Improve Treatment Resistant Major Depression with Yoga
By John M. de Castro, Ph.D.
“Some people who haven’t responded to traditional treatments might do well with yoga, because unlike antidepressant drugs, yoga and deep breathing target the autonomic nervous system.” – Amanda MacMillan
Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. Depression can be difficult to treat and is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).
Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can relieve the suffering. Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs fail. Yoga practice is a mindfulness training and has the added benefit of being an exercise which has been also found to be effective for depression.
Recently, it has been discovered that there are genetic differences between patients with major depression who respond to antidepressant drugs and those who don’t. In particular non-responders appear to have a 5-HTTLPR variant of the serotonin transporter gene (SLC6A4) and MTHFR 677C>T polymorphisms. The serotonin system in the brain is a target of antidepressant drugs and these genetic variants may underlie non-responsiveness to the drugs. Since, yoga practice appears to be effective for depression in patients who do not respond to antidepressant drugs, it is likely that yoga practice works in spite of these genetic variants.
In today’s Research News article “5-HTTLPR and MTHFR 677C>T polymorphisms and response to yoga-based lifestyle intervention in major depressive disorder: A randomized active-controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278208/ ), Tolahunase and colleagues recruited patients with major depressive disorder and randomly assigned them to receive either a 12-week yoga program or to receive antidepressant drugs (SSRIs). Yoga was practiced for 2 hours per day, 5 days per week, for 12 weeks and consisted of postures, breathing exercises, and meditation. They were measured before and after treatment for depression, other psychiatric conditions, and childhood trauma. Blood was drawn for DNA genotyping.
They found that both groups had significant reductions in depression over the treatment period, but, the yoga group had significantly greater reductions in depression and higher remission rates (59% compared to 33%) than the antidepressant drug group. The participants with 5-HTTLPR and MTHFR 677C>T polymorphisms had significantly lower reductions in depression and remission rates in the antidepressant drug group but not in the yoga group. The participants in the yoga group with the polymorphisms benefited with reductions in depression and increases in remission rates to the same extent as those without the polymorphisms.
These are remarkable results. Yoga practice produced greater relief of depression than antidepressant drugs and, in addition, yoga practice produced this relief irrespective of the genetic polymorphisms that affect responses to antidepressant drugs. This suggests that yoga practice my work to relieve depression through a different mechanism than antidepressant drugs. Hence, yoga practice appears to be an almost ideal treatment for major depressive disorder, producing high remission rates and great reductions in depression, safely, without major side effects, and irrespective of the genetic polymorphisms that reduce responsiveness to antidepressant drugs. This suggests that yoga practice should be the first line treatment for major depressive disorder.
So, improve treatment resistant major depression with yoga
“many patients dealing with depression, anxiety, or stress, yoga may be a very appealing way to better manage symptoms. Indeed, the scientific study of yoga demonstrates that mental and physical health are not just closely allied, but are essentially equivalent. The evidence is growing that yoga practice is a relatively low-risk, high-yield approach to improving overall health.” – Harvard Mental Health Newsletter
CMCS – Center for Mindfulness and Contemplative Studies
This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch
Tolahunase, M. R., Sagar, R., & Dada, R. (2018). 5-HTTLPR and MTHFR 677C>T polymorphisms and response to yoga-based lifestyle intervention in major depressive disorder: A randomized active-controlled trial. Indian journal of psychiatry, 60(4), 410-426.
There is growing evidence suggesting that both genetic and environmental factors modulate treatment outcome in, a highly heterogeneous, major depressive disorder (MDD). 5-HTTLPR variant of the serotonin transporter gene (SLC6A4) and MTHFR 677C>T polymorphisms have been linked to the pathogenesis of MDD, and antidepressant treatment response. The evidence is lacking on the clinical utility of yoga in patients with MDD who have 5-HTTLPR and MTHFR 677C>T polymorphisms and less likely to respond to medications (SSRIs).
We aimed to examine the impact of YBLI in those who have susceptible 5-HTTLPR and MTHFR 677C>T polymorphisms and are less likely to drug therapy with SSRIs.
Settings and Design:
In a 12 week randomized active-controlled trial, MDD patients (n = 178) were randomized to receive YBLI or drug therapy.
Genotyping was conducted using PCR-based methods. The clinical remission was defined as BDI-II score ≤ 9.
Statistical Analysis Used:
An intent-to-treat analysis was performed, and the association of genotype with treatment remission consisted of the logistic regression model. A P value of <0.05 was considered statistically significant.
Multivariate logistic regression models for remission including either 5-HTTLPR or MTHFR 677C>T genotypes showed statistically significant odds of remission in YOGA arm vs. DRUG arm. Neither 5-HTTLPR nor MTHFR 677C>T genotype showed any influence on remission to YBLI (P = 0.73 and P = 0.64, respectively). Further analysis showed childhood adversity interact with 5-HTTLPR and MTHFR 677C>T polymorphisms to decrease treatment response in DRUG treatment arm, but not in YOGA arm.
YBLI provides MDD remission in those who have susceptible 5-HTTLPR and MTHFR 677C>T polymorphisms and are resistant to SSRIs treatment. YBLI may be therapeutic for MDD independent of heterogeneity in its etiopathogenesis.