A Randomized Controlled Trial of Community-Delivered Heated Hatha Yoga for Moderate-to-Severe Depression

Maren B. Nyer, PhD; Lindsey B. Hopkins, PhD; Megha Nagaswami, BA; Richard Norton, MA; Chris C. Streeter, MD; Bettina B. Hoeppner, PhD, MS; Chloe E. C. Sorensen, BA; Lisa Uebelacker, PhD; Jill Koontz, MEd; Simmie Foster, MD, PhD; Christina Dording, MD; Naoise Mac Giollabhui, PhD; Albert Yeung, MD, ScD; Lauren B. Fisher, PhD; Cristina Cusin, MD; Felipe A. Jain, MD; Paola Pedrelli, PhD; Grace A. Ding, BA; Ashley E. Mason, PhD; Paolo Cassano, MD, PhD; Darshan H. Mehta, MD, MPH; Christina Sauder, MS; Charles L. Raison, MD; Karen K. Miller, MD; Maurizio Fava, MD; David Mischoulon, MD, PhD

J Clin Psychiatry 2023;84(6):22m14621

ABSTRACT

Objective: To evaluate feasibility, acceptability, and preliminary efficacy of heated yoga to treat moderate-to-severe depression.

Design: An 8-week randomized controlled trial (RCT) of heated yoga versus waitlist control was conducted from March 2017 to August 2019.

Methods: Participants in the yoga condition were asked to attend heated yoga classes at 2 community heated yoga studios at least twice weekly. We assessed acceptability and feasibility using exit interview and attendance data, respectively. The primary intervention efficacy outcome variable was change in the Inventory of Depressive Symptomatology—Clinician Rated (IDS-CR) score from baseline to post-intervention (week 8).

Results: We randomized 80 participants and included 65 (mean [± SD] age 32.7 [± 11.7] years; 81.5% female) in the analyses (yoga n = 33, waitlist n = 32). The mean IDS-CR score at baseline was 35.6 (± 7.9) for the full sample, 36.9 (± 8.8) for yoga participants, and 34.4 (± 6.7) for waitlist participants. Participants attended an average of 10.3 (± 7.1) total classes over the 8-week intervention period. Yoga participants had a significantly greater pre- to post-intervention reduction in IDS-CR scores than waitlist participants (Cohen d = 1.04, P < .001). More yoga participants (59.3%; n = 16) than waitlist participants (6.3%; n = 2) evidenced larger treatment responses (IDS-CR ≥ 50% decrease in symptoms). Participants rated the heated yoga and its aftereffects positively in exit interviews.

Conclusions: Approximately 1 heated yoga session per week (mean of 10.3 classes over 8 weeks) was associated with significantly greater reduction in depression symptoms than a waitlist control. Participants rated heated yoga positively. Taken together, results suggest feasibility, acceptability, and preliminary efficacy for patients with depression and warrant further research using active control conditions.

Trial Registration: ClinicalTrials.gov identifier: NCT02607514

J Clin Psychiatry 2023;84(6):22m14621

Author affiliations are listed at the end of this article.

Continue Reading...

Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Purchase PDF for $40

Members enjoy free PDF downloads on all articles. Join today

References (37)

WHO. WHO | Depression. Published September 24, 2018. Accessed September 24, 2018. https://www.who.int/mental_health/management/depression/en/
Insel TR, Wang PS. The STAR*D trial: revealing the need for better treatments. Psychiatr Serv. 2009;60(11):1466–1467. PubMed CrossRef
Trivedi MH, Daly EJ. Treatment strategies to improve and sustain remission in major depressive disorder. Dialogues Clin Neurosci. 2008;10(4):377–384. PubMed CrossRef
Cassano P, Fava M. Tolerability issues during long-term treatment with antidepressants. Ann Clin Psychiatry. 2004;16(1):15–25. PubMed CrossRef
Uebelacker LA, Tremont G, Gillette LT, et al. Adjunctive yoga v. health education for persistent major depression: a randomized controlled trial. Psychol Med. 2017;47(12):2130–2142. PubMed CrossRef
Prathikanti S, Rivera R, Cochran A, et al. Treating major depression with yoga: a prospective, randomized, controlled pilot trial. PLoS One. 2017;12(3):e0173869. PubMed CrossRef
Chu IH, Wu WL, Lin IM, et al. Effects of yoga on heart rate variability and depressive symptoms in women: a randomized controlled trial. J Altern Complement Med. 2017;23(4):310–316. PubMed CrossRef
Cramer H, Lauche R, Langhorst J, et al. Yoga for depression: a systematic review and meta-analysis. Depress Anxiety. 2013;30(11):1068–1083. PubMed CrossRef
Cramer H, Anheyer D, Lauche R, et al. A systematic review of yoga for major depressive disorder. J Affect Disord. 2017;213:70–77. PubMed CrossRef
Janssen CW, Lowry CA, Mehl MR, et al. Whole-body hyperthermia for the treatment of major depressive disorder: a randomized clinical trial. JAMA Psychiatry. 2016;73(8):789–795. PubMed CrossRef
Masuda A, Nakazato M, Kihara T, et al. Repeated thermal therapy diminishes appetite loss and subjective complaints in mildly depressed patients. Psychosom Med. 2005;67(4):643–647. PubMed CrossRef
Nyer M, Hopkins LB, Farabaugh A, et al. Community-delivered heated hatha yoga as a treatment for depressive symptoms: an uncontrolled pilot study. J Altern Complement Med. 2019;25(8):814–823. PubMed CrossRef
La Rocque CL, Mazurka R, Stuckless TJR, et al. Randomized controlled trial of Bikram yoga and aerobic exercise for depression in women: efficacy and stress-based mechanisms. J Affect Disord. 2021;280(Pt A):457–466. PubMed CrossRef
La Rocque C. A Randomized Controlled Trial of Bikram Yoga and Aerobic Exercise in the Treatment of Depression: Efficacy and Underlying Physiological and Psychological Mechanisms. Thesis. 2018. Accessed May 30, 2020. https://qspace.library.queensu.ca/handle/1974/24495
Moonaz S, Nault D, Cramer H, et al. CLARIFY 2021: explanation and elaboration of the Delphi-based guidelines for the reporting of yoga research. BMJ Open. 2021;11(8):e045812. PubMed CrossRef
Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8(1):18. PubMed CrossRef
Rush AJ, Gullion CM, Basco MR, et al. The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychol Med. 1996;26(3):477–486. PubMed CrossRef
Posner K, Brown GK, Stanley B, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168(12):1266–1277. PubMed CrossRef
Reynolds BJ, Choudhury B. Bikram’s Beginning Yoga Class. 2nd ed. TarcherPerigee; 2000.
First M, Gibbon M, Spitzer R, et al. Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non-Patient Edition (SCID-I/NP). New York State Psychiatric Institute. New York State Psychiatric Institute; 1997.
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(suppl 20):22–33, quiz 34–57. PubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5. American Psychiatric Association; 2013.
Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6(4):278–296. PubMed CrossRef
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(1):56–62. PubMed CrossRef
Spielberger CD, Gorsuch RL, Lushene RE. Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press; 1970.
Ware JE Jr, Kosinski M, Bayliss MS, et al. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995;33(suppl):AS264–AS279. PubMed
Endicott J, Nee J, Harrison W, et al. Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacol Bull. 1993;29(2):321–326. PubMed
Gauvin L, Rejeski WJ. The Exercise-Induced Feeling Inventory: development and initial validation. J Sport Exerc Psychol. 1993;15(4):403–423. CrossRef
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–396. PubMed CrossRef
Hopkins LB, Medina JL, Baird SO, et al. Heated hatha yoga to target cortisol reactivity to stress and affective eating in women at risk for obesity-related illnesses: a randomized controlled trial. J Consult Clin Psychol. 2016;84(6):558–564. PubMed CrossRef
Streeter CC, Gerbarg PL, Whitfield TH, et al. Treatment of major depressive disorder with Iyengar yoga and coherent breathing: a randomized controlled dosing study. J Altern Complement Med. 2017;23(3):201–207. PubMed CrossRef
Nyer M, Gerbarg PL, Silveri MM, et al. A randomized controlled dosing study of Iyengar yoga and coherent breathing for the treatment of major depressive disorder: Impact on suicidal ideation and safety findings. Complement Ther Med. 2018;37:136–142. PubMed CrossRef
Stubbs B, Vancampfort D, Rosenbaum S, et al. Dropout from exercise randomized controlled trials among people with depression: a meta-analysis and meta regression. J Affect Disord. 2016;190:457–466. PubMed CrossRef
Vöhringer PA, Ghaemi SN. Solving the antidepressant efficacy question: effect sizes in major depressive disorder. Clin Ther. 2011;33(12):B49–B61. PubMed CrossRef
Park CL, Braun T, Siegel T. Who practices yoga? a systematic review of demographic, health-related, and psychosocial factors associated with yoga practice. J Behav Med. 2015;38(3):460–471. PubMed CrossRef
Sakurai H, Nagaswami M, Tan E, et al. A patient with treatment-resistant depression who achieved remission with heated yoga: a case report. Clin Neuropsychopharmacol Ther. 2021;12(0):12–17. CrossRef
Sakurai H, Norton RJ, Fisher LB, et al. A patient with electroconvulsive therapy-resistant major depressive disorder with a full response to heated yoga: a case report. J Psychiatr Pract. 2021;27(6):486–491. PubMed CrossRef