K.Pilkington et al.Journal of Affective Disorders 89 (2005)13-24 15 survey of 6618 randomly selected adults suggested Additionally,many of the trials of yoga are small that self-help strategies including complementary and the results difficult to generalise therapies were very commonly used to cope with However,a recent bibliometric analysis has demon- depression,particularly in mild-moderate psychologi- strated an increase in publication frequency of research cal distress (Jorm et al.,2004). on the clinical application of yoga and growing use of A range of therapeutic approaches is available for randomised controlled trials (Khalsa,2004).Clinical the management of depressive disorders but patients trials were located on the use of yoga for depression, may turn to complementary therapies due to adverse anxiety,cardiovascular conditions (e.g.hypertension, effects of medication,lack of response or simply heart disease),respiratory problems(e.g.asthma),dia- preference for the complementary approach. betes and a variety of others.Systematic reviews of these trials have not yet been conducted although a systematic review of trials of yoga in epilepsy(Ramar- 2.Yoga atnam and Sridharan,2000)concluded that insufficient robust evidence was available.No systematic reviews Yoga has its origins in Indian culture and in its of yoga in depression have been published. original form consisted of a complex system of spiritual,moral and physical practices aimed at attaining 'self-awareness'.Hatha yoga,the system 3.Aim and objectives on which much of Western yoga is based,has 3 basic components,asanas (postures),pranayama The aim of this study was to evaluate the evidence (breathing exercises)and dhyana (meditation).The on the effectiveness of yoga for the treatment of postures involve standing,bending,twisting and bal- depression. ancing the body and consequently improve flexibility and strength.The controlled breathing helps to focus the mind and achieve relaxation while meditation 4.Methods aims to calm the mind (Riley,2004).Although yoga has its origins in Indian religion,it can be 4.1.Summary of the search strategy practised secularly and has been used clinically as a therapeutic intervention.Several explanations based A comprehensive search for clinical research was on Western physiology have been proposed to carried out.Systematic searches were conducted on a account for potential effects of yoga in the treatment range of databases,citations were sought from rele- of various conditions.These can be summarised as vant reviews and several websites were also included modulation of autonomic nervous tone and conse- in the search,including those of MIND and the Men- quent reduction in sympathetic tone,activation of tal Health Foundation. antagonistic neuromuscular systems,which may increase the relaxation response in the neuromuscular 4.2.Databases searched system,and stimulation of the limbic system primar- ily by meditation(Riley,2004). General databases: A national survey conducted in the US demon- CINAHL,Cochrane Central Register of Con- strated that 7.5%of respondents had used yoga at trolled Trials (CENTRAL),Cochrane Database least once in their lifetime and 3.8%had used it in of Systematic Reviews,Database of Abstracts the previous year.Users were more likely to be of Reviews of Effects,EMBASE,IndMED female,college educated and urban dwellers and use (Indian Medlars Centre),MEDLINE (and was for both wellness and specific health conditions PubMed),PsycINFO. (Saper et al.,2004).The authors point out that despite Specialist CAM and condition based databases: greater prevalence of use than other CAM therapies AMED,CISCOM,Cochrane Depression,Anxi- such as acupuncture and homeopathy,yoga receives ety and Neurosis (CCDAN)Review Group less coverage in the Western biomedical literature. register.survey of 6618 randomly selected adults suggested that self-help strategies including complementary therapies were very commonly used to cope with depression, particularly in mild–moderate psychologi￾cal distress (Jorm et al., 2004). A range of therapeutic approaches is available for the management of depressive disorders but patients may turn to complementary therapies due to adverse effects of medication, lack of response or simply preference for the complementary approach. 2. Yoga Yoga has its origins in Indian culture and in its original form consisted of a complex system of spiritual, moral and physical practices aimed at attaining dself-awarenessT. Hatha yoga, the system on which much of Western yoga is based, has 3 basic components, asanas (postures), pranayama (breathing exercises) and dhyana (meditation). The postures involve standing, bending, twisting and bal￾ancing the body and consequently improve flexibility and strength. The controlled breathing helps to focus the mind and achieve relaxation while meditation aims to calm the mind (Riley, 2004). Although yoga has its origins in Indian religion, it can be practised secularly and has been used clinically as a therapeutic intervention. Several explanations based on Western physiology have been proposed to account for potential effects of yoga in the treatment of various conditions. These can be summarised as modulation of autonomic nervous tone and conse￾quent reduction in sympathetic tone, activation of antagonistic neuromuscular systems, which may increase the relaxation response in the neuromuscular system, and stimulation of the limbic system primar￾ily by meditation (Riley, 2004). A national survey conducted in the US demon￾strated that 7.5% of respondents had used yoga at least once in their lifetime and 3.8% had used it in the previous year. Users were more likely to be female, college educated and urban dwellers and use was for both wellness and specific health conditions (Saper et al., 2004). The authors point out that despite greater prevalence of use than other CAM therapies such as acupuncture and homeopathy, yoga receives less coverage in the Western biomedical literature. Additionally, many of the trials of yoga are small and the results difficult to generalise. However, a recent bibliometric analysis has demon￾strated an increase in publication frequency of research on the clinical application of yoga and growing use of randomised controlled trials (Khalsa, 2004). Clinical trials were located on the use of yoga for depression, anxiety, cardiovascular conditions (e.g. hypertension, heart disease), respiratory problems (e.g. asthma), dia￾betes and a variety of others. Systematic reviews of these trials have not yet been conducted although a systematic review of trials of yoga in epilepsy (Ramar￾atnam and Sridharan, 2000) concluded that insufficient robust evidence was available. No systematic reviews of yoga in depression have been published. 3. Aim and objectives The aim of this study was to evaluate the evidence on the effectiveness of yoga for the treatment of depression. 4. Methods 4.1. Summary of the search strategy A comprehensive search for clinical research was carried out. Systematic searches were conducted on a range of databases, citations were sought from rele￾vant reviews and several websites were also included in the search, including those of MIND and the Men￾tal Health Foundation. 4.2. Databases searched General databases: ClNAHL, Cochrane Central Register of Con￾trolled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, EMBASE, IndMED (Indian Medlars Centre), MEDLINE (and PubMed), PsycINFO. Specialist CAM and condition based databases: AMED, CISCOM, Cochrane Depression, Anxi￾ety and Neurosis (CCDAN) Review Group register. K. Pilkington et al. / Journal of Affective Disorders 89 (2005) 13–24 15