Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder

doi:10.1016/j.mehy.2012.01.021

Medical Hypotheses

Volume 78, Issue 5, May 2012, Pages 571-579

https://doi.org/10.1016/j.mehy.2012.01.021 Get rights and content

Abstract

A theory is proposed to explain the benefits of yoga practices in diverse, frequently comorbid medical conditions based on the concept that yoga practices reduce allostatic load in stress response systems such that optimal homeostasis is restored. It is hypothesized that stress induces (1) imbalance of the autonomic nervous system (ANS) with decreased parasympathetic nervous system (PNS) and increased sympathetic nervous system (SNS) activity, (2) underactivity of the gamma amino-butyric acid (GABA) system, the primary inhibitory neurotransmitter system, and (3) increased allostatic load. It is further hypothesized that yoga-based practices (4) correct underactivity of the PNS and GABA systems in part through stimulation of the vagus nerves, the main peripheral pathway of the PNS, and (5) reduce allostatic load. Depression, epilepsy, post traumatic stress disorder (PTSD), and chronic pain exemplify medical conditions that are exacerbated by stress, have low heart rate variability (HRV) and low GABAergic activity, respond to pharmacologic agents that increase activity of the GABA system, and show symptom improvement in response to yoga-based interventions. The observation that treatment resistant cases of epilepsy and depression respond to vagal nerve stimulation corroborates the need to correct PNS underactivity as part of a successful treatment plan in some cases. According to the proposed theory, the decreased PNS and GABAergic activity that underlies stress-related disorders can be corrected by yoga practices resulting in amelioration of disease symptoms. This has far-reaching implications for the integration of yoga-based practices in the treatment of a broad array of disorders exacerbated by stress.

Introduction

A unifying theory is proposed to explain the effects of yoga in medical conditions with overlapping pathophysiologies based on the principle that yoga practices reduce allostatic load in stress response systems and restore optimal homeostasis. It is hypothesized that stress induces: (1) imbalance of the autonomic nervous system (ANS) with decreased parasympathetic nervous system (PNS) increased sympathetic nervous system (SNS) activity, (2) underactivity of the inhibitory neurotransmitter, gamma amino-butyric acid (GABA) and (3) increased allostatic load. It is further hypothesized that yoga practices (4) correct underactivity of the PNS and GABA system in part through stimulation of the vagal nerves and (5) reduce allostatic load resulting in symptom relief. Depression, epilepsy, post traumatic stress disorder (PTSD), and chronic pain exemplify conditions that are exacerbated by stress, have low PNS and low GABA system activity, respond to pharmacologic agents that increase activity of the GABA system, and improve in response to yoga-based interventions. It is proposed that as yoga-based interventions support the return towards optimal balance in the PNS and GABA system, function improves in regions of the brain that regulate response to threat, such as threat perception, interoception, fear processing, emotion regulation, and defensive reactions. As central regulatory systems become more balanced and flexible, allostatic load is reduced leading to health improvements.

Section snippets

Allostatic load

The brain determines what is threatening and therefore stressful. Stress response involves two-way communication between the brain and the cardiovascular, immune, metabolic and other systems via the nervous system, endocrine system and hypothalamic–pituitary–adrenal (HPA) axis [1]. Homeostasis refers to the mechanisms that keep the parameters of an organism’s internal milieu within the ranges necessary for survival [2]. In this discussion, optimal homeostasis is considered to be the state in

Yoga treatment for epilepsy

Stress is associated with increased seizure frequency [93]. Most adults with poorly controlled seizures have complex partial seizures with a temporal lobe focus [17]. As part of the limbic system, medial temporal lobe structures including the amygdala, hippocampus and entorhinal cortex are considered to be an anatomical link between emotional stress and its neurophysiological consequences [10], [94]. Eggers theorized that resonator neurons, which process information from sensory stimuli and

Discussion

The autonomic nervous system plays a central role in the response to stress. The imbalances that develop under conditions of stress can be traced to decreased PNS activity and increased SNS activity. Stress exacerbates symptoms in disorders associated with low GABA activity, such as epilepsy, depression, PTSD, and chronic pain. These stress exacerbated disorders are marked by PNS underactivity as indicated by low HRV, increased HPA Axis activity as indicated by increased cortisol, and reduced

Conflict of interest

C.C. Streeter reports no conflicts of interest. P.L. Gerbarg reports no conflicts of interest. D.A Ciraulo reports no conflicts of interest. R.B. Saper reports no conflicts. R.P. Brown reports a possible conflict with a pending patent, Confirmation No. 9891, using 7-keto DHEA for the treatment of Post Traumatic Stress Disorder.

Acknowledgements

This paper was supported, in part, by Grants from the National Institute of Complementary and Alternative Medicine (R21 AT004015 to C.C.S., and K07 AT002915 to R.B.S.), the National Institute of Drug Abuse (DA50038 to D.A.C.), the National Institute on Alcohol Abuse and Alcoholism (K23AA13149 to C.C.S., and AA013727 to D.A.C), the National Center for Research Resources (M01RR0533) and the Gennaro Acampora Charity Trust to the Division of Psychiatry, Boston Medical Center. We would like to thank

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Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder

Abstract

Introduction

Section snippets

Allostatic load

Yoga treatment for epilepsy

Discussion

Conflict of interest

Acknowledgements

J Affect Disord

Prog Neuropsychopharmacol Biol Psychiatry

Neuropsychopharmacology

Psychoneuroendocrinology

Med Hypotheses

Brain Res

Psychiatry Res

J Psychosom Res

Biol Psychiatry

Biol Psychiatry

Epilepsy Behav

J Affect Disord

Epilepsy Behav

Int J Psychophysiol

Neurosci Lett

Physiol Behav

Biol Psychiatry

Neurosci Biobehav Rev

J Psychosom Res

Horm Behav

Physiol Behav

Psychoneuroendocrinology

Neuroscience

Neurosci Lett

Biol Psychiatry

Horm Behav

Pharmacol Biochem Behav

Neuropsychopharmacology

Biol Psychiatry

Biol Psychiatry

Med Hypotheses

J Affect Disord

Gen Hosp Psychiatry

Physiology and neurobiology of stress and adaptation: central role of the brain

Physiol Rev

Beyond heart rate variability: vagal regulation of allostatic systems

Ann N Y Acad Sci

Protective and damaging effects of stress mediators

N Engl J Med

Elevated CSF corticotropin-releasing factor concentrations in posttraumatic stress disorder

Am J Psychiatry

Heart rate dynamics in refractory and well controlled temporal lobe epilepsy

J Neurol Neurosurg Psychiatry

Signaling mechanisms of angiotensin II-induced attenuation of GABAergic input to hypothalamic presympathetic neurons

J Neurophysiol

Vagal tone, development, and Gray’s motivational theory: toward an integrated model of autonomic nervous system functioning in psychopathology

Dev Psychopathol

Chronic stress and insulin resistance-related indices of cardiovascular disease risk, part 2: a potential role for mind-body therapies

Altern Ther Health Med

A biobehavioral model of cancer stress and disease course

Am Psychol

Death: Leading Causes for 2006

National Vital Statistics Reports

Yoga as a therapeutic intervention: a bibliometric analysis of published research studies

Indian J Physiol Pharmacol

Reduced cortical gamma-aminobutyric acid levels in depressed patients determined by proton magnetic resonance spectroscopy

Arch Gen Psychiatry

GABAergic mechanisms in the pathogenesis and treatment of epilepsy

Br J Clin Pharmacol

Reduced GABAA benzodiazepine receptor binding in veterans with post-traumatic stress disorder

Mol Psychiatry

GABAergic dysfunction in mood disorders

Mol Psychiatry

Human brain gamma-aminobutyric acid levels and seizure control following initiation of vigabatrin therapy

J Neurochem