Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder
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
References (123)
- et al.
A model of neurovisceral integration in emotion regulation and dysregulation
J Affect Disord
(2000) - et al.
Human corticotropin releasing hormone: clinical studies in patients with affective disorders, alcoholism, panic disorder and in normal controls
Prog Neuropsychopharmacol Biol Psychiatry
(1988) - et al.
Drug addiction, dysregulation of reward and allostasis
Neuropsychopharmacology
(2001) - et al.
Psychosomatics and psychopathology: looking up and down from the brain
Psychoneuroendocrinology
(2005) Temporal lobe epilepsy is a disease of faulty neuronal resonators rather than oscillators, and all seizures are provoked, usually by stress
Med Hypotheses
(2007)- et al.
Stress-induced behavioral depression in the rat is associated with a decrease in GABA receptor-mediated chloride ion flux and brain benzodiazepine receptor occupancy
Brain Res
(1989) - et al.
Autonomic dysregulation in panic disorder and in post-traumatic stress disorder: application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks
Psychiatry Res
(2000) - et al.
Effect of autogenic training on cardiac autonomic nervous activity in high-risk fire service workers for posttraumatic stress disorder
J Psychosom Res
(2006) - et al.
Low respiratory sinus arrhythmia and prolonged psychophysiological arousal in posttraumatic stress disorder: heart rate dynamics and individual differences in arousal regulation
Biol Psychiatry
(2004) - et al.
Heart period variability and depressive symptoms: gender differences
Biol Psychiatry
(1998)
Acceptance and commitment therapy and yoga for drug-refractory epilepsy: a randomized controlled trial
Epilepsy Behav
Yoga for depression: the research evidence
J Affect Disord
Modulation of cardiac autonomic balance with adjuvant yoga therapy in patients with refractory epilepsy
Epilepsy Behav
The polyvagal theory: phylogenetic substrates of a social nervous system
Int J Psychophysiol
Afferent contributions to intermediate area of the cat ventral medullary surface during mild hypoxia
Neurosci Lett
The Polyvagal Theory: phylogenetic contributions to social behavior
Physiol Behav
Reduced heart rate variability in chronic alcohol abuse: relationship with negative mood, chronic thought suppression, and compulsive drinking
Biol Psychiatry
Claude Bernard and the heart-brain connection: further elaboration of a model of neurovisceral integration
Neurosci Biobehav Rev
The utility of prolonged respiratory exhalation for reducing physiological and psychological arousal in non-threatening and threatening situations
J Psychosom Res
Adrenocortical activity during meditation
Horm Behav
Effect of Buddhist meditation on serum cortisol and total protein levels, blood pressure, pulse rate, lung volume and reaction time
Physiol Behav
Effects of the transcendental meditation program on adaptive mechanisms: changes in hormone levels and responses to stress after 4 months of practice
Psychoneuroendocrinology
Autonomic brainstem nuclei are linked to hippocampus
Neuroscience
Increased amygdala activation is related to heart rate during emotion processing in adolescent subjects
Neurosci Lett
Brain circuits in panic disorder
Biol Psychiatry
Acute and chronic restraint stress alter the incidence of social conflict in male rats
Horm Behav
GABAergic modulation of learned helplessness
Pharmacol Biochem Behav
Vigabatrin decreases cholecystokinin-tetrapeptide (CCK-4) induced panic in healthy volunteers
Neuropsychopharmacology
Low posttrauma GABA plasma levels as a predictive factor in the development of acute posttraumatic stress disorder
Biol Psychiatry
Dysfunctions of cortical excitability in drug-naive posttraumatic stress disorder patients
Biol Psychiatry
Redrawing Papez’ circuit: a theory about how acute stress becomes chronic and causes disease
Med Hypotheses
Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine
J Affect Disord
Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders
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
Cited by (354)
A novel method for distinction heart rate variability during meditation using LSTM recurrent neural networks based on visibility graph
2024, Biomedical Signal Processing and ControlHigh-intensity interval training in individuals with posttraumatic stress disorder: A randomized controlled pilot trial
2024, Mental Health and Physical ActivityHealth benefits of yoga for cancer survivors: An updated systematic review and meta-analysis
2024, Asia-Pacific Journal of Oncology NursingPossible role of exercise therapy on depression: Effector neurotransmitters as key players
2024, Behavioural Brain ResearchUsefulness of Yoga in the management of tinnitus during COVID-19: A narrative review
2024, Journal of Ayurveda and Integrative Medicine