Articles

Depression: understanding and appropriate yogic treatment

Author: Thomas Marcilly

Thomas Marcilly

Part I: Understanding the depression (unipolar mood disorder)

Certainly one of ‘THE’ diseases of the century, depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviors, feelings and physical well-being. Depression is not just the result of a chemical imbalance in the brain, and cannot simply be cured with medication. 

Experts believe that depression is caused by a combination of biological, psychological, and social factors. In other words, lifestyle choices, relationships, and coping skills matter just as much, if not more so than genetics. A patients full medical history, physical assessment, and thorough evaluation of symptoms will help to determine the cause of the depression. Standardized questionnaires can be helpful such as the Hamilton Rating Scale for Depression, and the Beck Depression Inventory.

Risk factors which can make the person more vulnerable to depression

Loneliness 

Lack of social support 

Recent stressful life experiences

Family history of depression

marital or relationship problems

Financial strain

Early childhood trauma or abuse

Alcohol or drug abuse

Unemployment or underemployment

Health problems or chronic pain

Depression can be result of infectious diseases and physiological problems

Mononucleosis

Hypothyroidism

Disturbed circadian rhythm

Common signs and symptoms of depression

Feelings of helplessness and hopelessness.

Loss of interest in daily activities. 

Appetite or weight changes. 

Sleep changes

Anger or irritability

Loss of energy 

Self-loathing 

Strong feelings of worthlessness or guilt 

Reckless behavior 

Concentration problems 

Unexplained aches and pains



Diagnosis: 3 major levels of depression

Mild depression

It may improve by itself but should be monitored with a follow up assessment after two weeks to confirm progress. Exercise seems to help some people. Chronic mild depression (which is present for two years or more) is called dysthymia. This is more common in people over 55 years old and can be difficult to treat. In these cases a GP (General Practitioner) may suggest antidepressants.

Moderate depression

Mild depression that is not improving. With moderate depression, your GP may recommend some form of talk therapy and/or prescribe an antidepressant

Severe depression

GP may recommend antidepressants, together with talking therapy. A combination of an antidepressant and cognitive behavioral therapy (CBT) usually works better than having just one of these treatments. 



AVAILABLE TREATMENTS AND THEIR LIMITATIONS 

Information

Patient has to learn as much as possible about depression. It takes time to find the right treatment.

Lifestyle change

An essential part of depression treatment is lifestyle changes. These are simple but powerful tools in treating and may turn out to be all that a patient needs. 

Psychotherapy

Talk therapy is an extremely effective treatment for depression. Therapy gives you tools to treat depression from a variety of angles. Once these tools are learned, the individuals can continue to use them in their daily for maintenance and help to prevent depression from coming back. 

There are many types of therapy available. Three of the more common methods used in depression include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used.

Physical exercise

Outdoor activities will offer the patient fresh air and a new approach to life.

CBT and CCBT

Cognitive behavioral therapy helps patients to understand their current thoughts and behaviors as well as how they affect them. Computerized cognitive behavioral therapy works through a computer screen.

IPT

Interpersonal therapy focuses on relationships with other people and on problems, such as difficulties with communication or coping with bereavement.

Counseling

This form of therapy is aimed to help the patient to think about the problems they are experiencing in life and find new ways of dealing with them. 

SSRIs

Selective serotonin reuptake inhibitors :  help increase the level of a natural chemical in the brain called serotonin

TCAs

Tricyclic antidepressants are used to treat moderate to severe depression. They work by raising the levels of the chemicals serotonin and noradrenalin in the brain. 

MAOIs

Monoamine oxidase inhibitors are sometimes used to treat depression. When taking these the individual will have to avoid food that contains the chemical tyramine (foods that have been fermented or cured to increase their flavor i.e., cheese, pickled meat or fish).

St John's wort

 St John's wort is a suggested herbal treatment

ECT

Electroconvulsive therapy is used for severe depression, but only when antidepressants and other treatments have not worked. The patient will receive electrical shock to the brain through electrodes placed on the head, generally twice a week for 3-6 weeks. 

Lithium

 If patient has tried several different antidepressants and has experienced no improvement, in addition to thecurrent treatment. 

Some Supportive therapies

Music Therapy, Acupuncture, Naturopathy, Aromatherapy, Energy healing, Shamanism, art therapy, group therapy, animal-assisted therapy (also known as pet therapy), keeping a gratitude journal 



AND HERE COMES YOGA THERAPY...

Part II: The yogic Treatment : a lifestyle change !

The paradox of depression which can be present in other diseases is that a depressed patient finds it easier to continue being depressed rather than becoming free from it. Present lifestyles are the culmination of decades of trying to imitate others, fulfill desires, habits, and faulty thinking... a vicious circle. Many patients think there is no other way to live and. Change can be difficult for a healthy person so it is especially difficult for someone suffering from depression. Even minor improvements in a destructive lifestyle can have great benefits in the healing process. 

Therefore, incorporating Yoga into the daily life of the patient can be a great achievement. In addition to working on a simple way to relax the patient, Yoga will bring them many tools. They can learn to face their inner-selves, the world, and above all develop an awareness of their body and senses, while learning acceptance, understanding, and so on.

As time goes on, we see an increasing number of psychosomatic problems being added to the list of symptoms of depression. Diseases such as hypertension, weakness, back problems, and reproductive disorders to name a few will also be best treated with yoga therapy. 

Experts believe that depression is caused by a combination of biological, psychological, and social factors. To treat someone suffering from depression Yoga has to work on different levels:

Finding a balance between material and spiritual life

Finding a balance between intellect, emotions and actions.

APPROPRIATE YOGIC TREATMENT =

RAJA YOGA + JNANA YOGA + BHAKTI YOGA + KARMA YOGA + HATHA YOGA

A lifestyle change  

RAJA YOGA would be a great gift to the patient as a lifestyle recommendation before going further in the inner process. The lifestyle principles are self-restraint (with Yama) and personal codes (with Niyama). By learning about these principles the patient may realize how they can help them to evolve.

When working on finding a balance between material and spiritual life is important first to develop the awareness of the patient with JNANA YOGA: an understanding of personal thoughts, vicious circles, reactions and conditioning. This Yoga of knowledge is a process of self-inquiry / self-analysis to find our true nature through a process of meditative awareness. The SWAN principle (Strength / Weakness / Ambition / Need) is a great tool. 

Also, BHAKTI YOGA will have aim to work on the emotional part; developing unconditional love, devotion, feelings, and surrender. As depression is the result of a spiritual vacuum, Bhakti will focus on compassion and service for the benefit of others, for overall positive feelings, so that the patient will be able to express their emotional vitality.

With the practice of KARMA YOGA, finding an often missing meaning of life can be brought out. The person can learn how to live in the present moment. Karma Yoga is the yoga of action in a specific way. It is a service done without attachment, expectation and ego while having a positive attitude. In western countries especially where everyone is growing in a “give and take society”, Karma Yoga is a real tool of personal-growth. 

Besides the aforementioned practices, HATHA YOGA will develop the awareness of the physical body with different kinds of practices: asanas, pranayama, cleansing techniques, chanting, yoga nidra, meditation, mudras, diet and lifestyle.

Many asanas help to balance the nervous system, quiet the mind and so on. Asanas will especially help to develop the awareness of the physical body and balance the chakras and pachakosha.  Depression often occurs in cycles and can drain the natural flow of energy. In fact, suffering from depression is almost like getting into a roller coaster, bringing your emotions, feelings and physical health as high and as low as they can be.

Contra indications: In a severe stage of depression, even a relaxation with closed eyes can be impossible for a patient so variations will have to be added to a basic program to make it fit to the individuals’ capacities. Karma Yoga can be a way for a patient to get out of themselves instead of looking straight into the inner-self. Other contra-indications would have to be considered by the yoga therapist when treating coinciding psychosomatic diseases.

Do / Don’ts: Depression treatment is a very long process where, as we have just talked about, many tools are studied with the patient. The process of understanding and acceptance of a new lifestyle can take months or years, so LITTLE STEP BY LITTLE STEP will be the key factor. Whether it is meditation, relaxation or cleansing techniques, these practices can be scary for a patient in the beginning. As a suggested daily program with can look use the table below and teach it slowly and in steps with AWARENESS. The relationship between the patient and the therapist will be a delicate balance to find.

 Daily program with details we can think about :

Yoga practice

Duration

Observation

FACE TO FACE THERAPY BETWEEN THE PATIENT AND THE THERAPIST

As previously discussed, approximately 80 % of the treatment will focus on RAJA / JNANA / BHAKTI and KARMA yoga. As yoga psychotherapy, practicing around one hour per day (in addition to a Hatha Yoga practice) will allow the patient to slowly adapt to the philosophy. Eventually the technique can be reduced to once time per week. 

ASANAS / YOGA MOVEMENTS 

Prana invocation mudra

3 min

Awakens the vital energy. Develops awareness of the nadis chakras and pranic energy. It leads to an inner attitude of peace by offering and receiving energy

Shavasana

5 min 

As a initial awareness of the body before the practice and each time the patient will need it to rest 

Yoga Sopan Body movements

30 min per day 

In a supine / standing  / sitting position, preparation practice for leg / knees / arms / shoulders / head TYPE 1+2+3

Matsya Kridasana / flapping fish

3 min

To enjoy the benefits of the Yoga Sopan Body movements

Vajrasana

2 min

Stimulates prana in sushumna, quiet the mind

Shashankasana

2 min

Relaxing pose and good for the management of anger

Supta Vajrasana

1 min

Opening to the world

Padadhirasana / breath balance pose

2 min

Balance nervous system

Simhagarjanasana / roaring lion pose

2 min

Relieves frustration and emotional tension

Marjari asana / cat pose

2 min

Relaxing pose to release tensions to the back

Sarvangasana 

2 min

Balance nervous and endocrine system

Pashinee mudra

1 min

Brings balance and tranquility to the nervous system

Halasana

2 min

Balance the body metabolic rate

Bhujangasana

2 min

To balance inverted poses and open the chest with the anahata chakra for unconditional love

SURYANAMASKAR or GURUJI S SURYANAMASKAR (from vajrasana)

12 rounds with awareness

Early in the morning can be a beautiful practice to active the flow of energy in the whole body and give strength for the day

CLEANSING PRACTICES

Jala Neti

Every morning

Calm and smooth the brain and alleviates anxiety anger depression

Vaman dhauti

Once a week

Help to release emotions and emotional blocks or feelings of heaviness in the heart caused by inner and external conflict  and pressures

Agnisara

3 every morning

Stimulates appetite and the five pranas. Alleviates depression

Kapalbhati

30 x 3 every morning

Same effects as jala neti but intensified

PRANAYAMAS

Natural breathing focus

10 rounds

To develop awareness of the natural breath

Right nostril breathing

10 rounds

To work on the left part of the brain and increase the process of activities, outgoing

Bhramari

10 rounds

Relieves stress, cerebral tension, anger, anxiety and insomnia. Directs as well the awareness inward

Wave breathing

5 min

To develop awareness of the breathing in the body, feeling the flow of prana, opening the thoracic cage

CHANTING

Omkar chanting

30 min

Universal mantra to practice after yoga nidra session

Gayatri Mantra

11 times loud chanting in the morning

To heat the body and awake in the morning

Mahamrityunjaya Mantra

11 times in the evening

To increase the healing process

Omkar listening 

During the night

Vibration will be as powerful even if the patient is sleeping

MEDITATION

Yoga Nidra (TWICE A DAY)

30  min

Healing and positive attitudes and thoughts as sampaka

Chakra meditation with Om Chanting

Once a day instead of Osho meditation

To develop the awareness of chakras and balance the energetic body

Osho meditation dynamic

Once day instead of Chakra meditation

To develop the awareness of the chakras and release any blockages

“The views expressed above are solely those of the author. Yogapoint.com may or may not agree with these statements.”

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