By Mary Vilcheck
“Depression is the common cold of the deluded human being. And according to the Buddha, all human beings are quite deluded”. Stephen Cope, Kripalu
Depression is a constellation of emotions, cognitions, behaviors and health issues. Both its roots and treatment (cure and management) lie in bio-psycho-social, spiritual aspects. Depression evokes hopelessness and helplessness. It arises when internal and external conflicts destabilize someone and can involve despair, sadness, and melancholy. It can erode self esteem and health, and can result in isolation and separation, further adding to its spiraling. Since chemical neurotransmitters and other hormone fluctuations are involved in depression, women are more prone to it.
There are several levels and types of depression – the word is widely used in our Western culture. Acute depression can range from a temporary sadness in response to a life event or situation, to an insidious, chronic state, defined clinically and marked by distinct features. The most recognized categories are major depression, dysthymia, bipolar, and post-traumatic stress disorder/PTSD. Major depression is marked by five or more symptoms for at least 2 weeks (sad, hopeless, worthless, pessimistic, low energy, agitation, changes/problems in eating and/or sleeping, pain, cognitive issues, memory impairment, suicidal ideology, and others). Dysthymia is a lower grade chronic situation that may not disable someone, but can result in low functioning, joylessness, ongoing relationship and job problems. This condition can go under the radar and thus is very important to identify. Bipolarity is a cycling mood changes, marked by highs (mania) and lows (depression). Cyclothymia is a lower grade Bipolar. PTSD is marked by cascading and debilitating panic attacks, disturbing flashbacks, unrelenting dread, and deep shame.
While depression and other mental illnesses can be pushed under the rug and viewed as a failure, weakness, or dreaded fate, the symptoms of depression can also be viewed as an opportunity to probe – to journey through the ‘dark night of the soul’, so to speak. Since the body has wisdom, depression is an opportunity to move through discomfort, confusion, agony, worry, and stagnation to literally open up new pathways – both physically and mentally. Mindful reflection, not always valued in this culture, has made ‘rescuing’ practices somewhat difficult or taboo. Now, thankfully, dialogs about depression include fewer stigmas, an understanding of the situation within the cultural context, and are yielding integrative treatment options. This is good news. Depression can and should be treated holistically. Although antidepressant medications are popular, they can carry many unpleasant sides, be expensive, and may simply act as a band-aid. Using them in conjunction with other treatments such as bodymind yoga may be key. Then weaning off may be possible. Of course, depressive energy, like happiness, can be contagious, so it is important to give it its due of exploration, respect, and treatment. Practices using energy, elemental, Vedic doshas, positive psychology, therapeutic laugher, qigong, walking, and yoga – are great – this is where Yoga can instill hope.
Yoga practiced to relieve depression is a hopeful and compassionate modality shown to quell suffering. Components of yoga have long been recognized as helpful to improve mood. Of course, aspects of meditation with and without mantra, exercising, and breathing are well known, long-standing parts of treatment for health problems, including depression. Yoga possesses all of those components and more making it a perfect union for the treatment of all types of depressive related mood disorders.
Interestingly, Yogic science offers three psychological archetypes; called gunas, which can loosely correspond, to depressive states. Sattvic refers to a balanced state, tamasic is marked by lethargy (our depression/dysthymia), and rajasic denotes an anxious or aggressive state (anxious depression and bipolar disorder). All yoga practices can bring bodymind into balance. Yoga and postures can sooth and evoke calm; others create dynamic energy. In order to achieve balance/sattva via yoga practice design, it is helpful to identify which type of depression is being experienced (1).
A review of the literature shows that yoga is having success in the research lab. Just today as I turned on the computer and up popped another journal noting the study conducted at Brown and Butler Universities in Rhode Island. Here, 8 weeks of vinyassa classes yielded a decrease in uncomfortable symptoms and an increase in focus and ability to solve certain problems. Elements of mindfulness, together with asana, pranayama, meditation, and relaxation attributed to this positive behavior change reporting (2). Another promising study in India compared the effects two participant groups – some practiced yoga without meditation, others practiced yoga together with breathwork. Results showed a 42% improvement in the first group, and a 73% improvement with yoga and meditation (3). Yoga can also relieve pain symptoms related to depression. This was illustrated in a 2008 study conducted at the University of Utah looking at yoga and the stress response. Undergirding this study is the fact that people with poorly regulated responses to stress are commonly more sensitive to pain. In this 2008 study, 12 experienced yoga instructors’ responses to pain were compared with the pain responses of 14 people with fibromyalgia after being given thumbnail pressure. Interestingly, the yoginis reported less pain. In addition, their functional MRIs showed lower pain activity in the brain than their counterparts (4). Currently, many veterans returning with traumatic stress are being treated with yoga therapy and related techniques. In fact, Walter Reed Medical Center offers yogic deep relaxation to those returning from the Middle East (5). These practices are being received so well that yoga is being used as part of post deployment PTSD awareness classes. Yoga for PTSD has been widely used at the Trauma Center in Brookline, MA with trauma expert, Dr. Bessel Van Der Kolk and staff. With such widespread interest and success in their programs, they offer training and resources for both yoga practitioners and psychotherapists, including comprehensive material about principles and practice of trauma sensitive yoga.
Essential to alleviating depression is learning how to calm down and self regulate. Putting events and situations into perspective, living in the moment – verses grieving or regretting the past (depression) or worrying about the future (anxiety) is key. Yoga practice can reduce autonomic sympathetic activation, blood pressure, racing mind (aka monkey mind), muscle tension, and pain sensation. The postures/asanas can literally move stagnant energy, freeing up pathways for blood to circulate more effectively. It creates space. It lends well to the saying ‘the issues are in the tissues’. By nudging energy and lymph, yoga can ease and free the bodymind. It can decrease emotional and physical distress and improve hormonal and neuroendocrine activity, thus promoting full body balance and well-being. This in turn can improve outlook, mood, and quality of life. Used as an adjunctive therapy, yoga is cutting edge medical treatment.
When taking about yoga, pranayma – vital life-force breathing is key. There are three aspects of effective pranayama breathing to consider during all yoga practice (6). One is to have fresh air circulating in the room. Another is to leave at least two hours in between eating and yoga practice. The third is to be mindful that the spine is erect; the legs are crossed in Easy Pose or Half-Lotus hands on the knees and open to receive. Several types of breathing exercises can help. Ujjayi is beneficial for healing depression. It is soothing, grounding, and involves the back of the throat. Alternate nostril breathing is perfect for centering and peace. Both are helpful components of mindfulness, which is key to yoga. Breath of fire will activate, so those in highly anxious state may not choose this breath. Bellows breath is great for dysthymia, as the vagus nerve is stimulated – this is good for depression. During bellows, breath, ‘feel good’ hormones such as oxytocin and prolactin are released. Moving with breath in asana invites being in ‘the moment’ thinking, which can benefit depressive states, which can leave people ‘stuck’ in past or future thinking). Staying with the breath, just witnessing, not judging, not trying to change a thing, and delighting in sensation and grounded space are beautiful. The continued breath allows sensations to be tolerated and allows deepening into a pose. Yoga teachers can cue students how to move with inhalation and exhalation with regard to asana. Although the yoga practice and breathing are personal and individual, if practiced in a group, there is almost an experience of unison breathing, which can add social support to the depressed practitioner. In savasana, or relaxation pose, the breath is natural, not contrived – just breathing in and breathing out.
There are yoga asanas recommended for depression. Of course, with any practice, the regular contraindications and modification must be adhered to. For instance, inversions and some twists are not good for those with hypertension. Those menstruating should also refrain from inversions. Pregnant women and those with spine and neck injuries also need special considerations. And so on.
Similar to being in touch with which breath promotes well-being, knowing which pose will be helpful is great. Many yoga teachers agree that open heart poses and bends greatly help low energy, sullen, closed in depression, and that poses such as forward bends can sooth anxious states. Prop assisted traditional restorative poses help any type of depression, keeping in mind contraindications and considerations/modifications. Most postures, when sequenced correctly, can be practiced by those with depression. Many yoga teachers have favorite postures to introduce to people who are experiencing depression, such as: sun salutation reps, bow, plough, camel, threading the needle, bridge, shoulder stand, and cat/cow extension and flexion. Vinyassa can be delightful. Some enjoy promoting powerful warrior sequences for those who have depleted esteem or confidence. Some suggest delightful side stretches for those who are jumpy and anxious. So in this yoga flow, pranayama and asana nicely balance right and left-brain – a balance disrupted in depression. Many yoga teachers agree that practicing yoga upon waking in the morning helps to move the day in a positive direction, and thus assist with depressive symptoms, such as dread, rumination, and worry, which are often tweaked upon rising. For individuals with a slow fog depression, meeting and honoring this energy level can be nice, so beginning with slower asanas is fine. Doing so with mindful breathing can gently transform any negative spiral energy. Popular is the knowledge that heart-opening postures yield open and loving hearts, so healing and softening mood. A bit of levity holds that if one keeps armpits open, one will never be depressed. Yoga does have a sense of humor. The Breath of Joy sequence, which involves synchronized arm movements, deep breathing, and some bending can also be practiced first thing in the morning, moving stagnated energy to begin the day with positive intention and outlook. It warms the body and can be practiced in up to nine rounds (7). This practice increases blood oxygen levels and circulation, releases tension, aids the nervous system, and can improve mood. Those with hypertension and eye injury should avoid this practice.
Sometimes, highly anxious individuals may desire to move into vigorous postures upon rising to nudge extra energy out of the body, and then continue with a slower flow. Those who have adrenal fatigue benefit from a later rising time (8), so for them yoga practice might include restorative poses, so not to deplete their cortisol levels. In every instance, people will honor themselves and their practice by listening to what the body wants during each visit to the mat. Incorporating affirmation, chants, and/or prayer can boost the mood, plus set the intention for living a fully conscious day. Using guided meditation and chakra (energy center) balancing are also fortifying parts of a yoga for depression session. Finally, being with a loving presence (teacher/class) itself can be gratifying and nurturing to a person experiencing a mood problem, and thus the yoga teacher must show up totally prepared to serve and gently help with adjustments.
Some yoga teachers are licensed or trained in psychotherapy, Phoenix Rising Yoga Therapy, Yoga for Depression, Yoga for Trauma, or other specialized training, which will likely include material about working with people experiencing depression. All yoga teachers must adhere to their Codes of Ethics and have the highest regard for any student – doing no harm – to all they teach, including those who may experience a sense of fragility as they move through their depressive journey and into healing.
1. Yoga For Depression: A Compassionate Guide to Relieve Suffering Through Yoga, Weintraub, Amy. Broadway Books/Division of Random House, 2004.
2. Yoga for Anxiety and Depression, www.bing.com/health/article/harvard
3. Yoga, Not Just and Exercise, www.psychologytoday.com/articles200011/
4. Yoga, Not Just an Exercise, www.psychologytoday.com/article200011/
5. Trauma Sensitive Yoga: Principles, Practice, and Research. Emerson, D, Sharman, R, Chaudhry, S, and Turner, J. International Journal of Yoga Therapy.
6. Yoga for Depression, www.aurawellnesscenter.com.2010.24.yoga-for-depression
7. Breath of Joy. Weintraub, A. Yoga International, Winter, 2010-11, pg. 58.
8. Adrenal Fatigue, Wilson, J. Smart Publications, 2001.