Critically Appraised Paper in Adults On Antidepressants For - 2023 - Journal of

Journal of Physiotherapy 69 (2023) 124
j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / j p hy s
Appraisal
Critically appraised paper: In adults on antidepressants for mild-to-moderate

depression, yoga improves several aspects of quality of life
Synopsis
Summary of: Kumari N, Yadav A, Garg N, Yadav K, Sankhla M, Goothy (physical health, psychological health, social relationships and
SSK, et al. Effectiveness of yoga on quality of life among patients with environment), with the scores in each domain ranging from 0 (worst)
depression: a randomised controlled trial. J Clin Diagnostic Res. to 100 (best). Participants also gave evaluations of overall quality of life
2022;16:CC22–CC27. and general health, each on a 5-point Likert scale. Results: Sixty
participants completed the study. At 3 months, the yoga group had
Question: Does a 12-week program of yoga improve quality of life in
better improvement on the physical health domain (MD 19, 95% CI 15
adults taking antidepressants for depression? Design: Randomised
to 23) and the psychological health domain (MD 13, 95% CI 10 to 17)
controlled trial with concealed allocation. Setting: Participants
than the control group. Those in the yoga group also improved
were recruited from the psychiatry outpatient department of a
their general health score more than the control group (MD 1.0, 95% CI
medical college in India. Participants: The inclusion criteria were
0.8 to 1.3). The between-group difference was unclear on the
mild-to-moderate depression diagnosed using the Hamilton
remaining outcomes. Conclusion: A 12-week course of five sessions
Depression Rating Scale, aged 18 to 45 years, and receiving
per week of supervised yoga improves physical, psychological and
stable treatment with conventional antidepressant medication for
general health in people who are taking antidepressant medication for
1 month. Severe mental or medical comorbidities and receipt of
mild-to-moderate depression. [Mean difference in change scores and
cognitive behavioural therapy or psychotherapy were exclusion
95% CIs calculated by the Editor.]
criteria. Randomisation of 60 participants allocated 30 to a yoga group
and 30 to a control group. Interventions: Both groups received
conventional antidepressant medication. Those in the yoga group Provenance: Invited. Not peer reviewed.
were asked to also practise yoga postures for 15 minutes, breathing
exercises for 20 minutes and meditation for 20 minutes per session, at
least 5 days per week, under the supervision of a trained yoga
Mark Elkins
instructor. Outcome measures: The primary outcome was quality of
Editor, Journal of Physiotherapy
life measured at 1 and 3 months with the World Health Organisation
Quality of Life-BREF (WHOQOL-BREF), which has four domains https://doi.org/10.1016/j.jphys.2023.02.005
1836-9553/© 2023 Published by Elsevier B.V. on behalf of Australian Physiotherapy Association. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
Commentary
The intervention in this trial was quite intensive, but it may still be psychotherapies are typically considered first-line treatment ahead of
cost-effective in the public health system. A qualified yoga instructor pharmacotherapy. Future studies should consider the use of
would be an inexpensive addition in comparison to existing medical psychotherapy with yoga. Other considerations include supervised
staff and also cater for large groups. Unlike a structured compared with independently performed yoga, and follow-up to
psychotherapy group program, yoga would have flexible entry points assess continuation of yoga.
(useful in outpatient hospital settings) and few or no side effects.
Physiological mechanisms may be responsible for improving
physical and mental health in depression, such as by enhancing Provenance: Invited. Not peer reviewed.
synaptic transmission in the brain (like the mechanism of
anti-depressant medications) or by increasing endorphin excretion
after exercise.1 Improvements in body weight and fitness may also Leon Gantert
contribute. As participants were yoga naïve, skill mastery and National Centre for Veterans’ Healthcare, Concord Repatriation General
frequent distraction may have contributed to improvements in the Hospital, Sydney, Australia
psychological domain. https://doi.org/10.1016/j.jphys.2023.02.006
The authors did not specify which antidepressant medication(s)
were used or the yoga intensity, which hampered external validity.
Also, patients being managed with psychotherapy or cognitive Reference
behavioural therapy were excluded. In mild depression, 1. Craft L, Perna F. Prim Care Companion J Clin Psychiatry. 2004;6:104–111.
1836-9553/Crown Copyright © 2023 Published by Elsevier B.V. on behalf of Australian Physiotherapy Association. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Journal of Physiotherapy 69 (2023) 124

Critically appraised paper: In adults on antidepressants for mild-to-moderate

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