in

at io

n sc

o re

o ve

r ti m

e L ak

k ir

e d d y

e t

al ,1

4

U S A

2 0 1 3

P re

yo ga

— 3 -m

o n th

n o

in te

rv e n ti o n

o b se

rv at

io n

p e ri

o d

Y o ga

in te

rv e n ti o n —

T w

ic e

p e r

w e e k : 6 0 -

m in

u te

s Iy

en ga

r yo

ga , p ra

n a ya

m a s,

w ar

m -u

p e x e rc

is e s,

a sa

n a s,

an d

re la

x at

io n

e x e rc

is e s

fo r

1 2

w e e k s

1 8 -8

0 B as

e lin

e ; 1 2

w e e k s

P re

te st

/p o st

te st

, 4 9

at ri

al fi b ri

lla ti o n

p at

ie n ts

T h e re

w as

a si

gn if ic

an t

im p ro

ve m

e n t

(P <

.0 0 1 )

in th

e d e p re

ss io

n an

d an

x ie

ty sc

o re

s in

at ri

al fi b ri

lla ti o n

(A F )

p at

ie n ts

u p o n

co m

p le

ti o n

o f th

e yo

ga in

te rv

e n ti o n

p h as

e Y

o ga

si gn

if ic

an tl y

re d u ce

d th

e am

o u n t

o f

sy m

p to

m at

ic A

F e p is

o d e s,

sy m

p to

m at

ic n o n -A

F e p is

o d e s,

an d

as ym

p to

m at

ic A

F e p is

o d e s

(P <

.0 0 1 )

fr o m

th e

e n d

o f th

e co

n tr

o l p h as

e to

th e

e n d

o f th

e in

te rv

e n ti o n

L av

re ts

k y

e t

al ,1

5

U S A

2 0 1 3

K ir ta

n K ri ya

yo ga

— D

ai ly

1 2 -m

in u te

s yo

ga re

la x at

io n

b re

at h in

g an

d m

e d it at

io n

ch an

ti n g

fo r

8 w

e e k s

R e la

x at

io n

gr o u p —

D ai

ly 1 2 -m

in u te

s o f

lis te

n in

g to

in st

ru m

e n ta

l m

u si

c o n

C D

fo r

8 w

e e k s

4 5 -9

1 B as

e lin

e ; 8

w e e k s

R an

d o m

iz e d , 3 9

fa m

ily d e m

e n ti a

ca re

gi ve

rs T

h e re

w e re

si gn

if ic

an t

im p ro

ve m

e n ts

in d e p re

ss iv

e sy

m p to

m s,

m e n ta

lh e al

th ,a

n d

co gn

it io

n (P

< .0

5 )

an d

te lo

m e ra

se ac

ti vi

ty (P ¼

.0 5 )

in th

e yo

ga gr

o u p

co m

p ar

e d

to th

e co

n tr

o l

S ig

n if ic

an t

co rr

e la

ti o n s

w e re

fo u n d

b e tw

e e n

te lo

m e ra

se ac

ti vi

ty , d e cl

in e

in d e p re

ss io

n (r ¼

.3 3 ; P ¼

.0 5 )

an d

m e n ta

l h e al

th (r ¼

.4 4 ;P ¼

.0 5 ) in

al lp

ar ti ci

p an

ts N

av e e n

e t al

,1 6

Ir an

2 0 1 3

Y o ga

-o n ly

— A

tt e n d

d ai

ly gr

o u p s

fo r

1 0

d ay

s to

le ar

n yo

ga p ra

ct ic

e s;

p e rf

o rm

yo ga

in ce

n te

r 1

h /w

e e k

fo r

th e

n e x t

2 w

e e k s;

h o m

e p ra

ct ic

e s;

b o o st

e r

yo ga

se ss

io n

at e n d

o f 2

m o n th

s Y

o ga

an d

m e d ic

at io

n —

A tt

e n d

d ai

ly gr

o u p s

fo r

1 0

d ay

s to

le ar

n yo

ga p ra

ct ic

e s;

p e rf

o rm

yo ga

in ce

n te

r 1

h /w

e e k

fo r

2 w

e e k s;

h o m

e p ra

ct ic

e s;

an ti d e p re

ss an

ts an

d co

n su

lt at

io n ;

b o o st

e r

yo ga

se ss

io n

at e n d

o f 2

m o n th

s M

e d ic

at io

n al

o n e —

an ti d e p re

ss an

ts an

d co

n su

lt at

io n

1 8 -5

5 B as

e lin

e ; 1 2

w e e k s

P re

te st

/p o st

te st

, 6 2

d e p re

ss io

n d is

o rd

e r

p at

ie n ts

at te

n d in

g o u tp

at ie

n t

se rv

ic e s

D e p re

ss io

n sc

o re

s d ro

p p e d

si gn

if ic

an tl y

o ve

r ti m

e in

al lg

ro u p s

[F ¼

2 7 1 .7

;d f ¼

1 ,

5 9 ; P

< .0

0 1 ]

Y o ga

gr o u p s

h ad

gr e at

e r

im p ro

ve m

e n t

th an

th e

m e d ic

at io

n o n ly

gr o u p

[F ¼

5 .7

; d f ¼

2 , 5 9 ; P

< .0

0 5 ]

w h e n

e x am

in in

g gr

o u p

e ff e ct

In th

e yo

ga -o

n ly

gr o u p ,t

h e re

w as

a p o si

ti ve

co rr

e la

ti o n

b e tw

e e n

th e

d e cl

in e

in d e p re

ss io

n an

d a

ri se

in b ra

in d e ri

ve d

n e u ro

tr o p ic

fa ct

o r

le ve

ls (r ¼

.7 0 2 ,

P ¼

.0 0 1 )

(c o n ti n u ed

)

1022

T a b

le 2 .

(c o n ti n u e d )

S tu

d y,

C o u n tr

y Y

e ar

In te

rv e n ti o n

an d

D e sc

ri p ti o n

A ge

T im

e o f

A ss

e ss

m e n t

D e si

gn an

d S am

p le

S iz

e S al

ie n t

F in

d in

gs

S at

ya p ri

ya e t

al ,1

7

In d ia

2 0 1 3

Y o ga

— D

ai ly

1 h o u r:

IA Y T

a sa

n a

p o st

u re

s; p ra

n a ya

m a , m

e d it at

io n

fo r

1 6

w e e k s

C o n tr

o l—

S ta

n d ar

d ca

re ; as

se ss

m e n ts

2 0 -3

5 B as

e lin

e ; 2 0 th

ge st

at io

n ; 3 6 th

ge st

at io

n

R an

d o m

iz e d , 9 6

w o m

e n

b e tw

e e n

1 8 th

an d

1 9 th

ge st

at io

n (w

it h

o n ly

o n e

ch ild

)

D e p re

ss io

n sc

o re

s d e cr

e as

e d

in yo

ga (3

0 .6

7 %

, P

< .0

0 1 )

w it h

si gn

if ic

an t

d if fe

re n ce

in gr

o u p s

b u t

in cr

e as

e d

3 .5

7 %

in co

n tr

o l

A n x ie

ty sc

o re

s d e cr

e as

e d

in yo

ga (2

9 .1

2 %

, P

< .0

0 1 )

w it h

si gn

if ic

an t

d if fe

re n ce

in gr

o u p s

T h e re

w as

si gn

if ic

an t

ch an

ge in

P E Q

sc o re

s am

o n g

yo ga

gr o u p

(P <

.0 0 0 1 )

U m

ad e vi

e t

al ,1

8

In d ia

2 0 1 3

Y o ga

gr o u p —

1 0

d ay

s o f ta

u gh

t a sa

n a s

an d

p ra

n a ya

m a ; 2 0

d ay

s o f yo

ga p ra

ct ic

e s

o n

th e ir

o w

n C

o n tr

o l gr

o u p —

A ss

e ss

m e n ts

o n ly

1 8 -6

0 B as

e lin

e ; 4

w e e k s

R an

d o m

iz e d , 6 0

ca re

gi ve

rs o f

p at

ie n ts

in n e u ro

lo gy

w ar

d s

w h o

co u ld

p e rf

o rm

yo ga

A si

gn if ic

an t

(P <

.0 0 1 )

re d u ct

io n

in an

x ie

ty an

d d e p re

ss io

n sc

o re

s an

d im

p ro

ve d

q u al

it y-

o f-

lif e

to o k

p la

ce am

o n g

yo ga

gr o u p

co m

p ar

e d

to th

e co

n tr

o l gr

o u p

B e rs

h ad

sk y

e t

al ,1

9

U S A

2 0 1 4

H a th

a yo

ga —

9 0 -m

in u te

yo ga

tw ic

e : e ar

ly an

d m

id p re

gn an

cy : b o d y

p o st

u re

s, st

re tc

h in

g, sa

va sa

n a , p ra

n a ya

m a , sa

liv a

sa m

p le

at b as

e lin

e an

d co

m p le

ti o n

o f yo

ga C

o n tr

o l—

A ss

e ss

m e n t

o n ly

> 1 8

B as

e lin

e ; 2 �

e ar

ly p re

gn an

cy ; 2 �

m id

-p re

gn an

cy ; 2

m o n th

s af

te r

d e liv

e ry

R an

d o m

iz e d , 5 1

p e ri

n at

al d e p re

ss e d

w o m

e n

b e tw

e e n

1 2 th

an d

1 9 th

ge st

at io

n ; d id

n o t

p ra

ct ic

e yo

ga o r

re la

x at

io n

te ch

n iq

u e s

W o m

e n

in th

e yo

ga gr

o u p

re p o rt

e d

le ss

d e p re

ss iv

e sy

m p to

m s

th an

w o m

e n

in th

e co

n tr

o l gr

o u p

in th

e p o st

p ar

tu m

p e ri

o d

af te

r co

n tr

o lli

n g

fo r

an te

p ar

tu m

d e p re

ss iv

e sy

m p to

m s

in e ar

ly an

d m

id -

p re

gn an

cy W

o m

e n

w h o

p ra

ct ic

e d

yo ga

at le

as t tw

ic e

a w

e e k

p ri

o r

to fi rs

t as

se ss

m e n t

re p o rt

e d

fe w

e r

d e p re

ss io

n sy

m p to

m s

(M ¼

2 .1

3 ,

S D ¼

1 .5

5 )

th an

w o m

e n

p ra

ct ic

in g

yo ga

le ss

(M ¼

4 .7

2 , S D ¼

2 .7

2 ; t(

2 4 ) ¼

2 .5

1 ,

P <

.0 5 )

C o rt

is o l le

ve ls

w e re

lo w

e r

in yo

ga co

m p ar

e d

to co

n tr

o l gr

o u p

in e ar

ly p re

gn an

cy (b ¼ �

.5 0 ,S

E ¼

.2 3 ,P ¼

.0 2 9 )

b u t

d id

n o t

ch an

ge o ve

r ti m

e , n o

tr aj

e ct

o ri

e s

w e re

o b se

rv e d

b e tw

e e n

gr o u p s

(b ¼ �

.0 1 , S E ¼

.2 0 , n s)

K in

se r

e t

al ,2

0 U

S A

2 0 1 4

Y o ga

gr o u p —

W e e k ly

: 7 5 -m

in u te

H a th

a yo

ga ;

b re

at h in

g an

d re

la x at

io n

p ra

ct ic

e s

fo r

8 w

e e k s

C o n tr

o l gr

o u p —

W e e k ly

: 7 5 -m

in u te

h e al

th e d u ca

ti o n

se ss

io n

fo r

8 w

e e k s

> 1 8

B as

e lin

e ; 2 , 4 , 6 , 8

w e e k s;

5 2

w e e k

R an

d o m

iz e d , 7 7

w o m

e n

w it h

M D

D o r

d ys

th ym

ia d ia

gn o si

s; ca

n p ar

ti ci

p at

e in

yo ga

P ar

ti ci

p an

ts in

b o th

gr o u p

sh o w

e d

a si

gn if ic

an t

re d u ct

io n

in d e p re

ss io

n o ve

r ti m

e T

h e

yo ga

gr o u p

m ai

n ta

in e d

a m

ild le

ve l o f

d e p re

ss io

n 1

ye ar

af te

r th

e in

te rv

e n ti o n

B o th

gr o u p s

re p o rt

e d

a si

gn if ic

an t d e cr

e as

e in

p e rc

e iv

e d

st re

ss , st

at e

an x ie

ty , an

d h e al

th -r

e la

te d

q u al

it y

o f lif

e

(c o n ti n u ed

)

1023

T a b

le 2 .

(c o n ti n u e d )

S tu

d y,

C o u n tr

y Y

e ar

In te

rv e n ti o n

an d

D e sc

ri p ti o n

A ge

T im

e o f

A ss

e ss

m e n t

D e si

gn an

d S am

p le

S iz

e S al

ie n t

F in

d in

gs

N e w

h am

e t

al ,2

1

U K

2 0 1 4

A n te

n at

al yo

ga —

E x e rc

is e s,

p o st

u re

s, an

d re

la x at

io n /b

re at

h in

g m

e th

o d s

fo r

8 w

e e k s

C o n tr

o l—

T re

at m

e n t

as u su

al , as

se ss

m e n t

> 1 8

B as

e lin

e ; 8

w e e k s

R an

d o m

iz e d , 5 9

lo w

-r is

k w

o m

e n

in th

e se

co n d

an d

e ar

ly th

ir d

tr im

e st

e r

(f ir

st p re

gn an

cy an

d h ig

h an

x ie

ty )

Y o ga

se ss

io n s

w e re

e ff e ct

iv e

in re

d u ci

n g

an x ie

ty at

th e

b e gi

n n in

g (3

7 [I

Q R ¼

3 0 -

4 4 ])

an d

th e

e n d

o f th

e 8 -w

e e k

p ro

gr am

(3 2

[I Q

R ¼

2 5 -3

9 ])

D e p re

ss io

n sc

o re

s d id

n o t

ch an

ge o ve

r ti m

e ; h o w

e ve

r, d e p re

ss io

n sc

o re

s w

e re

si gn

if ic

an tl y

gr e at

e r

am o n g

w o m

e n

in th

e co

n tr

o l gr

o u p

co m

p ar

e d

to th

e w

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d T

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al ,2

2

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h in

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d re

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io n

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m p to

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o ve

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n e r

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al ,2

4

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2 0 1 5

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gr o u p —

1 6

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o u r

cl as

se s:

su n

sa lu

ta ti o n s,

b al

an ci

n g,

tw is

ti n g,

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re la

x at

io n

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s; 3 0 -m

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e yo

ga vi

a D

V D

fo r

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e e k s

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gr o u p —

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e ss

m e n ts

o n ly

1 8 -4

5 B as

e lin

e ; 2 , 4 , 6 , 8

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d o m

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e n

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ss iv

e sy

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e as

e d

o ve

r ti m

e fo

r b o th

gr o u p s

(t ¼ �

1 0 .1

7 ;d

f ¼

5 5 ;P

< .0

0 0 1 )

Y o ga

gr o u p

p ar

ti ci

p an

ts e x p e ri

e n ce

d a

st e e p e r

lin e ar

d e cl

in e

in d e p re

ss iv

e sy

m p to

m s

(t ¼ �

2 .9

4 ;d

f ¼

5 2 ;P ¼

.0 0 5 )

an d

an x ie

ty sy

m p to

m s

(t ¼ �

3 .2

6 ; d f ¼

5 2 ; P ¼

.0 0 2 )

an d

st e e p e r

lin e ar

in cr

e as

e in

w e ll-

b e in

g sc

al e

sc o re

s (t ¼

2 .9

4 ; d f ¼

5 2 ; P ¼

.0 0 5 )

co m

p ar

e d

to th

e co

n tr

o l

gr o u p

D av

is e t

al ,2

5 U

S A

2 0 1 5

Y o ga

— W

e e k ly

: 7 5 -m

in u te

cl as

se s—

sy n ch

ro n iz

in g

b re

at h , m

o ve

m e n t

an d

st an

d in

g p o st

u re

fo r

8 w

e e k s

C o n tr

o l—

T re

at m

e n t

as u su

al ; as

se ss

m e n ts

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5 B as

e lin

e ; 4 , 8

w e e k s

R an

d o m

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u p

to 2 8

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ge st

at io

n T

h e re

w as

a si

gn if ic

an t

im p ro

ve m

e n t

in d e p re

ss io

n an

d an

x ie

ty sc

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s fo

r b o th

gr o u p s

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r ti m

e

D o ri

a e t

al ,2

6 It

al y

2 0 1 5

S K

Y gr

o u p

1 —

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: m

in im

u m

o f 6

m o n th

s p h ar

m ac

o lo

gi ca

l tr

e at

m e n t w

it h

m e d ic

at io

n ;

b re

at h in

g e x e rc

is e s

S K

Y gr

o u p

2 —

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: m

in im

u m

o f 6

m o n th

s se

lf -

h e lp

gr o u p s;

b re

at h in

g e x e rc

is e s

2 5 -6

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e lin

e ; 3 , 6

m o n th

s; 1 5

d ay

s af

te r

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te st

/p o st

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an tl y

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.0 0 1 )

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s af

te r

tr e at

m e n t

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o re

s si

gn if ic

an tl y

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r S K

Y gr

o u p

(c o n ti n u ed

)

1024

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le 2 .

(c o n ti n u e d )

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d y,

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y Y

e ar

In te

rv e n ti o n

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p le

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e S al

ie n t

F in

d in

gs

F al

sa fi

e t

al ,2

7 U

S A

2 0 1 5

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rv e n ti o n —

1 .5

h o u rs

p e r

w e e k

o f

m in

d fu

ln e ss

, se

lf -c

o m

p as

si o n

an d

yo ga

tr ai

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at e ri

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o m

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fr o m

p re

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to fo

llo w

- u p

(P <

.0 5 )

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w e re

al so

st at

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l im

p ro

ve m

e n ts

in an

x ie

ty (P

< .0

5 ) fr

o m

p re

- to

p o st

te st

an d

fo llo

w -u

p (P

< .1

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co m

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si o n

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ge n e ra

l w

e ll-

b e in

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o m

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fo llo

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p (P

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d ia

2 0 1 5

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gr o u p —

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t o f a sa

n a s,

b re

at h in

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n a ya

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e d it at

io n

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yo gi

c re

la x at

io n

te ch

n iq

u e s

w it h

im ag

e ry

fo r

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o u p —

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iv e

th e ra

p y:

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o f d is

e as

e an

d tr

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m e n t

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ss th

e ir

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h e n

re la

ti o n sh

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fi n d

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h e

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gr o u p

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e d

a d e cr

e as

e in

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n sc

o re

b e fo

re (F

(5 7 ) ¼

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¼ .0

2 ),

an d

af te

r (F

(5 7 ) ¼

1 0 .9

0 , P ¼

.0 0 2 )

ch e m

o th

e ra

p y

co m

p ar

e d

to th

e co

n tr

o l gr

o u p

T h e re

w as

a p o si

ti ve

si gn

if ic

an t

co rr

e la

ti o n

b e tw

e e n

d e p re

ss io

n sc

o re

s o f sy

m p to

m se

ve ri

ty an

d an

d d is

tr e ss

d u ri

n g

ad ju

va n t

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th e ra

p y

an d

ch e m

o th

e ra

p y

M an

in co

r e t

al ,2

9

A u st

ra lia

2 0 1 6

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gr o u p —

1 d ay

a w

e e k

V in

iy o ga

; tr

e at

m e n t

as u su

al fo

r 6

w e e k s

C o n tr

o l gr

o u p —

T re

at m

e n t

as u su

al ;

as se

ss m

e n ts

> 1 8

B as

e lin

e ; 6

w e e k s

R an

d o m

iz e d , 1 0 1

d e p re

ss e d

an d

an x ie

ty p at

ie n ts

S ta

ti st

ic al

ly si

gn if ic

an t

d if fe

re n ce

s o n

re d u ce

d d e p re

ss io

n sc

o re

s w

e re

fo u n d

in yo

ga gr

o u p

co m

p ar

e d

to th

e co

n tr

o l

gr o u p

(� 4 .3

0 ;9

5 %

C I: �

7 .7

0 ,�

0 .0

1 ;P ¼

.0 1 ; E S �

.4 4 );

d if fe

re n ce

in re

d u ce

d an

x ie

ty sc

o re

s w

e re

n o t

st at

is ti ca

lly si

gn if ic

an t

(� 1 .9

1 ; 9 5 %

C I: �

4 .5

8 , 0 .7

6 ;

P ¼

.1 6 )

S ta

ti st

ic al

ly si

gn if ic

an t

d if fe

re n ce

s fa

vo ri

n g

yo ga

w as

fo u n d

o n

to ta

l d e p re

ss io

n an

d an

x ie

ty sc

o re

s (P ¼

.0 3 )

A b b re

vi at

io n s:

IA Y

T , in

te gr

at e d

ap p ro

ac h

o f yo

ga th

e ra

p y;

S K

Y , S u rd

a sh

a n

K ri ya

yo ga

.

1025

intervention with depressed patients with chronic back pain 10

showed positive results. These findings suggest that brief yoga

treatment or therapy can be effective in reducing depressive

symptoms. The longest intervention 19

followed women

through their pregnancy to 2 months postpregnancy. The preg-

nant women showed a reduction in depressive symptoms.

These findings suggest that yoga interventions can have a

long-term positive effect on depressive symptoms. Seven stud-

ies implemented some form of follow-up with participants after

the intervention; 11,13,17-20,22,27,28

only in 6 studies did effects

persist. 11,13,17,19,22,25

There were many commonalities in the articles reviewed. Per

this current review of literature, common interest of yoga and

depression took place with pregnant and postpartum women

(n ¼ 7), patients diagnosed with a depressive disorder (n ¼ 4), caregivers (n ¼ 2), and breast cancer patient (n ¼ 2). They reported positive impacts of yoga in treating depression in

patients. This information gives value to the positive effect yoga

has in reducing depression among these groups. Most of the

studies examined the effect of yoga on depressed patients with

medical (n ¼ 13) and mental health conditions (n ¼ 6). Two studies examined the impact of yoga on reducing depression

among caregivers. 15,18

As both reported positive effects, more

research is needed for caregivers of medical and mental health

patients. Another commonality of the interventions involved

yoga practices among the adult population. Only one study 11

examined the effectiveness of yoga for treating depression,

stress, and worry among college students. As yoga was found

to reduce depressive symptoms in college students, more studies

are needed to add to the body of knowledge with this population.

These findings provide support for mind-body interventions

such as yoga for improving depression symptoms. While mind-

body interventions may not be more effective than existing

evidence-based treatments for depression, 31

there is one great

benefit. Yoga can serve as alternative to many individuals who

may not participate in psychotherapy or antidepressants due to

factors such as side effects, unmet needs, lack of access/

resource, and personal choice.

The results of this review are in line with those of prior

systematic reviews on yoga for depression. Two systematic

reviews found evidence of the effectiveness of yoga for reduc-

ing depression; 32,33

another more recent review article reported

that yoga was better than usual care, relaxation techniques, or

aerobic exercises in reducing depressive symptoms. 34

Limitations of the Interventions

There were some limitations of the interventions. Majority of

the studies utilized a small sample, which limits the power of

statistical analysis. Many of the studies were randomized con-

trolled trials; however, there were also other designs used.

Next, majority of the studies examined the short-term effects

of yoga to treat depression. Studies examining the long-term

effectiveness of yoga for depression are limited and more stud-

ies in this area are warranted. While the literature reports find-

ings on various population and study area, it limits the variety

Table 3. Risk of Bias in Included Studies.

Study, Year

Random Sequence Generation

Allocation Concealment

Blinding of Participants and Personnel

Blinding of Outcome Assessment

Incomplete Outcome Data

Selective Reporting Other Bias

Marefa et al,7 2011 Unclear No No No Yes Unclear Unclear Chan et al,8 2012 Yes Yes Unclear Yes Yes Unclear None Muzik et al,9 2012 No No No No Unclear Unclear Unclear Tekur et al,10 2012 Yes Yes Yes Yes Yes Yes None Eastman-Muller et al,

11 2013 No No No No Unclear Unclear Yes

Field et al,12 2013 Unclear Unclear Unclear Unclear Yes Unclear Unclear Kinser et al,

13 2013 Yes Unclear Unclear Unclear No Unclear Unclear

Lakkireddy et al,14 2013 No No No No Unclear Unclear Yes Lavretsky et al,

15 2013 Yes Unclear Unclear Unclear Unclear Unclear Unclear

Naveen et al,162013 No No No No No Unclear Unclear Satyapriya et al,

17 2013 Yes Unclear No No Unclear Unclear Unclear

Umadevi et al,18 2013 Yes Yes Unclear Unclear Unclear Unclear Unclear Bershadsky et al,

19 2014 Unclear Unclear Unclear Unclear No Unclear Unclear

Kinser et al,20 2014 Yes Unclear Unclear Unclear No Unclear Unclear Newham et al,

21 2014 Yes Yes Unclear Unclear Unclear Yes Unclear

Taso et al,22 2014 Yes Yes Unclear Unclear Yes Yes None Battle et al,

23 2015 No No No No Unclear Unclear Yes

Buttner et al,24 2015 Unclear Unclear Unclear Unclear Yes Unclear Unclear Davis et al,

25 2015 Yes Unclear Unclear Unclear Unclear Unclear Unclear

Doria et al,26 2015 No No Unclear Unclear Unclear Unclear Yes Falsafi et al,

27 2015 No No Unclear Unclear Unclear Unclear Yes

Rao et al,28 2015 Unclear Yes Unclear Unclear Unclear Unclear Unclear Manincor et al,29 2016 Yes Yes Unclear Unclear Unclear Unclear Unclear

1026 Journal of Evidence-Based Complementary & Alternative Medicine 22(4)

of literature of the effect of yoga on depression regarding other

populations and study areas. These findings support Mehta and

Sharma’s 6

suggestion for more studies that examine the effect

of yoga on depression within youth and among various ethni-

city groups, cultures, sex, and occupation. Finally, none of the

interventions utilized any behavioral theory to help participants

adhere to the practice of yoga. The use of cognitive and beha-

vioral theories and strategies are suggested because they are

used as a form of treatment for reducing depression in patients

with depressive disorder.

Limitations of This Review

There were some limitations of this review. This search only

consisted of restricted databases and there are other databases

that were not included in this research. Grey literature was not

searched in this study. Only articles in the English language

were included; articles in other languages were not included.

There could have been publication bias as many of the studies

used in this review reported positive findings and many arti-

cles with negative results may have been rejected. Quality of

studies was not assessed. Finally, studies that measured

depression or depressive symptoms as an outcome measure

were used, omitting articles that measured depression but not

as an outcome measure.

Implications for Practice

While literature on yoga intervention for depression continues to

lengthen, there continues to be a growing need for more studies

of yoga practices for treating depression and depressive symp-

toms. Based on the review, the following recommendations for

future studies are made. More studies are needed on yoga for

reducing depression and depressive symptoms in various comor-

bid mental health and physical health conditions and for care-

givers. Such research should be conducted on studies of yoga for

depression among groups such as race and ethnicity, cultures,

youth and young adults, and socioeconomic status in various

geographical location and conditions. For example, more studies

are needed on yoga for reducing depression symptoms among

the various depressive disorders and other mental health illnesses

(eg, posttraumatic stress disorder) and medical conditions (eg,

breast cancer patients) as this review reports limited research and

mixed results on these areas This will result in more knowledge

in understanding the direct impact of yoga for depressive symp-

toms among various groups of individuals.

While there are many aspects of yoga, there is also a need to

examine more of the styles and specific aspects of yoga on

depression. These will merit the full or exact understanding

of the impact that yoga has on depression. Finally, yoga inter-

ventions should utilize behavioral theories/techniques such as

social cognitive theory, 35

multi-theory model of health beha-

vior change, 36,37

and others in designing and evaluating the

interventions. This is imperative as psychotherapy techniques

are used in managing depressive symptoms and stress

management.

Conclusions

Yoga is a fairly new treatment or practice utilized for more than

mind-body fitness in the West. In fact, yoga is being used more

and more as an alternative form of treatment for improving

many conditions. One way that yoga is used is in individuals

with depressive symptoms. Recently, researchers have exam-

ined the benefits and effectiveness of depression for managing

depressive symptoms. This review reveals that yoga provides

limited evidence that a restricted number of studies (those pub-

lished between 2011 and 2015) may influence depression out-

comes in various populations. Many more interventions on the

subject area are needed to continue to learn and understand

fully the impact of yoga and depression.

Acknowledgements

We are thankful to Center for University Scholars, Jackson State

University, for awarding a graduate assistantship in order to complete

this project.

Author Contributions

MS conceptualized the study, both MS and LB retrieved the articles,

LB prepared the first draft, and MS worked on the final draft and

submission.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to

the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the

research, authorship, and/or publication of this article: Only graduate

assistantship support was provided by the Center for University Scho-

lars, Jackson State University.

Ethical Approval

As human subjects were not involved in this study, ethical approval

was not required.

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