Evidence-Based Yoga Therapy for Older Adults (page 4)

Depression
When you have depression, it's more than feeling sad. Intense feelings of sadness and other symptoms, like losing interest in things you enjoy, may last for a while. Depression is a medical illness, not a sign of weakness.

Types of Depression
All depression types are not the same. Learn about the different types of depression, the signs and symptoms, and talk to your doctor about treatment:

Major Depression
Feeling sad and helpless? It's possible you have major depression, also known as clinical depression. People with major depression feel a profound and constant sense of hopelessness and despair.
With major depression, you may have symptoms that make it difficult to work, study, sleep, eat, and enjoy friends and activities. Some people have clinical depression only once in their life. Others may have it several times in a lifetime.
Most people feel sad or low at some point in life. But clinical depression is marked by a depressed mood most of the day, particularly in the morning. In addition, you may have other symptoms with major depression. Those symptoms might include:

  • Fatigue or loss of energy almost every day
  • Feelings of worthlessness or guilt almost every day
  • Impaired concentration, indecisiveness
  • Insomnia or hypersomnia (excessive sleeping) almost every day
  • Markedly diminished interest or pleasure in almost all activities nearly every day (called anhedonia, this symptom can be indicated by reports from significant others.)
  • Psychomotor agitation or retardation (restlessness or being slowed down)
  • Recurring thoughts of death or suicide (not just fearing death)
  • Significant weight loss or gain (a change of more than 5% of body weight in a month)

Chronic Depression (Dysthymia)
Chronic depression or dysthymia is a milder form of depression that affects millions. This form of chronic depression is thought to be related to brain changes that involve serotonin, a chemical or neurotransmitter that aids your brain in coping with emotions. Major life stressors, chronic illness, medications, and relationship or work problems may also increase the chances of dysthymia.

Atypical Depression
Many people with depression don't have the typical symptoms. In general, people with atypical depression don't have as many of the symptoms that people with classical depression may have. They also tend to have first experienced depression at an early age, during their teenage years.
Despite its name, atypical depression is probably rather common. Some doctors believe that it is underdiagnosed. Researchers are considering whether or not atypical depression might be a type of dysthymia -- a low-level depression that has lingered for at least two years. Researchers are also investigating the idea that atypical depression may be a milder form of bipolar disorder called cyclothymia. People with cyclothymia typically have less extreme switches in mood.
The main characteristic of atypical depression that distinguishes it from major depression is mood reactivity. In other words, the person with atypical depression will see his or her mood improve if something positive happens. In major, or melancholic, depression, positive changes will not bring on a change in mood. In addition, diagnostic criteria call for at least two of the following symptoms to accompany the mood reactivity:

  • sleeping too much (hypersomnia)
  • eating too much (hyperphagia), resulting in weight gain
  • having a more intense reaction or increased sensitivity to rejection, resulting in problems with social and work relationships
  • having a feeling of being weighed down, paralyzed, or "leaden"

Postpartum Depression
Postpartum depression is increasingly common. Postpartum depression is linked to chemical, social, and psychological changes associated with having a baby. The term describes a range of physical and emotional changes that many new mothers experience. The good news is postpartum depression can be treated with medication and counseling.
The chemical changes involve a rapid drop in hormones after delivery. The actual link between this drop and depression is still not clear. But what is known is that the levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy. Then, they drop sharply after delivery. By three days after a woman gives birth, the levels of these hormones drop back to what they were before she got pregnant.
In addition to these chemical changes, social and psychological changes associated with having a baby create an increased risk of depression. Symptoms of postpartum depression are similar to what happens normally following childbirth. They include lack of sleep, appetite changes, excessive fatigue, decreased libido, and frequent mood changes. However, these are also accompanied by the symptoms of major depression -- depressed mood; loss of pleasure; feelings of worthlessness, hopelessness, and helplessness; and thoughts of death or suicide.

Bipolar Depression (Manic Depression)
Bipolar disorder is a complex genetic disorder. The mood swings associated with it alternate from major, or clinical, depression to mania or extreme elation. The mood swings can range from very mild to extreme, and they can happen gradually or suddenly within a time frame of minutes to hours. When mood swings happen frequently, the process is called rapid cycling. Along with the dramatic mood swings, patients with bipolar disorder may have disturbances in thinking and they may also have distortions of perception and impairment in social functioning.

Seasonal Depression (SAD)
There are two seasonal patterns with SAD. One starts in the fall and continues through the winter, and the other starts in late spring or early summer. The fall-onset type of SAD, often referred to as "winter depression," is better known and easier to recognize -- and we know more about it than we know about its counterpart.
Hormones manufactured deep in the brain automatically trigger attitudinal changes at certain times of year. Experts believe that SAD is related to these hormonal changes. One theory is that reduced sunlight during fall and winter leads to reduced production of serotonin in the brain. Serotonin is a neurotransmitter that has a soothing, calming effect. The result of there not being enough serotonin is feelings of depression along with symptoms of fatigue, carbohydrate craving, and weight gain. Because foods high in carbohydrates (chips, pretzels, cookies) boost serotonin, it is thought that they have a calming, soothing affect on the body and mind.
SAD usually starts in young adulthood and is more common in females than in males. Some people with SAD experience very mild symptoms and feel out of sorts or irritable. Others have debilitating symptoms that interfere with relationships and productivity. Because the lack of enough daylight during wintertime is related to SAD, it is seldom found in countries within 30 degrees of the Equator where there is plenty of sunshine year round.

Serotonin Syndrome
Serotonin is a chemical produced by the body that enables brain cells and other nervous system cells to communicate with one another. Too little serotonin in the brain is thought to play a role in depression, while too much can lead to excessive nerve cell activity, causing a potentially deadly collection of symptoms known as serotonin syndrome or serotonin reuptake syndrome. Serotonin syndrome can occur if you are taking medications, particularly antidepressants, that affect the body's level of serotonin. The greatest risk of serotonin syndrome occurs if you are taking two or more drugs and/or supplements together that influence serotonin. The condition is more likely to occur when you first start a medicine or increase the dose.  The most commonly prescribed class of antidepressants, which work by increasing serotonin, are the serotonin reuptake inhibitors (SSRIs).These include Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline).

Conventional Treatment for Anxiety and Depression
The first step in treating a mental disorder is recognizing that something is not right. The second step is getting help. These two steps may in fact be the hardest part of the entire healing process. Once you seek help from a qualified health care provider, a correct diagnosis can be made and proper treatment can be given to help you get back on track.
Early recognition and treatment of a mental illness will offer you the greatest chance of recovery and the earlier you seek help the greater the chance that recurrences can be prevented. Once you decide to seek medical help for your mental health, start with your primary doctor. He or she can evaluate you to make sure that medicines or another illness are not the cause of your symptoms. If your symptoms are not caused by an underlying physical illness, your doctor will likely refer you to a mental healthcare professional -- someone trained in treating your particular mental condition.
Medications that prescribed for depression and anxiety include antidepressants, particularly the SSRIs (Prozac, Zoloft, Paxil, Celexa, Lexapro, Luvox, and Viibryd). Other anti-anxiety drugs include the benzodiazepines, such as Valium, Ativan and Xanax. These drugs do carry a risk of addiction so they are not as desirable for long-term use. Other possible side effects include drowsiness, poor concentration, and irritability. Psychotherapy is often used either alone or in combination with medications to treat mental illnesses. Called "therapy" for short, the word psychotherapy actually involves a variety of treatment techniques. During psychotherapy, a person with a mental illness talks to a licensed and trained mental health care professional who helps him or her identify and work through the factors that may be triggering their illness. (34)
Psychotherapy helps people with a mental disorder:
Understand the behaviors, emotions, and ideas that contribute to his or her illness.
Understand and identify the life problems or events -- like a major illness, a death in the family, a loss of a job, or a divorce -- that contribute to their illness and help them understand which aspects of those problems they may be able to solve or improve.
Regain a sense of control and pleasure in life.
Learn coping techniques and problem-solving skills.

Alternative Treatment for Anxiety and Depression
Medications and psychotherapy are still the mainstays when it comes to treating anxiety and depression, but alternative therapies can help. There's growing evidence that caviar, exercise, SAM-e, even meditation can help ease mood disorders.
St. John's Wort
This may be the most-studied herb -- with more than 30 studies so far -- and some show it to be effective for treatment of mild forms of anxiety and depression. In fact, the University of Pittsburgh is participating in a study of the herb.
Despite the promise, the story of St. John's wort illustrates some important points.
There is data suggesting an effect -- a number of studies in Europe showed that it worked for major clinical depression, but when double-blind, placebo-controlled 'gold-standard' studies were done, researchers found that it was not effective for major depression. That shows the peril of looking at small studies that are not well controlled to establish that something works.
Also, the FDA has issued a warning on St. John's wort, saying it dangerously interferes with a long list of prescription drugs. Too many people don't recognize that herbs affect the body physiologically just like prescription drugs do.
Herbals can cause side effects, such as dizziness, headaches, stomach upset, or can dangerously affect how the body metabolizes other drugs, he says.
SAM-e
It's short for S-adenosylmethionine, a molecule that naturally occurs in the cells of plants and animals -- and it's not an herb. As we age, our bodies produce less SAM-e, so replacing it with a supplement can theoretically treat clinical depression. In some studies, it has held up as well as an antidepressant in treatment of major clinical depression. It's a compound in the body, involved in a number of pathways, including the neurotransmitters serotonin and norepinephrine. And it doesn't cause side effects for most people. Most people don't realize these products are medicines and that there are certain precautions. You don't want to take them with another antidepressant. You can get all kinds of side effects by getting too much serotonin. Also, SAM-e can be outrageously expensive, so that limits accessibility for most people.
Omega-3 Fatty Acids
Growing evidence shows that caviar, salmon, mackerel, and sardines can chase away clinical depression. These coldwater fish -- as well as walnuts and flaxseed -- have high amounts of omega-3 fatty acids.
This is another natural substance that plays a part in the functioning of every cell of the body. It reduces the risk of heart disease, stroke, and Alzheimer's disease, and it seems to have a preventive effect on manic depression -- but also is beneficial for clinical depression. In parts of the world where fatty fish are a dietary mainstay, there is less depression. One small study showed that people with manic depression who took omega-3-rich fish oil capsules every day had fewer episodes of manic-depression than those who took a placebo.
Again, omega-3 is not intended to replace other medications, but it can help in treating clinical depression. There's no downside to eating an omega-3-rich diet.
Exercise
Regular exercise can beat the blues. But research suggests it helps with all levels of anxiety and depression, even the most severe. Exercise may also help keep depression from coming back. We're talking about aerobic exercise -- getting your heart pumping, getting winded, and doing it for at least 20 minutes three times week.
One study showed that people who kept exercising after they recovered from depression had a lower risk of relapse compared with those who took antidepressant medication but did not exercise. Exercise helps clinical depression and anxiety disorders.

Yoga for Anxiety and Depression
Whether it's guided imagery, meditation, or yoga, anyone who suffers from clinical depression or anxiety disorders can benefit from some mind-body relaxation technique. It is really important that someone experiencing clinical depression, anxiety disorders, fatigue, or insomnia begin a mind-body technique. It can help with mood, concentration, and energy. Indeed, studies of meditation -- an ancient spiritual tradition -- show that daily meditation can have long-lasting positive effects on heart rate and other physiological processes.
Yoga, tai chi, Lamaze breathing, and repetitive prayer (like a rosary) can do the same thing. Any condition that is caused or exacerbated by stress can be relieved by these means -- and that includes clinical depression and anxiety disorders. Relaxation is the key, however it is achieved.
Research has verified the beneficial effects of exercise on psychological health and well-being across different popula­tions, including the elderly.(35) A meta-analysis of interven­tion studies concerning physical activity and psychological well-being in advanced age revealed that exercise does have a small but significant effect in older adults without clini­cal disorders. (36) Regular physical activity is associated with reduced symptoms of anxiety and depression. Yoga and meditation interven­tions have been shown to improve psychological well-being and decrease anxiety and depression. (37, 38,39)
In one recent study, researchers studied the effects of a six-week yoga program versus other forms of exercise on stress, anxiety and depression in 45 older adults. (40) The interventions were a chair yoga class, a chair aerobics class, a walking program and a game-playing program. All of the exercise groups, including the Yoga group, showed a decrease in mean stress frequency and depression from the beginning to the end of the intervention. Only the Yoga and aerobics groups showed a decrease in mean stress severity, and only the Yoga group showed a decrease in mean anxiety. (40)

In yogic philosophy, materiality manifests in 3 ways: sattva (balance, clarity), rajas (action, activity) and tamas (stability, inertia). In its imbalanced state, rajas may express as anxiety and tamas may express as depression.  These energetic states are linked to our cognitive state. In other words, our energetic/physiological state can drive our mental/emotional state and our mental/emotional state can drive our physiology. Because of this link, our entry point for yoga can be either one. To affect the physiology, we can use a langhana (calming) practice for anxiety and a brahmana (envigorating) practice for depression. Yoga asana and pranayama will alter physiology (especially pranayama). To affect the mental/emotional, we use chanting (mantra) and meditation. Pratipaksha bhavana is a cognitive reframing process used in yoga.

The Practice of Pratipaksha Bhavana
A healthy state of mind implies keeping one’s mind free from sadness, dejection, worry, and tension and negative sentiments such as anger, hate, greed, and pride. It also implies eliminating these negative impulses and replacing them with constructive ones. In Yoga, there is a useful method for promoting healthy thinking known as Pratipaksha Bhavana, which translates as “moving to the other side” and it points to the mind’s ability to completely transfer its awareness from a negative object to another more positive one.
It has 3 stages: dilution—you dilute the power of the negative thought back by denying it your attention; substitution—while holding back attention from negative thoughts, start asserting that which is positive; and sublimation—as you continue doing this, you will find that the negative becomes sublimated (i.e. vaporized) and fades away. To your great amazement, you realize that what seemed impossible to overcome has been overcome. (41)
The First Stage: Dilution
In the first stage, you recognize the presence of a negative thought the moment it arises, and take control of it. In this stage the negative thought is not allowed to root itself in the mind and held in check not so much by force but rather by simply withdrawing the attention. If done by force, the negativity tends to persist and push back.
You must practice the art of watching your mind at all times, and not allow yourself to entertain negative thoughts. You should not become too upset about any negative thoughts, because that will only draw additional energy to them and intensify your negativity. One of the common mistakes people make is to resist and struggle with their thoughts, emotions, habits, and situations.
The Second Stage: Substitution
Instead, as you notice the negative thought and gently restrain it by not attending to it, try to develop a positive affirmation within the mind. Substitute positive thoughts that are contrary to the negative thought that is disturbing your mind. Try thinking exactly the opposite of what is going on in your mind. For example, if you are perplexed or worried about something, try overcoming this feeling by reflecting on those great personalities who never worry. Try visualizing the blissful face of Buddha or Jesus or any spiritual ideal. Present before your mind feelings of cheerfulness. Relax your face and eyes. If you become angry, try presenting before your mind a state of forbearance in which your anger is converted into compassion.
The Third Stage: Sublimation
As you practice the substitution process, the negative may come back again and again, but it will gradually dissipate and lose its force and momentum. The positive will begin to assert itself—it is just a matter of time and patience. With sustained practice, as you go on developing the positive within yourself, the negative becomes sublimated and, to your surprise, soon vanishes.
The Divine Self Within
As you develop more understanding of your Self, you will discover that its positive qualities are able to overcome all that is negative. There is a boundless ocean of peace and harmony within you. There is boundless light within you and when you even crack open the door of your soul to that light, the darkness will quickly vanish. This door has become a little jammed, so it will take some time to open. But no matter how long it takes, you must have patience day by day. No matter how many times your mind may falter in this project, you must keep on ignoring the negative. Negativity is just like a mirage; it is only an illusion. The reality is the supremely positive presence of the Divine within you. (41)

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