Role of yoga in stress management and implications in major depression disorder.

Major Depressive Disorder (MDD) is one of the leading causes of disability affecting more than 340 million people and second largest contributor to global burden of disease. Chronic stress is a common risk factor and important contributor for MDD. Stress could be defined as the "perceived inability to cope". Stressful life events are shown to provoke a sequence of psychological and physiological adjustments including nervous, endocrine and immune mechanisms. Stress can lead to elevation of a variety of inflammatory cytokines and stress hormones, can cause autonomic dysfunction and imbalance in neurotransmitters. Yoga can reduce depressive symptoms by alleviating stress. Studies have shown that yoga can reduce inflammation, maintain autonomic balance and also has a role in maintaining the neurotransmitters. It has role on hypothalamic-pituitary-adrenal (HPA) axis, the peripheral nervous system including GABA, limbic system activity, inflammatory and endocrine responses. Yoga along with antidepressants can help in reducing the depressive symptoms in patient with MDD. Yoga is an ideal complementary and alternative therapy for mental health disorders.

Development and Validation of Yoga Protocol for Patients with Depression.

Background: Scientific evidence suggests that yoga is beneficial for treating mental health disorders. To the best of our knowledge, minimal studies have been done on the development of a yoga module for the specific clinical aspects of depression and there is no particular study on yoga protocol development for mild depression and moderate depression. Purpose: The primary aim of this study is to develop specific yoga protocol modules for treating patients affected with mild and moderate depression. Methods: Yoga protocols for treating mild and moderate depression were developed using classical yoga texts, previous literature, and with the help of yoga experts. 26 practices for mild depression and 35 practices for moderate depression were identified, each of which was scored as (a) not essential, (b) useful but not essential, and (c) essential, and content validity ratio (CVR) determined using Lawshe's formula for the validation. Results: Expert's opinion revealed that 13 out of 28 practices and 12 out of 35 practices showed significant CVR (>0.60) for mild and moderate depression. Conclusions: The yoga practices developed based on experts' opinion is the first step toward the development of a validated protocol for mild and moderate depression. This will be assessed for its effectiveness through a randomized controlled study to confirm the module's efficiency.