Background: Depression remains a tremendous public health concern, despite many approved treatments. Consequently, highly utilized, novel, and promising complementary and alternative treatments for depression warrant investigation. Thermal therapy and yoga both demonstrate active antidepressant components, though to date, no studies of hot yoga for depression have been conducted. Bikram Yoga, a standardized, protocol-based form of hot yoga, has received very little scientific attention, and none for the treatment of depression. Training Program: Four training areas will allow me to reach academic independence: 1) methodology of patient-oriented depression research, including trial design and advanced statistical analyses; 2) clinical and research applications of mind-body interventions for depressed populations, with a specific focus on yoga- based interventions; 3) physiological biomarkers critical to understanding the mechanisms of action of mind- body interventions in depressed populations; and 4) training in the responsible conduct of randomized controlled trials with depressed patients. These training goals will be obtained through: 1) a strong team of mentors and consultants: Primary Mentor, Dr. Maurizio Fava; Co-Mentors, Drs. David Mischoulon and Chris Streeter; and Consultants, Drs. Jonathan Alpert, Lee Baer, Karen Miller, and Michael Otto; 2) targeted coursework and academic seminars on research methodology, biostatistics, mind-body medicine, physiology, and neuroscience; 3) execution of the proposed research project; and 4) exposure to the resource-rich environment, as described in the Description of Institutional Environment and Facilities and Resources documents. Research Proposal: I propose a randomized controlled trial to assess the feasibility, acceptability, efficacy, and mechanisms of action of Bikram yoga monotherapy versus a waitlist control for 80 medically healthy adults with mild to moderate depressive symptoms. The primary aim is to test the acceptability and feasibility of Bikram Yoga as a treatment for depression. The secondary aim is to examine the effect size/efficacy of Bikram Yoga for depressive symptoms. The tertiary aim is to explore physiological and psychological mechanisms of action. Implications: Results of the proposed study will provide preliminary data for an R01 application, and will lay the foundation for a career-long research program focused on evaluating mind-body interventions for depression, with a specific focus on yoga-based interventions. Due to the notably large effect sizes reported in thermal therapy for the treatment of depression and the preliminary data on Bikram Yoga for stress-induced eating, I anticipate that the results of the training and research plan will facilitate future applications for standardized hot yoga for depressive disorders.
Depression is among the most significant public health burdens of our time and current treatments frequently fail to bring individuals to complete remission and wellness. As such, novel strategies for treating depression are sorely needed. To date, no studies have been conducted to evaluate hot yoga as a treatment for depression. Bikram Yoga, a popular and standardized form of hot yoga, is a promising treatment for depression, as it combines two active antidepressant components, thermal therapy and yoga postures/breathing exercises. We propose to conduct a methodologically rigorous trial for 80 medically healthy adults with mild to moderate depressive symptoms who will be randomized to 8-weeks of twice weekly Bikram Yoga classes vs. a waitlist control.