Elsevier

Journal of Affective Disorders

Volume 57, Issues 1–3, January–March 2000, Pages 255-259
Journal of Affective Disorders

Preliminary communication
Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine

https://doi.org/10.1016/S0165-0327(99)00079-8Get rights and content

Abstract

Background: Sudarshan Kriya Yoga (SKY) is a procedure that involves essentially rhythmic hyperventilation at different rates of breathing. The antidepressant efficacy of SKY was demonstrated in dysthymia in a prospective, open clinical trial. This study compared the relative antidepressant efficacy of SKY in melancholia with two of the current standard treatments, electroconvulsive therapy (ECT) and imipramine (IMN). Methods: Consenting, untreated melancholic depressives (n=45) were hospitalized and randomized equally into three treatment groups. They were assessed at recruitment and weekly thereafter for four weeks. Results: Significant reductions in the total scores on Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HRSD) occurred on successive occasions in all three groups. The groups, however, did not differ. Significant interaction between the groups and occasion of assessment occurred. At week three, the SKY group had higher scores than the ECT group but was not different from the IMN group. Remission (total HRSD score of seven or less) rates at the end of the trial were 93, 73 and 67% in the ECT, IMN and SKY groups, respectively. No clinically significant side effects were observed. Discussion: Within the limitations of the design (lack of double blind conditions), it can be concluded that, although inferior to ECT, SKY can be a potential alternative to drugs in melancholia as a first line treatment.

Introduction

Sudarshan Kriya (Su=right, Darshan=vision, Kriya=procedure) was devised by a spiritual guru, Pundit Ravi Shankar of the Art of Living Foundation, Bangalore, India. It has been practiced as a brief and practical self-help stress-management strategy. Impressionistic reports of the participants indicate that it reduces anxiety and depression. From the biomedical point of view, it is essentially hyperventilation with demonstrable effects on brain function (Meti and Desiraju, 1984; Meti and Raju, 1993). These observations suggest that this procedure may have antidepressant potential. However, to make it widely acceptable to patients and the medical profession, some of the adventitious components (e.g., briefing about positive attitudes to life, ‘living in the present’, etc.) were dropped as were the meditative aspects. The procedure is devised as a physiological technique consisting of only specified rhythms of breathing. This adaptation for clinical purposes was designated Sudarshan Kriya Yoga (SKY; Yoga Research Group, 1995).

In an open, three-month clinical trial, SKY, as the sole treatment in dysthymic patients (n=46), produced significant antidepressant effects, with 25 (68%) of the 37 patients who completed the treatment in remission (Janakiramaiah et al., 1998). Small but significant elevations of serum prolactin (but not of cortisol) occurred following a session of SKY (Janakiramaiah et al., 1998). Following improvement with SKY therapy, significant increments in P300 (ERP) amplitude (‘normalization’) occurred (Naga Venkatesha Murthy et al., 1997). In an independent sample of major depressive disorder patients, SKY lengthened REM sleep latency and slow wave sleep (Harish, 1997). These objective changes, associated with therapeutic effects and a response rate of 68%, further suggest that SKY produces more than a placebo antidepressant effect. In this study, we compared the therapeutic efficacy of SKY with two standard antidepressant treatments, electroconvulsive therapy (ECT) and imipramine, in melancholia.

Section snippets

Patients

Consenting inpatients (n=45) of DSM-IV melancholic depression (American Psychiatric Association, 1994) who were never treated for the current episode were recruited consecutively. All were medically fit and scored 17 or more on the total 17-item Hamilton depression rating scale (HRSD; Hamilton, 1960). They were randomized into three equal groups (Table 1) to receive SKY, ECT or imipramine (IMN) treatment for four weeks.

SKY

The procedure was documented previously (Yoga Research Group, 1995;

Results

Significant reductions in total BDI scores occurred in all three groups but there were no differences between them. There was, however, a significant group×occasion interaction. Although there were no overall differences between the groups, the ECT group had the lowest mean scores at weeks three and four, whereas the SKY and IMN groups appeared to be similar (Fig. 1). The results were similar to those obtained using the total 17-item HRSD as well as its six-item subscale (Table 2). In view of

Discussion

In this prospective randomized controlled trial, SKY produced a 67% remission rate at four weeks (Table 3). This compares with the response rate in dysthymia observed earlier (Janakiramaiah et al., 1998). As the present response rate was obtained in severe, hospitalized, melancholic depressives, the placebo response explanation is inadequate (Nelson et al., 1990; Peselow et al., 1992). Those who remitted at different points maintained their status until the end of the study, suggesting

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