This document discusses healing depression from an Ayurvedic perspective using yoga, meditation, and massage. It provides background on Ayurveda as an ancient Indian system of natural healing that focuses on balancing doshas. Research evidence is presented showing that yoga, meditation, and massage can help treat depression. Systematic reviews found moderate evidence that yoga reduces depression symptoms short-term compared to standard care. Meditation was also found to moderately to largely reduce depression symptoms. A study on prenatal depression found that both yoga and massage therapy significantly decreased depression, anxiety, and pain more than a control group.

1. Healing Depression
From an Ayurvedic
Perspective
Donna Petko, MSN, RN, APN, FNP-BC
University of Massachusetts, Amherst
Nursing 697Q: Integrative Therapies

2. Objective
To increase understanding of the treatment of depression from an
Ayurvedic perspective
• Therapies that will be reviewed include the following:
– Yoga
– Meditation
– Massage

3. Abstract
Ayurveda is an Indian Hindu System of healing that was developed
thousands of years ago. When it comes to treating chronic
conditions, the Ayurvedic system of natural healing has a variety of
practices which promote health and well-being. The goal of this
system is to maintain health through the elimination of impurities,
reduction of symptoms, reduction of worry, increase in harmony,
and elimination of physical and psychological distress. According
to a review of the literature, Ayurvedic practices such as yoga,
meditation, and massage have all been shown to be beneficial in
the treatment of depression.
Keywords: Ayurveda, complementary and alternative
medicine, dysthymic disorder, depression, integrative health,
persistent depressive disorder, whole medical systems

4. Introduction
The purpose of this presentation is to explore the treatment of
depression from an Ayurvedic perspective. The history, country of
origin, and integrative health uses of this modality will be explored
along with the available evidence. Indication for the use of this
system of natural healing will be examined in the context of treating
depression and a summary of the findings will be presented.
Additionally, risks, benefits, insurance coverage, health care policy,
and ethical and legal considerations will be discussed and
analyzed.

5. What is Ayurveda and Where Did it Come
From?
Ayurveda is the Indian Hindu system of healing (Keegan, 2001):
• Originated in India
• Developed >2000 years ago
• Whole medical system that is based on various theories of health
and illness
• Focuses on prevention, management, and the treatment of health
problems

6. What is Ayurveda and Where Did it Come
from?
• The system focuses on eight branches of medicine (Keegan,
2001):
– pediatrics, gynecology, obstetrics, ophthalmology, geriatrics, otolaryngology,
general medicine, and surgery
• Ailments are addressed through five elements (Keegan, 2001):
– air, earth, fire, and water; the humors of the body; the tissues of the body;
bodily excretions; and the trinity of life which consists of awareness of the
body, mind, and spirit; these are all necessary to healing

7. Beliefs
People who subscribe to the Ayurvedic system have some basic
beliefs about health and illness (NCCAM, 2006):
• Individuals, their health, and the Universe are related
• Illness can occur when relationships are out of balance
• An individual’s composition is called prakriti
– Prakriti is a combination of physical and psychological characteristics which
influence the body
– 3 qualities, doshas, form significant aspects of the prakriti

8. Beliefs Cont.
– Each person has a balance of doshas:
– corresponds with body and personality types
– impacts health
– What can cause an imbalance in doshas?
– unhealthy lifestyle and diet
– too little or too much mental and physical stimulation
– not being properly protected from environmental elements
• In the Ayurvedic system, it is believed that health and illness are
related to the balance or imbalance of the doshas (NCCAM, 2006)

9. Integrative Health Uses
• The goal of Ayurveda is to integrate and balance the mind, body,
and spirit (NCCAM, 2006)
• Patients are expected to be active participants in their care
– Active participation is needed because it is up to the patient to make diet
and lifestyle changes

10. Integrative Health Uses
• When Ayurvedic methods are included with Western Medicine, the
approach is considered integrative.
• Integrative medicine includes aspects of both Eastern and
Western medicine.

11. Integrative Health Uses Cont.
The goals of Ayurvedic treatment include the following (NCCAM,
2006):
• Eliminate impurities
• Reduce symptoms
• Reduce worry
• Increase harmony
• Elimination of physical and psychological distress

12. Integrative Health Uses Cont.
• Ayurvedic practitioners may recommend a variety of methods
such as:
– Yoga
– Meditation
– Massage
– Diet
– Herbs
• We will examine Yoga, Meditation, & Massage

13. Integrative Health Uses Cont.
• Yoga:
– Mind-body practice that utilizes movement, postures, breathing exercises
• Meditation:
– Contemplation, reflection, relaxation; spiritual awareness
• Massage:
– Rubbing different parts of the body to release tension and reduce pain

14. Depression
• While there are several forms of depression and episodes can vary
in duration, recurrent or prolonged episodes of depression can be
considered a chronic condition which impacts an individual’s
ability to eat, sleep, work, and play (National Institute of Mental
Health [NIMH], 2015).

15. Depression Cont.
• Depression is a serious medical condition with mood, cognitive,
and physical symptoms (Pratt & Brody, 2014).
• Common symptoms of depression include (NIMH, 2015):
– poor appetite or overeating
– insomnia or hypersomnia
– low energy or fatigue
– low self-esteem
– poor concentration or difficulty making decisions
– feelings of hopelessness

16. Depression Cont.
• In persistent depressive disorder (i.e., dysthymia,) a depressed
mood lasts for at least two years.
• Depression is associated with other chronic conditions (Pratt &
Brody, 2014):
– Increases healthcare utilization, costs, and overall expense
• Of the various forms of depression, major depression is one of the
most common mental disorders in the United States (NIMH,
2015).

17. Depression Cont.
• Major depressive disorder affects > 14 million Americans annually
– Approx. 6.7% of the US population age 18+
• In the US (CDC, 2015):
– 8% of those age 12+ had depression in any 2 week period from 2007-2010
– >8 million ambulatory care visits for depression occurred between 2009-2010
– As many as 1 in 33 children and 1 in 8 adolescents has a diagnosis of
clinical depression

18. Depression Cont.
• Those with depression are 4 times more likely to experience a
heart attack than those without depression (CDC, 2015):
– After a heart attack, those with depression have an increased risk of death,
or a second heart attack, compared to those without

19. Evidence for Practice
Healing depression from an Ayurvedic perspective using
yoga, meditation, and massage

20. Yoga
Systematic review and meta-analysis for yoga in the treatment
of depression (Cramer et al., 2013):
• Medline, Pub Med, Scopus, the Cochrane Library, PsychINFO, and
IndMed
– Reviewed for randomized controlled trials of yoga for patients with
depression
• Main outcomes consisted of depression severity and remission
rates
• Secondary outcomes consisted of anxiety, safety, and quality of
life
• Of the 12 randomly controlled trials that were reviewed, 619
participants were included.

21. Yoga Cont.

22. Yoga Cont.
• Moderate evidence for short-term effects of yoga when
compared to standardized care:
– Standardized mean difference (SMD) = −0.69; 95% confidence interval (CI)
−0.99, −0.39; P < .001
• Limitations to this study include no meta-analyses on the long-
term effects of yoga
• Findings are significant because they show promise in the
treatment of depression with yoga.
• Yoga can be considered one treatment option for patients with
depression which may be a cost-effective approach.

23. Meditation
Systematic review conducted on the effectiveness of meditation on
depression (Jain et al., 2014):
• Researchers reviewed all randomly controlled trials of techniques
meeting the Agency for Healthcare Research and Quality’s definition of
meditation.
• Participants with a clinical diagnosis of depression, who were not in
remission, were selected for participation in the study.
• Meditation techniques were separated into categories and the outcomes
reviewed.
• Of the 18 studies meeting inclusion criteria, 7 meditation techniques
and 1,173 participants were included.
• Mindfulness-based cognitive therapy was the most commonly employed
therapy.

24. Meditation Cont.
• For the diagnosis of major depression, n = 10 studies
• For those with subacute depression, n = 8 studies
• Both groups demonstrated a moderate to large reduction in
symptoms within the group as opposed to the controls.
• Limitations include (Jain et al., 2014):
– methodological insufficiencies, trial heterogeneity, and the need for large-
scale, randomly controlled trials with better described interventions and
measures
– the role of meditation in depression must also be better clarified

25. Meditation Cont.
• Significance of these findings include (Jain et al., 2014):
– substantial evidence that meditation may have beneficial effects on patients
experiencing clinical depression
– No risk was demonstrated in the use of this approach
– Meditation may offer a low-cost option and cost-effective approach to
treating and managing depression

26. Massage
Randomly controlled study to determine the effectiveness of yoga
and massage therapy on prenatal depression and neonatal
outcomes (Field et al., 2011):
• 84 prenatally depressed women randomly assigned to yoga, massage
therapy, or a standard prenatal care control group
• After 12 weeks of an intervention, either yoga or massage therapy,
twice a week for 20 minutes, both therapy groups, when compared to
the control, had a greater decrease in depression, anxiety, and physical
pain.
• Analyses conducted utilized repeated measures of group ANOVAS
which suggested significantly greater clinical improvements in the
intervention groups

27. Massage Cont.
• Decreased depression scores (F= 82.40, p<.001); 2)
• Decreased anxiety scores (F= 26.23, p< .001); 3)
• Decreased anger scores (F= 14.59, p<.001); 4)
• Decreased back pain scores (F= 39.06, p<.001); 5)
• Decreased leg pain scores (F= 19.77, p>.001)
• Increased relationships scores (F= 7.88, p<.001)” (Field et al.,
2011, p. 206).

28. Massage Cont.
• When yoga and massage therapy groups were compared, no
differences existed between maternal/neonatal outcomes
– this suggests that both yoga and massage were equally beneficial
• Limitations to this study include its small sample size and
population of interest

29. Massage Therapy Cont.
• The significance of these findings include:
– Beneficial nature of both yoga and massage therapy on the reduction of
depression in prenatal women and on neonatal outcomes.
– No risk was demonstrated in the use of yoga or massage therapy.
– Because conventional medicine and pharmaceutical approaches can
increase the risk of fetal harm, yoga and massage may offer a safer
alternative.

30. Risks and Benefits
Yoga, meditation, and massage therapy are all safe activities when
provided under the guidance of trained professionals when no
contraindications are present.
• Yoga that is performed under the guidance of a professionally
trained instructor is considered a low-impact and safe activity
(NCCIH, 2014)
– Caution must be taken with pregnant women or with individuals with physical
restrictions

31. Risks & Benefits Cont.
• Meditation is also considered safe for most people (NCCIH, 2014):
– Individuals with physical restrictions may need to refrain from certain
practices involving movement
• Massage therapy has few associated risks when conducted by a
trained professional (NCCIH, 2014)

32. Access to Care & Health Care Policy
• Many alternative, integrative, or complementary treatments, as
used in Ayurveda, are not covered by insurance.
• Even if services are covered for one diagnosis, they may not be
covered for another.
• It is up to the provider to work with the patient in terms of
developing a patient-centered treatment plan which is both safe
and cost-effective.

33. Access to Care & Healthcare Policy Cont.
• In terms of health care policy, it is important for providers to be
knowledgeable on coverage and insurance issues
• Providers should advocate for necessary changes in policy which
can decrease gaps in care, increase access to services, and
increase the quality of care provided to patients.

34. Legal and Ethical Issues
• Care must be taken when recommending any Ayurvedic practice
– Ayurveda utilizes a variety methods which may not have undergone rigorous
study
• Care must also be taken when integrating two or more
approaches
• Any health care provider that utilizes Ayurvedic methods must
review the literature for best practices:
– This limits liability and allows the provider to provide high quality, safe, and
cost effective patient-centered care

35. Legal and Ethical Issues Cont.
• Consideration must be given to cultural differences when devising
a treatment plan:
– Individuals of different cultures may not be open to various treatments
• After obtaining consent, the provider should discuss the pros and
cons of each practice and allow the patient to make the best
possible decisions based on the available evidence.
• The provider should exercise “do no harm” and keep all patient
records confidential following Health Insurance Portability and
Accountability Act guidelines.

36. Legal and Ethical Issues Cont.
• When treating a patient with depression, it is of utmost
importance that the provider assess the patient for the risk of
self-harm, suicidal risk, and the risk of harm to others.
• The patient should be given instructions for what to do in the case
of an emergency, adverse effects, or if signs or symptoms worsen:
– Dialing “911” or local emergency services number
– Contacting the National Suicide Prevention Lifeline: 1-800-273-8255

37. Conclusion
• In the Ayurvedic system, there are multiple ways to achieve
balance and maintain health and well-being such as:
– Yoga
– Meditation
– Massage
• These approaches provide safe, cost-effective approaches in the
management of depression
– can be used alone or in conjunction with other approaches
• While these treatments may not work as the sole treatment of
depression in some individuals, evidence suggests that they may
be beneficial as an integrated approach.

38. References
• Cramer, H., Lauche, R., Langhorst, J., & Dobos, G. (2013). Yoga for depression:
A systematic review and meta-analysis. Journal of Depression & Anxiety,
30(11), 1068-1083. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1002/da.22166/full
• Depression and Bipolar Support Alliance. (2015). Depression statistics.
Retrieved from
http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_d
epression
• Field, T., Diego, M., Hernandez-Reif, M, Medina, J., Hernandez, A. (2011). Yoga
and massage therapy reduce prenatal depression and prematurity. Journal of
Body-Work and Movement Therapies, 16(2), 204-209. Retrieved from
http://www.sciencedirect.com/ science/article/pii/S1360859211001409
• Jain, F.Q., Walsh, R.N., Eisendrath, S.J., Christensen, S., & Cahn, B.R. (2014).
Critical analysis of the efficacy of meditation therapies for acute and subacute
phase treatment of depressive disorders: A systematic review.
Psychosomatics, 56(2), 140-152. Retrieved from
http://www.sciencedirect.com/science/article/pii/S0033318214001674

39. References
• Keegan, L. (2001). Healing with complementary and alternative
therapies. New York: Delmar Cengage Learning.
• National Center for Complementary and Alternative Medicine. (2006). A
closer look at Ayurvedic medicine. CAM at the NIH: Focus on
Complementary and Alternative Medicine, 4. Retrieved from
https://web.archive.org/web/20061209114559/http://nccam.nih.gov/
news/newsletter/2006_winter/ayurveda.htm
• National Center for Complementary and Integrative Health. (2014).
Massage therapy for health purposes: What you need to know.
Retrieved from https://nccih.nih.gov/
health/massage/massageintroduction.htm
• National Center for Complementary and Integrative Health. (2014).
Meditation: What you need to know. Retrieved from
https://nccih.nih.gov/health/meditation/overview.htm

40. References
• National Center for Complementary and Integrative Health. (2013).
Yoga for your health. Retrieved from
https://nccih.nih.gov/health/yoga/introduction.htm
• National Institute of Mental Health. (2015). What is depression?
Retrieved from
http://www.nimh.nih.gov/health/topics/depression/index.shtml
• National Suicide Prevention Helpline. (2015). Why call? Retrieved
from http://www.suicidepreventionlifeline.org/
• Pratt, L.A., & Brody, D.J. (2014, December). Depression in the US
household population, 2009-2012 (Issue Brief No. 172). Retrieved from
http://www.cdc.gov/nchs/data/databriefs/db172.pdf

41. References
• Saeed, S.A., Antonacci, D.J., & Bloch, R.M. (2010). Exercise, yoga, and
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