Yoga and social support reduce prenatal depression, anxiety and cortisol

Summary

The purpose of this study was to compare the effects of yoga (physical activity) versus social support (verbal activity) on prenatal and postpartum depression. Ninety-two prenatally depressed women were randomly assigned to a yoga or a social support control group at 22 weeks gestation. The yoga group participated in a 20-min group session (only physical poses) once per week for 12 weeks. The social support group (a leaderless discussion group) met on the same schedule. At the end of the first and last sessions the yoga group reported less depression, anxiety, anger, back and leg pain as compared to the social support group. At the end of the last session the yoga group and the support group did not differ. They both had lower depression (CES-D), anxiety (STAI), and anger (STAXI) scores and improved relationship scores. In addition, cortisol levels decreased for both groups following each session. Estriol and progesterone levels decreased after the last session. At the postpartum follow-up assessment depression and anxiety levels were lower for both groups.

Introduction

As many as 49% of pregnant women have reported depressive symptoms, especially ethnic minorities (Field et al., 2009; Gavin et al., 2011), lower income and unmarried women (Lancaster et al., 2010). Prenatal depression contributes to prematurity (Field et al., 2009), developmental delays (Deave et al., 2008), and behavior problems in childhood (de Bruijn et al., 2009) and adolescence (Hay et al., 2010), highlighting the need for prenatal intervention.

Traditional treatments for depression have been underutilized in the case of prenatal depression for various reasons. For example, antidepressants have been used by a very small percentage (1–5%) of prenatally depressed women because of the mixed data on fetal and neonatal outcomes (Einarson et al., 2010; Field, 2010). Limitations of the Einarson et al. and Field studies included small sample sizes, uncontrolled study designs and unknown long-term medication effects. In addition, most women, even those already on antidepressants, have elected to stop taking antidepressants during pregnancy and have expressed a preference for the use of alternative therapies.

Different forms of psychotherapy including cognitive behavior therapy have also received mixed reviews (Butler et al., 2006; Parker et al., 2008) in addition to being unaffordable by most women. Interpersonal Psychotherapy (IPT) has been shown to be effective in at least one study on depressed pregnant women (Spinelli and Endicott, 2003). In this study, the IPT group received 16 weeks of individual sessions, and a comparison group received the same number of sessions focused on parenting education. The IPT group showed significant improvement compared to the control group on ten measures of depression including the Edinburgh Postnatal Depression Scale, The Beck Depression Inventory and The Hamilton Depression Rating Scale, and they also had a lower attrition rate. Problems with this study included a lack of generalizability given that all the women were immigrants from Dominican Republic, and many of the women had been abused. The data on the three depression scores in this study suggested that the significant decrease in depression scores had occurred by the sixth week of the treatment period. In a study by our group, depressed pregnant women who received six weeks of Group Interpersonal Psychotherapy (1 h session once per week) showed increased positive affect and social relatedness, although negative affect also increased (Field et al., 2009). No studies could be found on the use of social support groups with depressed pregnant women.

Alternative therapies including massage therapy and yoga have also been notably effective. For example, moderate pressure massage therapy has been shown to decrease prenatal depression (Field et al., 2009), as well as prematurity (Field et al., 2004). However, unless partners are willing to massage pregnant women, it can be a costly therapy.

Yoga has the advantages of being more affordable, being transportable, and can be learned and practiced using a DVD. Several studies have reported positive effects of yoga on depression (Uebelacker et al., 2010) and anxiety (Javnbakht et al., 2009; Telles et al., 2009). A few studies have reported positive effects of yoga on the well-being of pregnant women including less stress, anxiety and pain (Beddoe et al., 2009), less discomfort (Sun et al., in press), less painful labor and less time in labor (Chuntharapat et al., 2008). Yoga versus walking has led to fewer complications like pregnancy-induced hypertension with associated intrauterine growth retardation and a lower incidence of preterm labor and Caesarean delivery (Narendran et al., 2005). Uterine artery resistance, which would limit transport of oxygen and nutrients to the fetus, would lead to intrauterine growth delays and lower birthweight. However, it is not clear whether the benefits derived from the physical postures, the breathing, the meditation and/or all the components of the yoga sessions.

In the present study, the yoga sessions included only physical poses. A short yoga routine (20 min) was used because better attendance was expected and at the end of the study it could be practiced at home on a daily basis (Field et al., 2012). The routine is limited to yoga poses that are appropriate for pregnant women, consistent with the Narendran et al. (2005) study conducted on yoga with pregnant women. The purpose of the present study was to compare the effects of yoga (physical activity) versus social support (verbal activity) on prenatal and postpartum depression. Most interventions for prenatal depression have been verbal (psychotherapy) rather than physical interventions, although physical interventions like yoga have been effective with depression (Uebelacker et al., 2010). The effects of these interventions on anxiety and cortisol levels also were explored because both anxiety and elevated cortisol have been comorbid with prenatal depression (Field et al., 2004). Finally, estriol and progesterone levels were assessed as they have been notably elevated in depressed women and could potentially be lowered by prenatal intervention.