1. Elisa Santizo Touro University Nevada

3. 8 Limbs of yoga YamaAsana NiyamaDharana PranayamaDhyana PratayaharaSamadhi Hatha Yoga AsanaPranayamaMeditation Yoga Sutras of Patanjali c. 200CE Yoga=religion?

4.  Ashtanga  Iyengar  Vinyasa – Power - Flow  Bikram - Hot  Restorative – Yin  Kundalini  Special populations: prenatal, kids

5. Class Setting Deep Breath Physica l Mental Focus Savasana

8. USA:  1 in 10 are currently depressed (or 9.1%)  More prevalent w/ chronic illness  Causes poor prognosis for chronic illness (CDC, 2010) Intl:  Higher rates where more awareness & services  Taboo against depression = underreporting  Data not available in developing countries (Ferrari et al., 2010)

10.  More prevalent in uninsured and undereducated  Social stigma  Side effects of antidepressant medication (Stimmel, 2001)  Suicide is the 10 th leading cause of death in the US (CDC, 2010)

11. What is the evidence for the effectiveness of yoga to treat depression?

12.  Databases: Pub-Med, Cochrane, Academic Search Complete  Search terms: yoga, depression, pranayama, yoga therapy  Inclusion: <10 years, level I evidence, participants with depression, instruments to measure depression severity and/or symptoms  Exclusion: Co-morbid physical or mental conditions, non-depressed, age <18, weak design or analysis

13.  6 Level I RCTs found  Sample size: 27-65 (mean=47.17)  Duration: most 8 weeks  3 American, 2 Iranian, 1 Brazilian  Setting: 3 class/home, 2 class, 1 home  5 adults, 1 older adults  2 Caregivers for family member with dementia  Depression varied from mild to MDD

14.  Most included all aspects of hatha yoga Asana 5/6 Pranayama 6/6 Meditation 5/6  Styles of yoga: Hatha yoga (2) Laughter yoga Yoga w/ compassion meditation Inner Resources Kirtan Yoga

15. Is it ethical to withhold known effective treatment for depression?  Two allowed antidepressants, provided they were established and did not change (Butler et al., 2008; Kinser et al., 2013) (had most depressed participants)  Two did not allow antidepressants (Lavretsky et al., 2013; Danucalov et al., 2013) (mild to moderate depression) One tranquilizers, a sedative not antidepressant (Danucalov et al., 2013)  Both Iranian studies did not specify (Javnbakht et al., 2009; Shahidi et al., 2011)

16.  Depression: 4/6 (Butler et al., 2008; Lavretsky et al., 2013; Danucalov et al., 2013; Shahidi et al., 2011)  Anxiety: 3/3 (Danucalov et al., 2013; Javnbakht et al., 2009; Lavretsky et al.,2013)  Life Satisfaction: 1/1 (Shahidi et al., 2011)  Ruminations 0/1 (Kisner et al., 2013)  Salivary cortisol 1/1 (Danucalov et al., 2013)  Stress: 1/1 (Danucalov et al., 2013)

17. Strengths  Recent RTC with sound statistical analysis Limitations  Variable populations, interventions, and measures Implications for future research  Larger samples and duration of study  What elements of yoga are most effective  Physiological changes: neurotransmitters, hormones

18.  Referral to community & senior centers  Advocate for adaptive yoga in practice setting  Use as preparatory method in treatment  Possibility of yoga therapy in community-based setting  Yoga could be effective for other physical conditions, mental conditions, kids

19. Tim Rushby-Smith, yoga instructor http://www.theguardian.com/lifeandstyle/2011/sep/26/wheelchair-yoga