• What is Depression and How Can Yoga Help?

    Is depression centered in the brain? The “broken brain” or “chemical imbalance” model is too simplistic. As you can already assess, there are multi-layered processes in both body and mind that factor in the development of depressive symptoms.

    Depression is a prevalent mental health condition worldwide and is the leading cause of disability in adults under the age of 45. The mechanisms underlying depression remain poorly understood even though stress and its correlates contribute to multiple aspects of the phenomenology of depression. Based on an emerging picture of how stress and mood are regulated within the nervous system, we can understand depression as a complex response to extreme stress. Exposure to chronic stress, whether physical or psychological in nature, has cumulative effects on the body and mind.

    The demands of “modern” life – requiring us to be constantly on the go, propelled by caffeine and perfectionism—seem to elicit a chronic over-activation of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal axis (HPAA). As we saw in the anxiety article, a chronically activated sympathetic response will eventually lead to a complete shutdown of the body mediated by the dorsal vagal parasympathetic branch – leading to symptoms of major depressive disorder (MDD):

    a) depressed mood or loss of pleasure (anhedonia)
    b) feelings of guilt or worthlessness because of negative interpretations of the immobility response which comes in conflict with societal demands.
    c) cognitive slowing, further eroding self-confidence and self-worth.
    d) changes in sleep, which increase inflammatory influences in the brain.
    e) changes in appetite, which may lead to eating inflammatory foods and interfering in the modulation of the nervous system.
    f) potential suicidal ideations if the weight of the self-judgment becomes unbearable and hopelessness ensues.

    Ongoing arousal of the SNS/HPAA has both physical and psychological consequences. Psychosocial stress can activate peripheral and neural inflammation, which is exaggerated in individuals with MDD. Individuals experiencing depression have higher circulating levels of proinflammatory cytokines. High levels of these cytokines are associated with fatigue, cognitive dysfunction, and altered sleep. Symptoms of depression seem to emerge as cytokines activate neural pathways that influence the basal ganglia, an area of the brain involved in motivation and motor activities. This could explain the low motivation and motor movement inhibition associated with depression.

    Other brain regions involved in the control of mood, including components of the PFC and limbic system are also affected by these inflammatory pathways, which is leading researchers to hypothesize that the release of stress hormones (corticotrophin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and cortisol) are a major factor in depression. Psychiatrists are experimenting with anti-inflammatory medications in patients who do not respond to common antidepressants – anecdotally with great success.

    Is depression centered in the brain? The “broken brain” or “chemical imbalance” model is too simplistic. As you can already assess, there are multi-layered processes in both body and mind that factor in the development of depressive symptoms. They involve multiple organ systems and a variety of hormones and neurotransmitters. However, emerging evidence implicates dysfunction in a circuit including cortical areas and limbic areas that regulates mood, learning, and memory processes. Research suggests that symptoms of depression may result from dysfunctional asymmetry of activity between the left frontal lobe (causing decreased positive affect) and the right frontal lobe (causing emotional lability, difficulty with emotional information processing, and decreased arousal). This is particularly true in individuals who experienced childhood abuse and developmental trauma that impaired the proper development of these emotion-modulation areas. This development occurs after birth in the dyadic interactions between infant and caregivers.

    A key individual factor in the effect of stress may be the degree to which an individual perceives the stress to be significant and to what degree the individual thinks she/he has control over the situation. Anything that helps an individual experience a sense of mastery over their internal experience and external world will help reduce depression. Paraphrasing Indu Arora, yoga is not a feel-good practice. Yoga is a practice that requires self-study, svadyaya, and consistent practice, abhyasa while cultivating qualities of non-judgment, self-compassion, and lovingkindness. The bad news is that quick fixes (demanded by a “rapid results” culture) do not exist. The good news is that healing is possible through effort mediated by santosha, or contentment for patient improvement.

    We begin by reducing the stress response that ultimately leads to depression. So, in addition to the outline on the eight (8) limbs of yoga outlined in the anxiety section of this 3-part blog post series, the following considerations should be taken for people experiencing depression:

    1. Goal: Establish the observer, a capacity to witness and deconstruct phenomenological experience rather than identify with it. Slowly increase sympathetic arousal through movement and deeper inhales. Expand the capacity to tolerate the potential “distress” of higher arousal states by shifting frequently between movement and restful phases – which will invite the natural rhythm of the nervous system.

    2. Attitude: Support motivation to practice by highlighting mastery of the foundational aspects of yoga. Facilitate continuity of effort by offering simpler, step-by-step practices that provide an experience of gradual change.

    3. Strategies: Begin slowly and gradually increase activity to break up inertia. Use mainly brahmana practices that emphasize dynamic movement coordinated with breath. Titrate entry into more energizing poses by starting with supine poses and move slowly to standing or balancing poses.

    4. Asana: Categories that are helpful: extensions, laterals, gentle backbends, and twists followed by a long savasana to help increase cardiovascular capacity, “digest” the sympathetic arousal that emerges, and integrate the balance of sympathetic/parasympathetic arousal. Savasana with rhythmic breathing has been shown in research to relieve depression.

    5. Bandhas/Chakras: Uddyana bandha is particularly important to awaken the dorsal vagus nerve (which is subdiaphragmatic and enervates digestive organs), activate the 3rd chakra (willpower, determination, self-awareness), build the energetic “fire” (agni) that supports transformation and the digestion and assimilation of food and psychological states.

    6. Pranayama: Focus on ujjai which is warming and centering; increase length of inhales with short holds after inhale to build energy and stamina; create heat with bhastrika.

    7. Meditation: Concentrate awareness at the navel center with the seed mantra for that region, RAM, to build courage and positive self-identity. Learn the Maha Mrityunjaya Mantra to dissolve fear and darkness.

    Current research supports the idea that various yoga interventions can help participants improve self-reported perceptions of stress and well-being. Little research, however, exists on physiological or neurological mechanisms that could mediate the positive effects of yoga on mood and symptoms of psychological depression. Below is a summary of some potential explanations for yoga’s benefits:

    • Yoga may influence the inflammatory processes involved in depression by influence on the vagus, the 10th cranial nerve. Efferent (brain-to-body) vagal nerve fibers, via the neurotransmitter acetylcholine, exert anti-inflammatory actions. Thus, because inflammation is implicated as contributing to depressive symptoms, activation of the vagal anti-inflammatory pathway could be an important mechanism by which yoga practice could decrease symptoms of depression.

    • The yoga components of slow breathing, relaxation practices, mindfulness of sensations in the body, and physical postures may influence drive on brain pathways to the limbic and cortical areas involved in mood regulation, influencing parasympathetic outflow.

    • Rhythmic breathing practices have been shown to affect heart-rate-variability (HRV) and decrease blood pressure. In addition, slow breathing patterns that stimulate the vagus, have been shown to increase levels of prolactin, dopamine, norepinephrine, and serotonin, which are often depleted in depression.

    • There have been few studies investigating the effects of yoga on brain chemistry; however, practicing the physical postures of yoga has been shown to increase levels of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain that can have anti-depressant and anxiolytic effects.

    • The repetitive practice of yoga, over enough weeks, may provide a sense of accomplishment, positively reinforcing healthy coping and self-mastery, as well as increasing positive self-regard and identity.

    • Another way yoga may help is the focus on bringing attention to present-moment thoughts, feelings, and bodily sensations in a non-judgmental way, helping to decrease self-criticism and increasing the experience of thoughts, feelings, and sensations as transient and not permanent events.

    • Researchers have also hypothesized that yoga may have a positive impact on related autonomic functioning and in reducing hypothalamic-pituitary-adrenal (HPA) axis activation. Change in these pathways interrupts the underlying stress physiology and decreases inflammation.

    • Exercise, as well as meditation, also influences the hypothalamic-pituitary-adrenal responsiveness and leads to adaptions in endocrine secretion of substances such as cortisol and adrenocorticotropic hormones.

    This is part 3 of a 3-part series. Subsequent blogs will deconstruct anxiety and depression as well as outline how yoga has been proven by research to help with these conditions. Inge Sengelmann is a licensed clinical social worker and certified ParaYoga teacher who specializes in disorders of extreme stress and is committed to anti-oppression practices and decolonizing mental health.

    By Inge Sengelmann

    Inge Sengelmann, LCSW, SEP, RYT is a licensed psychotherapist and certified ParaYoga teacher who promotes a practice of embodied psychology and spirituality. Visit her website at www.embodyyourlife.org.

    Photo by Anthony Tran on Unsplash

    Photo by Lina Trochez on Unsplash.

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  • Decolonizing and Demystifying Anxiety and Depression

    Yoga is not a feel-good practice; it is a practice of self-accountability. It asks us to be responsible for our inner experience and learn to divorce it from the outside world (vi-yoga). It further propels us to grow rather than to remain stuck in unhelpful patterns of thinking (vikalpas) and behaving (vasanas).

    The past year has been a reckoning for most of us as we faced:

    1. A life-threatening global pandemic, lockdown, and quarantine
    2. Global economic meltdown because of businesses shutting
    3. A rapidly worsening climate crisis that puts all life on the planet in peril
    4. A tipping point in the collective awareness of the ravages of racial oppression, white supremacy, and colonialism
    5. An ever-widening political divide that put the US on the brink of civil war
    6. The growth of extremism, conspiracy theories, and fringe cult groups unable to deal with these realities, perhaps as a form of counterphobia

    There is plenty to be anxious and depressed about, and data shows that anxiety and depression rates skyrocketed early in the pandemic lockdown. To top it off, the SARS-CoV-2 (or Coronavirus 19) also seems to have neurological and psychiatric impacts on those who have been infected, with 1 in 5 people who have had COVID meeting criteria for a mental health disorder after the infection. Given these facts, I propose that we cannot center problems in the individual without addressing also the social, cultural, economic, and political realities that influence people’s fears and hopelessness. Healing must happen in community.

    The year 2020 has challenged many of us to question in what unconscious ways colonialism, white supremacy and white privilege have shaped us personally and professionally. Asked to write a blog on yoga for anxiety and depression, I struggled to identify a context that felt satisfying. Finally, I understood that I wanted to bring a new perspective to these very real and disabling, but also all too common human experiences.

    Disease, according to Yoga Sutra 1:30, is one of nine obstacles that obstruct progress on our path to experiencing the state of yoga. The yoga tradition understands disease as a misalignment with the rhythms of nature. We are increasingly out of harmony with the natural universe. After industrialization, even less so. The planet’s rhythms and our individual circadian rhythms are out of sync. Conditioned by a white supremacist culture that tells us our worth is dependent on performance, achievement, and amassing material wealth, we resist rest. The brain then sends us signals that something has gone awry, and we become anxious and depressed.

    Anxiety and depression are not new phenomena. They have affected humans through millennia because they are natural responses to an over-taxed nervous system. In a way, they are both a warning, and an attempt to re-regulate the human organism when it has become dangerously imbalanced due to extreme stressors. Anxiety is the mobilization of metabolic energy towards necessary action, and depression is a demand that the system rest, so it goes into shutdown for energy conservation. These processes will be explained further in subsequent blogs detailing the neurophysiological and psychological or cognitive components of these experiences.

    Unfortunately, 20th century psychiatry, to categorize these phenomenological experiences as mental illnesses, began to reify these constructs and give them a life of their own—so we are no longer human beings having a transitory experience, but we become defined by our anxieties or our depressions. For many, their diagnoses begin to define their identities. Instead of seeking more complex explanations and taking corrective lifestyle actions, we look for a simple external agent (i.e., medications) to rapidly fix our distress. Our locus of control is outside of us, rather than within us. The yoga path, on the other hand, asks us to do self-study (svadyaya) and to engage in practice (sadhana) to shift states of consciousness and overcome the causes of suffering (kleshas).

    Yoga is not a feel-good practice; it is a practice of self-accountability. It asks us to be responsible for our inner experience and learn to divorce it from the outside world (vi-yoga). It further propels us to grow rather than to remain stuck in unhelpful patterns of thinking (vikalpas) and behaving (vasanas).

    Another disservice of modern psychiatry has been the simplification of solutions, so people (including some physicians) now commonly believe that depression is “a serotonin imbalance” to be rapidly resolved by a selective- serotonin-reuptake-inhibitor that will flood your brain with “feel good” neurotransmitters. But if that were the case, wouldn’t psychotropic medications have reduced the incidence and prevalence of anxiety and depression, and put a dent in the number of suicides recorded annually? Instead, what we are seeing are skyrocketing rates of all of these issues, especially in the more industrialized nations. And health and mental health professionals are bracing for a post-COVID wave of all of these “diseases” including post-traumatic stress disorder (PTSD). Clearly, our angst is a lot more complex than this simple neurotransmitter.

    Medications are fine as an adjunctive support, especially during times of extreme stress, but they will not “cure” the underlying causes and conditions that led to our “disordered” thinking, feeling, and behaving. They work best as a short-term salve to help us do the necessary work of change. In fact, most research done to get drugs approved is short term, and the bulk of the data shows that antidepressants, for example, only work better than placebo in cases of very severe depression. And many of these medications have undesirable effects and are difficult to withdraw from. Some Serotonin Reuptake Inhibitors (SSRIs), for example, have FDA black-box warnings about the potential increase in suicidality in certain age groups. Education on the pros and cons is imperative before agreeing to introduce psychotropic medications.

    The reality is that we are complex, multi-faceted beings whose unique and individual experiences require multi-faceted solutions. To decolonize therapy, we must humanize our experiences and bring back ancestral ways of healing in community by creating “communities of care.” We must de-mystify our experiences and put them in the context of social, cultural, economic, and political experiences and not “broken brains.” We must acknowledge the role of current and transgenerational, individual, and collective traumas. We must acknowledge all the ways that racist, sexist, fatphobic, transphobic, ableist, and capitalist ideologies impact individuals and communities – increasing anxiety and depression rates due to realistic fears and hopelessness regarding change. We must bring healing  (the process of ecoming whole) to the center of treatment.

    Decolonization is now used to talk about restorative justice through cultural, psychological, and economic freedom. Racial equality and eliminating wage disparities, for example, would do more for reducing depression and anxiety in certain groups than psychotherapy and anti-depressants. Decolonizing therapy means empowering individuals rather than making them dependent on a medical infrastructure designed to profit from illness. It means offering solutions that work for people within their cultural contest, even if they are not “evidence-based.” And finally, it means we must establish systems and institutions that understand dis-ease as just that: an attempt of the body and psyche to return to ease, flow, and coherence.

    This is part 1 of a 3-part series. Subsequent blogs will deconstruct anxiety and depression as well as outline how yoga has been proven by research to help with these conditions. Inge Sengelmann is a licensed clinical social worker and certified ParaYoga teacher who specializes in disorders of extreme stress and is committed to anti-oppression practices and decolonizing mental health.

    By Inge Sengelmann

    Inge Sengelmann, LCSW, SEP, RYT is a licensed psychotherapist and certified ParaYoga teacher who promotes a practice of embodied psychology and spirituality. Visit her website at www.embodyyourlife.org.

    Photo by Lina Trochez on Unsplash.

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