Fighting minor forms of depression with yoga
‘Paradigm shift’ stresses benefits of exercise
A notable group of psychiatrists is recommending a novel new treatment for moderate depression that they say appears to be tolerated well: yoga.
And they say jogging, swimming, dancing, brisk walking or any form of aerobic exercise that increases breathing and heart rate will also work.
“There is a paradigm shift,” says Dr. Arun Ravindran, a senior scientist at Toronto’s Centre for Addiction and Mental Health. “We’re starting to listen to the people we treat.”
New guidelines appearing in the latest edition of the Canadian Journal of Psychiatry from the Canadian Network for Mood and Anxiety Treatments recommend exercise as a first-line treatment for mild to moderate depression in adults, as well as the herbal remedy, St. John’s wort.
Yoga and omega-3 fatty acids are recommended as second-line, add-on therapy.
Accused by some of its own of being overly liberal and enthralled with the use of psychiatric drugs, conventional psychiatry has traditionally been skeptical of alternative medicine “in a blanket kind of way,” Ravindran said.
While the guidelines still state that, for most people with major depressive disorders, drugs and/ or psychotherapy should be considered before complementary or alternative treatments, “we’re increasingly realizing that there is a proportion of patients who are either unwilling for philosophical reasons (to take antidepressants) or find it difficult to tolerate them,” Ravindran said.
Sexual dysfunction, for example, is as high as 30 to 40 per cent for the Prozaclike drug class known as SSRIs, or selective-serotonin reuptake inhibitors.
There is also growing evidence that medication offers little advantage over placebo for mild depression, “and it brings all the side effects,” said renowned psychiatrist Dr. Allen Frances.
By contrast, “the literature is clear that exercise helps,” said Frances, who led the writing of the fourth edition of The Diagnostic and Statistical Manual of Mental Disorders, psychiatry’s encyclopedic tome of mental illness.
“Instead of taking a pill, you’re going to do yoga, that’s great, too,” he added, although he’s a little less sanguine about St. John’s wort and thinks “the fish stuff has been oversold.”
The overarching principle, said Frances, is that stress and sadness are part of life, and that mild, transient depression almost always gets better on its own. “You need to watchfully wait. Explain that this is normal, that people have ups and downs. And if it persists, then it may need treatment.”
Still, Canada sits among the top users of antidepressants in the world. In 2014 alone, 47.1 million prescriptions for antidepressants were filled, representing sales totalling $1.91 billion, according to market research firm IMS Brogan.
It’s estimated 11 per cent of the population is on an antidepressant, with the bulk of prescribing by family doctors.
Meanwhile, the use of alternative therapies grows. Nearly half of those with mental illness use alternative medicine, though most don’t divulge it to their doctors, Ravindran said.
Studies suggest “it’s not the uneducated people who resort to these kinds of alternative therapies,” he added, “but well-educated, sophisticated patients who suffer from depression or anxiety.”
“There will always be (psychiatrists) who will be more dogmatic about it,” Ravindran said. “But I think there is room for all options, and I think we owe it to our patients to have a more broader perspective on this,” he said, although he stressed that more severe forms of depression still dictate that antidepressants be used.