Elsevier

Journal of Affective Disorders

Volume 213, 15 April 2017, Pages 70-77
Journal of Affective Disorders

Review article
A systematic review of yoga for major depressive disorder

https://doi.org/10.1016/j.jad.2017.02.006Get rights and content

Highlights

  • Seven RCTs have investigated the effects of yoga in major depressive disorder.

  • There is some evidence of positive effects beyond placebo.

  • Yoga's efficacy seems to be comparable to that of antidepressant medication.

  • Larger and adequately powered RCTs using non-inferiority designs are needed.

Abstract

Background

The purpose of this review was to investigate the efficacy and safety of yoga interventions in treating patients with major depressive disorder.

Methods

MEDLINE, Scopus, and the Cochrane Library were screened through December 2016. Randomized controlled trials (RCTs) comparing yoga to inactive or active comparators in patients with major depressive disorder were eligible. Primary outcomes included remission rates and severity of depression. Anxiety and adverse events were secondary outcomes. Risk of bias was assessed using the Cochrane tool.

Results

Seven RCTs with 240 participants were included. Risk of bias was unclear for most RCTs. Compared to aerobic exercise, no short- or medium-term group differences in depression severity was found. Higher short-term depression severity was found for yoga compared to electro-convulsive therapy; remission rates did not differ between groups. No short-term group differences occurred when yoga was compared to antidepressant medication. Conflicting evidence was found when yoga was compared to attention-control interventions, or when yoga as an add-on to antidepressant medication was compared to medication alone. Only two RCTs assessed adverse events and reported that no treatment-related adverse events were reported.

Limitations

Few RCTs with low sample size.

Conclusions

This review found some evidence for positive effects beyond placebo and comparable effects compared to evidence-based interventions. However, methodological problems and the unclear risk-benefit ratio preclude definitive recommendations for or against yoga as an adjunct treatment for major depressive disorder. Larger and adequately powered RCTs using non-inferiority designs are needed.

Section snippets

Background

Depression is one of the most prevalent psychiatric disorders as it affects 25% of women and 12% of men during their lifetime and increases the psychological strain for the affected person (Kessler et al., 2003, Moussavi et al., 2007, Rubio et al., 2011). Moreover, depression is characterized by a high comorbidity with several chronic conditions like addictions (Lai et al., 2015), neurodegenerative diseases (Herbert and Lucassen, 2016, Riccelli et al., 2016) or different psychiatric diseases (

Methods

This review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009) as well as the recommendations of the Cochrane Collaboration (Higgins and Green, 2008).

Literature search

Nine hundred ninety-seven non-duplicate records were retrieved by literature search; 979 of which were excluded because they were not randomized, did not include participants with major depression and/or did not include yoga as an intervention. Eighteen full-texts were assessed for eligibility (Butler et al., 2008, Field et al., 2013a, Field et al., 2013b, Field et al., 2012, Gangadhar et al., 2013, Kinser et al., 2013, Kinser et al., 2014, Lavretsky et al., 2013, Naveen et al., 2013, Naveen et

Summary of evidence

In this systematic review of seven RCTs, comparable effects were found for yoga compared to exercise and medication. Electro-convulsive therapy induced stronger antidepressant effects than yoga. Conflicting evidence was found when yoga was compared to attention-control interventions or when yoga was used as an add-on to antidepressant medication was compared to medication alone. The safety of the intervention remained largely unclear.

Agreements with prior systematic reviews

To the best of our knowledge, this is the first systematic

Funding/support

None.

Potential conflict of interest

None.

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