E-ISSN:2456-3110

Review Article

Major Depressive Disorders

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 2 February
Publisherwww.maharshicharaka.in

Integrated Yoga as a first-line treatment for Antenatal and Postnatal Mental Health

Mishra M.1*, Bagade T.2, Jamunadevi C.3
DOI:

1* Mahi Mishra, Reader, Department of Prasuti Tantra and Stri Roga, Government Autonomous Ayurveda College and Hospital, F-1, Govt. Ayurveda College Campus, Near Mandre Mata Mandir, Kampoo, Lashkar, Gwalior, Madhya Pradesh, India.

2 Tanmay Bagade, Lecturer (Medical education, Global Health), Centre of Women’s Health Research, the University of Newcastle, School of Medicine and Public health, Callaghan Drive, New South Wales, Australia.

3 C Jamunadevi, Professor, Department of Stree Roga and Prasooti Tantra, Swaninarayan University, Katol, Gujarat, India.

Postnatal period of women is one of the most stressful events of a woman’s life. The journey from a pre-pregnant state to day-to-day challenges of managing a new born baby is not only stressful but also leads to several mental health issues in women during pregnancy and postnatally. Major Depressive Disorders (MDD) are becoming a global burden of diseases amongst women of child-bearing age. Major depressive disorder (MDD) is a mental disorder characterised by at least two weeks of pervasive depressed mood, loss of pleasure in daily activities, weight loss, insomnia, agitation, fatigue, feelings of worthlessness or guilt, attentional problems, thoughts of death, and suicidal ideation.

Keywords: Yoga, Pranayama, Meditation, Post-Natal Depression (PND), Major Depressive Disorders (MDD), Maternal mental health, Cognitive Behavioural Therapy (CBT), Interpersonal Psychotherapy (IPT)

Corresponding Author How to Cite this Article To Browse
Mahi Mishra, Reader, Department of Prasuti Tantra and Stri Roga, Government Autonomous Ayurveda College and Hospital, F-1, Govt. Ayurveda College Campus, Near Mandre Mata Mandir, Kampoo, Lashkar, Gwalior, Madhya Pradesh, India.
Email: 		Mahi Mishra, Tanmay Bagade, C Jamunadevi, Integrated Yoga as a first-line treatment for Antenatal and Postnatal Mental Health. J Ayu Int Med Sci. 2023;8(2):54-56.
Available From
https://jaims.in/jaims/article/view/2280

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-12-24 2022-12-27 2023-01-03 2023-01-10 2023-01-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Mahi Mishra, Tanmay Bagade, C Jamunadeviand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

In 2017, the MDD was found to be prevalent in 11.9% women during the perinatal period in a systematic review.[1] The prevalence of Post-natal Depression (PND) is also estimated to be more than 15%, which is much higher than MDD during the antenatal period.[3] In developing countries, an estimated 15.6% of women suffer from antenatal depression and 19.8% suffer from PND. WHO estimates that 20% of mothers in developing countries suffer from clinical depression. MDDs adversely affect women’s well-being as well as their children’s growth and development.[4] In low-income countries of South Asia, poor maternal mental health is associated with decreased infant growth.[5] Maternal mental health disorders are treatable and have become an international healthcare priority.[6] However, there is a wide range of choices available to the patients seeking care for PND.

Review on Yoga

Currently, numerous clinical and non-clinical treatments are available to manage MDDs. The most common treatments are Cognitive Behavioural Therapy (CBT), Interpersonal Psychotherapy (IPT), talk therapies, collaborative care models, complementary and alternative medicine approaches, light therapy, brain stimulation, and psychopharmacological interventions. CBT and IPT have shown promising results in managing MDDs.[7] However, due to ethical issues in conducting human trials on pregnant mothers, the effectiveness of most of these interventions is studied using small sample sizes; therefore the generalisability of these studies is questionable. Pharmacological interventions are mostly studied on animal models. Gaps in the literature on the efficacy of clinical and non-clinical interventions for PND have posed a significant challenge for the clinicians as well. Some studies have encouraged tailored approach to treat PND.[8] A discrete choice experiment in post-natal women in Australia revealed that women who had higher education chose effective treatment. Cost and treatment type was another critical predictor for women to choose a particular treatment. In this study, Yoga and meditation was one of the most popular and preferred choices of treatment for postnatal women suffering from depression.[6]


Yoga is one of the most cost-effective exercises used in the Indian sub-continent for thousands of years. Yoga, which includes yogic postures, Pranayama (breathing exercises), and meditation, is a simple, effective, and cost- a form of intervention that can be used to treat antenatal, as well as post-natal depression. Yoga has gained popularity globally since the last decade and has initiated numerous clinical studies across the world. Internationally, Yoga-related interventions are grouped into two types: physical-exercise-based Yoga and integrated Yoga which, besides physical exercises, includes pranayama, meditation or deep relaxation.[9] Physical-exercise-based Yoga is an incomplete type of Yoga and should not be recommended for managing any mental health-related disorders. Gong et al., in systematic review and meta-analysis of six randomised controlled trials (RCTs) have concluded that ‘Integrated Yoga’ significantly reduces post-natal depression.[9] In another review about health effects of yoga on pregnancy, Jiang et al. revealed that ten RCTs indicated yoga showed significant reduction in incidence of prenatal mental health disorders, lower levels of pain and stress, lower rate of small for gestational age child, and higher score of relationship.[10]

Result

Yoga can be safely recommended for antenatal and postnatal lumbopelvic pain.[10] Yoga has also shown a significant reduction in cortisol levels and other stress markers in other studies involving women with antenatal and postnatal depressive disorders.[11,12]

Discussion

Yoga benefits physical and mental health via down-regulation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS).[13] Downregulation of HPA axis can lead to the reduction of non-communicable diseases such as diabetes, cardiovascular diseases, obesity, and depression.[13] A literature review of Yoga with other forms of exercise elaborated on the effectiveness of Yoga in comparison to other forms of exercises.[13] In healthy, as well as diseased population, Yoga was found to be significantly effective in improving several health outcomes such as the reduction in blood glucose and lipid levels, salivary cortisol levels, and oxidative stress.[13]


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Yoga also had a positive effect on reducing sleep disorders.[13,14]

Conclusion

Yoga is also more effective than walking or other standard prenatal exercises.[10] In comparison to walking, Yoga is significantly effective in improving mood and alleviating anxiety.[15] Cognitive behavioural therapy (CBT) aids patients to modify irrational beliefs and specific cognitive distortions,[16] whereas, Yoga focuses on a holistic approach that combines spiritual, physical, and mental health, along with dealing with private events through meditation. Some studies have shown significantly enhanced and cumulative effect if Yoga is used in combination with CBT in stress management and treating depressive disorders.[16-18]

Reference

1. Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders 2017; 219: 86-92.

2. Kandel H, Pfaff DW. Chapter 1 - Arousal. In: Fink G, ed. Stress: Physiology, Biochemistry, and Pathology: Academic Press; 2019: 1-18.

3. Almond P. Postnatal depression: A global public health perspective. Perspectives in Public Health 2009; 129(5): 221-7.

4. WHO. Maternal mental health. 2020. https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/ (accessed 18 Jan 2020).

5. Patel V, Rahman A, Jacob KS, Hughes M. Effect of maternal mental health on infant growth in low income countries: new evidence from South Asia. BMJ 2004; 328(7443): 820-3.

6. Ride J, Lancsar E. Women's preferences for treatment of perinatal depression and anxiety: A discrete choice experiment. PLoS ONE 2016; 11(6).

7. Nillni YI, Mehralizade A, Mayer L, Milanovic S. Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review. Clinical Psychology Review 2018; 66: 136-48.

8. Vogel L. Tailored treatment for postpartum depression. Canadian Medical Association Journal 2011; 183(16): E1163-E4.

9. Gong H, Ni C, Shen X, Wu T, Jiang C. Yoga for prenatal depression: a systematic review and meta-analysis. BMC Psychiatry 2015; 15(1): 14.

10. Jiang Q, Wu Z, Zhou L, Dunlop J, Chen P. Effects of Yoga Intervention during Pregnancy: A Review for Current Status. American Journal of Perinatology 2015; 32(6): 503-14.

11. Field T, Diego M, Delgado J, Medina L. Yoga and social support reduce prenatal depression, anxiety and cortisol. J Bodywork Mov Ther 2013; 17(4): 397-403.

12. Bershadsky S, Trumpfheller L, Kimble HB, et al. The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms. Complementary Therapies in Clinical Practice 2014; 20(2): 106-13.

13. Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. The journal of alternative and complementary medicine 2010; 16(1): 3-12.

14. Carroll JE, Teti DM, Hall MH, Christian LM. Maternal Sleep in Pregnancy and Postpartum Part II: Biomechanisms and Intervention Strategies. Current Psychiatry Reports 2019; 21(3).

15. Chris C. Streeter, Theodore H. Whitfield, Liz Owen, et al. Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels: A Randomized Controlled MRS Study. The Journal of Alternative and Complementary Medicine 2010; 16(11): 1145-52.

16. Vorkapic CF, Rangé B. Reducing the Symptomatology of Panic Disorder: The Effects of a Yoga Program Alone and in Combination with Cognitive-Behavioral Therapy. Frontiers in Psychiatry 2014; 5(177).

17. Granath J, Ingvarsson S, von Thiele U, Lundberg U. Stress Management: A Randomized Study of Cognitive Behavioural Therapy and Yoga. Cognitive Behaviour Therapy 2006; 35(1): 3-10.

18. Khalsa MK, Greiner-Ferris JM, Hofmann SG, Khalsa SBS. Yoga-Enhanced Cognitive Behavioural Therapy (Y-CBT) for Anxiety Management: A Pilot Study. Clinical Psychology & Psychotherapy 2015; 22(4): 364-71.


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