Synopsis: There is growing evidence showing that yoga is beneficial for depression. Researchers are looking at biological mechanisms, but are there other factors involved? Yoga practices vary, which makes determining the mechanism of its benefit difficult. However, observing yoga from a holistic perspective, rather than only from a neurobiological standpoint, may lead to insights into how yoga helps depression.

BY LEN LANTZ, MD / 7.25.20; No. 31 / 7 min read

Disclaimer: Yes, I am a physician, but I’m not your doctor, and this article does not create a doctor-patient relationship. This article is for educational purposes and should not be seen as medical advice. You should consult with your physician before you rely on this information. This post might also contain affiliate links. Please click this LINK for the full disclaimer.

What is yoga?

A single and universally accepted definition of yoga is hard to find. My definition of yoga is that it is a mind-body practice including any combination of intentional breathing, physical postures and meditative thoughts. There are many different types of yoga, which are often popularized and named after the inventor/guru or after the activities in the yoga practice. Some of the more common current yoga styles are Ashtanga, Barkan, Bikram, Hatha, and Iyengar yoga.

What does the research show for depression?

Medical research shows that yoga helps depression and its benefits appear to range from mild to moderate. A recent meta-analysis of 13 studies showed that yoga has a moderate effect on reducing depression and that shorter, more frequent sessions per week, as opposed to longer, less-frequent sessions, show greater benefit (Brinsley et al., Br J of Sports Med, 2020). Yoga has also been shown to help depression in kids (James-Palmer et al. Front Pediatr, 2020).

It turns out that it is relatively difficult to study the benefits of yoga, as yoga practices vary. Researchers have been looking at biomarkers (heart rate variability, neurotransmitters, genetics and proteins) to help explain why yoga improves depression. A recent study (discussed later in this article) shows that heated or "hot" yoga is even more effective at improving depression. While I think it is great that so many researchers are looking for biomarkers to understand the mechanism of yoga’s benefit, I also believe that there are other aspects to yoga that help explain why it works.

Yoga usually involves some form of exercise

The first and most obvious reason why yoga helps depression is that most types of yoga involve the holding of a posture, which involves physical exertion - exercise. Even modest amounts of exercise can significantly improve depression. There is ample research showing this effect. It is hypothesized that exercise enhances neuroplasticity, which allows the brain to change out of its depressed activity and signaling patterns and return to normal. For more details on exercise helping depression, see my article, "The Surprising Results of Exercise for Depression."

The act of taking care of yourself

Yoga is very much about slowing down and taking care of yourself. When you engage in self-care, a cascade of other positive things happens. Yoga can be calm and restorative or very physically demanding. Many people express feelings of improved emotional and physical wellbeing after completing a yoga practice. Regular yoga practice can lead to self-reflection, which can allow you to see the changes that you need to make in your life. In my case, regular yoga practice helped me see a need for a job change that has led to greater autonomy and reduced stress.

Another aspect of regularly practicing yoga is that it can become part of your schedule or routine. Having a day filled with positive activities that are in alignment with your values, something called behavioral activation, is very effective at helping depression. I believe that yoga can be part of and enhance behavioral activation strategies. You can learn more about behavioral activation in my article, "Behavioral Activation for Depression."

Mindfulness, meditation and language that encourages self-integration

Mindfulness and meditation are components of yoga and also improve depression. Many people have a powerful Inner Critic, which is their own internal critical voice that beats them up and triggers feelings of insecurity. During yoga practice, there are usually moments of activity and moments of rest. The Inner Critic can become quite loud, either cutting a person down for not being as flexible or strong as another class member in yoga or reminding them of their failures and deficiencies during calming activities.

Yoga promotes acceptance and works to silence the Inner Critic. For some reason, past experiences and emotions, including reminders of past traumas, tend to bubble up in yoga. Yoga teachers often encourage students during practice to let go of negative thoughts, release tension in areas of their body that they were unaware of, focus on their own practice and give up the need to compare their progress to other students. I've written more on mindfulness in my article, "Mindfulness - How to Chill Out and Stop Beating Yourself Up."

Another component of yoga practice that can be helpful is the use of language that encourages body awareness. Where is your arm - not the arm - in relation to your shoulder, back, spine, leg, the floor, the sky? Life can be hectic, leaving us feeling fragmented. Yoga teachers often use integrated language to get you to see your body as a whole, not just various parts, as you hold positions and transition to new ones. Having peace about seeing your body as it is, working to control yourself and your own energies and letting go of trying to control others is a core practice of yoga.

Addressing the loneliness and isolation of depression with yoga classes

People with depression often feel very alone and isolated, even when they are with others. This feeling of disconnection often compounds depressive symptoms. Social distancing and quarantine have been compounding the social isolation that people were already feeling.

In yoga classes, even though there is an intense focus on what you - not others - are doing, there is also a sense of togetherness. While you are focused on yourself, you have a feeling of belonging and connectedness to others as you are in that moment together doing the same postures, movements and breathing. Yes, social distancing has been hard, but at least there is the option of using the internet to join a live class with others who are also striving to feel better.

Conquering inertia through postures, movement and mind activation

There is a significant amount of inertia - physical and mental - that occurs in depression. Yoga often combats this inertia through physical movement and mental activation. Yoga is very much a mind-body activity. It takes determination to hold poses in yoga because sometimes it's uncomfortable. Practicing working through the discomfort takes concentration and perseverance.

It is common in yoga to find your mind wandering and then needing to bring your awareness back to the present. Regardless of the style of yoga you choose to practice, it takes intention and effort, which are activating for the mind and body. This body-mind activation can push through the inertia of depression.

Hot yoga may be even more beneficial

Not all yoga practices (and not all exercise in general) increase a person's core body temperature significantly. What makes hot yoga different is that the room is heated a small amount or substantially. The additional heat makes the yoga practice more demanding. It's also thought to enhance blood flow to your muscles and joints and reduce the risk of injury during yoga practice.

It can take time to adapt to the extra heat if you are not used to it. Especially when you are first starting hot yoga, it is important to stay hydrated and take breaks, such as going into a resting "child's pose," if you are getting overheated or feeling exhausted. People starting hot yoga need to prepare to sweat and to be challenged. It is often more challenging than newcomers expect. However, it can be incredibly rewarding to get out of your comfort zone and try something new.

I have been wondering if there is something about the heat that might make hot yoga even more effective for depression. One interesting finding is that people with major depression often have an elevated core body temperature and reduced ability to sweat (Raison et al., Front Psychol, 2014). Does hot yoga help to correct this? There was a recent pilot study of heated Hatha yoga (Nyer et al., J Altern Complement Med, 2019) in which the participants on average had moderate-severity major depression. The results from the 8-week heated yoga intervention showed that 56% of participants achieved full freedom of depression (remission of depression).

I recently asked Nicky Twitchell, the owner of Hot Yoga Helena, some questions about the impact she observes that hot yoga has on mental health. Nicky expressed that she sees yoga as “a natural antidepressant.” She shared about a culture she has worked to create and maintain for yoga students so that her studio is a safe haven where “even the visitors...everyone feels safe and loved and therefore they feel happy.” Regarding the element of heat, Nicky stated, “When you sweat, you create energy in the body - you create synchronicity - your body is working for you and you are working your body.” And then she referenced studies of heat therapy, which has shown benefit for depression and other medical conditions.

Whole-body heating for depression

For decades, researchers have been looking at whole-body heating for the treatment of depression by either using hot baths or infrared heating. A recent study (Jannsen et al., JAMA Psychiatry, 2016) used infrared whole-body heating over 6 weeks on people with depression. It was a randomized, double-blind, sham-controlled (placebo-controlled) study. People who received active treatment did better than the placebo and the group collectively experience around a 50% reduction in depressive symptoms. Researchers concluded it was a "safe and rapidly acting modality," although it is not yet accepted as a standard of care or treatment recommendation in the field of psychiatry.

Consider adding yoga into your schedule and your life

People start yoga for many reasons, which range from wanting to improve anxiety to enhancing flexibility and strength. Yoga also promotes wellness and might prevent - not just alleviate - anxiety and depressive symptoms. Numerous health benefits have been demonstrated with yoga, but in this article, we only explored how it can help depression. Consider exploring what else it could do for you. Imagine looking forward to exercise that not only helps your body but also helps your mind. Wouldn't it be great to be able to let go of negative thoughts and effectively silence your Inner Critic while feeling better physically and having the satisfaction of trying something new? Think about taking time out of your schedule to take care of yourself by starting yoga. If you do, you'll thank yourself.

For further reading, check out:

• Len's article "The Surprising Results of Exercise for Depression"

• Len's article "Behavioral Activation for Depression"

• Len's article "Mindfulness - How to Chill Out and Stop Beating Yourself Up"

• Mindfulness for Beginners: Reclaiming the Present Moment and Your Life by Dr. Kabat-Zinn

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