A Randomized Controlled Trial of Community-Delivered Heated Hatha Yoga for Moderate-to-Severe Depression

Maren B. Nyer, PhD ; Lindsey B. Hopkins, PhD ; Megha Nagaswami, BA ; Richard Norton, MA ; Chris C. Streeter, MD ; Bettina B. Hoeppner, PhD, MS ; Chloe E. C. Sorensen, BA ; Lisa Uebelacker, PhD ; Jill Koontz, MEd ; Simmie Foster, MD, PhD ; Christina Dording, MD ; Naoise Mac Giollabhui, PhD ; Albert Yeung, MD, ScD ; Lauren B. Fisher, PhD ; Cristina Cusin, MD ; Felipe A. Jain, MD ; Paola Pedrelli, PhD ; Grace A. Ding, BA ; Ashley E. Mason, PhD ; Paolo Cassano, MD, PhD ; Darshan H. Mehta, MD, MPH ; Christina Sauder, MS ; Charles L. Raison, MD ; Karen K. Miller, MD ; Maurizio Fava, MD ; David Mischoulon, MD, PhD

J Clin Psychiatry 2023;84(6):22m14621

ABSTRACT

Objective: To evaluate feasibility, acceptability, and preliminary efficacy of heated yoga to treat moderate-to-severe depression.

Design: An 8-week randomized controlled trial (RCT) of heated yoga versus waitlist control was conducted from March 2017 to August 2019.

Methods: Participants in the yoga condition were asked to attend heated yoga classes at 2 community heated yoga studios at least twice weekly. We assessed acceptability and feasibility using exit interview and attendance data, respectively. The primary intervention efficacy outcome variable was change in the Inventory of Depressive Symptomatology—Clinician Rated (IDS-CR) score from baseline to post-intervention (week 8).

Results: We randomized 80 participants and included 65 (mean [± SD] age 32.7 [± 11.7] years; 81.5% female) in the analyses (yoga n = 33, waitlist n = 32). The mean IDS-CR score at baseline was 35.6 (± 7.9) for the full sample, 36.9 (± 8.8) for yoga participants, and 34.4 (± 6.7) for waitlist participants. Participants attended an average of 10.3 (± 7.1) total classes over the 8-week intervention period. Yoga participants had a significantly greater pre- to post-intervention reduction in IDS-CR scores than waitlist participants (Cohen d = 1.04, P < .001). More yoga participants (59.3%; n = 16) than waitlist participants (6.3%; n = 2) evidenced larger treatment responses (IDS-CR ≥ 50% decrease in symptoms). Participants rated the heated yoga and its aftereffects positively in exit interviews.

Conclusions: Approximately 1 heated yoga session per week (mean of 10.3 classes over 8 weeks) was associated with significantly greater reduction in depression symptoms than a waitlist control. Participants rated heated yoga positively. Taken together, results suggest feasibility, acceptability, and preliminary efficacy for patients with depression and warrant further research using active control conditions.

Trial Registration: ClinicalTrials.gov identifier: NCT02607514

J Clin Psychiatry 2023;84(6):22m14621

Author affiliations are listed at the end of this article.

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