Yoga for the Management of Depression Swami Satyaprakash Saraswati (England,UK) My inspiration for learning about the management of depression through yoga came directly from Swami Satyananda Saraswati of the Bihar School of Yoga. In the book Nawa Yogini Tantra(1), it states: “Depression is not so much a condition of having no energy, as a kind of psychic constipation blocking our energy flow.” Anyone who has suffered from depression, as distinct from sometimes feeling miserable, may recognize the truth of this statement. The feelings of excessive tiredness, lifelessness and apathy, often accompanied by intense introversion and inferiority are characteristic of the condition. Truly it is a state of tamas, where the simplest task becomes daunting to a normally competent human being. If we follow the yogic approach, we will not immediately look for the causes of this depression but, instead, look at the energetic state of the person. It is not so simple, but probably they are thinking too much and not doing sufficient physical exercise – whether that is in the form of physical work, sport, gardening or yogasanas. So, the first approach through yoga is to practise hatha yoga, to regain some balance between the 'ha' and the tha', pingala and ida nadis. We know that the aim of hatha yoga is to balance the flow of energy, prana, in these two nadis, so that neither the physical nor the mental faculty predominates. In the yogic management of depression, this is a central tenet. Shatkarmas It is logical (though not always practicable) to begin with the practice of shatkarmas, the cleansing practices, less for their physical effects in removing excess kapha and more for their energetic effects. Start with tongue cleaning, jihva dhauti or jihva shodhan(2),because this is acceptable for most people, seen merely an extension of their routine teeth cleaning. Practised correctly, jihva shodhan produces a gag-reflex, which raises energy immediately. Next I would teach the practice of jala neti (3), nasal cleansing, using a cool saline solution, rather than the normal warm solution. The mild shock to the system of the cool saline has an awakening effect on the brain, and the forced exhalations that follow (which are imperative to proper drying of the nasal chambers) are energizing. Now it is necessary to consider whether the person experiences anxiety symptoms, in addition to depression. Clinically, the two states often go hand-in-hand; the person alternates between feeling inert and depressed then, for no apparent reason, extremely anxious and possibly manifesting panic attacks. (Allopathic medicine recognizes this syndrome, frequently prescribing combined anxiety-depression drugs.) Energetically, we might regard this condition as swinging between overactivity in ida and pingala nadis. The next cleansing practice, kunjal kriya (vaman dhauti)(4) should normally be practised only by those who do not experience anxiety symptoms as a part of the depression. It involves the drinking and regurgitation of warm saline solution, which cleanses the stomach at a physical level. However, it is most valuable in the management of depression because it removes the energetic blocks which have formed as we have consistently repressed painful emotions. In psychotherapeutic circles, it is widely acknowledged that depression is an outcome of repressed anger, and therapies such as Gestalt therapy enable the individual to externalize previously unexpressed anger. Thus, the huge amount of energy which was being utilized to repress the old anger is liberated for joyful living. Kunjal kriya works similarly and, since this practice bypasses cognition, it often is successful for those people who resist (or cannot afford) psychotherapy. Clearly it is important to introduce these cleansing practices gradually, according to the needs, temperament and ideas of the person. Asanas Asanas form a very important part of the management program, especially the dynamic standing postures and the sequence surya namaskara. Strong backwardbending asanas such as bhujangasana, ushtrasana and dhanurasana are ideal because of their direct effect upon the adrenal glands and less directly on the thyroid gland. But, of course, this depends on the fitness and age of the person. Often, those with long-term mental health problems also have bodies that are stiff and otherwise unwell. So, in these cases, we need to begin asana learning with the conditioning practices of pawanmuktasana part 1(5), which will enable the practitioner to progress safely to the more powerful asanas at a later date. Recently, scientific research has shown that all dynamic physical exercise releases endorphins; chemicals which affect the brain and enhance the mood (producing what is sometimes termed the 'feel good' factor). However, we know that yogasanas also have a much more profound effect on the whole body-mind complex. Pranayama Pranayama practices can contribute enormously to a person's sense of well-being by giving them the skills and confidence to control physiological responses to stress. It is important that the individual, as well as mastering the practices, understands which practice is to be used to address each mental state. For this purpose, I adopt the classification used in the book, Prana Pranayama Prana Vidya (6), which is easily comprehensible and memorable. We begin with nadi shodhana, a balancing pranayama, which may be safely practised by everyone. It is quickly recognized as bringing about a calmer, more peaceful state and it helps people to understand the effects of nostril predominance on mental state. Further discussion of this pranayama may lead the practitioner to an elementary study of swara yoga and to choosing their activities according to which nostril is flowing at a given point in the day. Ujjayi pranayama (simple form) is taught as the main tranquillizing pranayama. People with depression symptoms may not appear to need tranquillizing, but they often experience agitated states, especially at night. Those who suffer panic attacks and non-specific anxiety quickly come to appreciate the value of this practice, especially as it can be used at any time, in any place, without attracting attention. Bhastrika and kapalbhati are the vitalizing pranayamas which enable the practitioner to raise their energy levels quickly and at will. For persons suffering from depression, this means that they can face the day instead of succumbing to their inclination to remain in bed. In conjunction with bandhas, these pranayamas are amongst the most effective in managing depression. (And, of course, the person must understand that these two pranayamas may increase agitation and therefore should be used judiciously.) Psychophysiology Yoga addresses the psychophysiology of a person; we know that prana pervades all levels of our being, from the annamaya kosha through to the manomaya and vijnanamaya koshas. The feelings of lifelessness and numbness, so characteristic of the depressed state, can be understood not as absence of energy, (which is how many depressed people describe themselves – “I'm always tired; I have no energy”) but as blocked energy or impaired energy flow. In Nawa Yogini Tantra, it states, “Wilhelm Reich pointed out that the checks and balances of the mind's energy were reflected in the body and that repression was expressed in psychophysical knots that he called 'muscle armour' and yogis call granthis. Although originally a defensive device to protect sensitive areas of the mind from further hurt, these knots are a kind of tourniquet, cutting the healthy flow of energy and blocking us off from whole sections of our being. Sensation is numbed and we become increasingly depleted persons.” Bandhas The practice of bandhas addresses the granthis. Moola bandha(7)lifts energy and begins the process of bringing repressed experiences into conscious awareness. Uddiyana bandha is effective in reducing the feeling of emptiness, so often experienced by depressed people. It is especially dramatic in managing post-natal depression, where the woman has physically 'lost' a part of herself; she has delivered a baby and now feels (consciously or unconsciously) empty, bereft. Because bandhas can only be satisfactorily practised in the early morning before eating or drinking, this may encourage the person to establish a yogic routine of morning practice. The benefits are immediately perceptible and provide the motivation to continue. Changing the thought patterns Motivation is one of the biggest hurdles for depressed persons to overcome; they may know and admit that regular yoga practice will enable them to feel better, but implementing it is often difficult for them. Hence, practices that take little time but produce an unmistakable improvement in mood are an invaluable source of motivation. Gradually, the enhanced mood leads the individual to adopt a more comprehensive yoga program, resulting in all-round improvement in health and wellbeing – and a cycle has been broken. Also, when energy is unblocked and the mood is lighter, the habitual thinking processes change. Some schools of contemporary psychology purport that depressed individuals think wrongly; that they cease to perceive their positive attributes and dwell only on their feelings of inadequacy and shortcomings – hence the discrepancy which so often arises between the person's self-image and the perception held by others. How often the depressed person is told by friends and family, “You are a wonderful person, so talented and you achieve so much...,” yet the individual is unable to hear this, because (s)he is locked into thought patterns which exclude these external realities. Ironically, such well-intentioned comments often serve to increase, rather than reduce, feelings of alienation – and the person withdraws further into their private world of circular, self-denigrating thinking. Relaxation Relaxation plays an important part in yogic management of depression. It offers the possibility of respite from the incessant flow of negative thoughts. When wholly engaged in a systematic relaxation practice such as yoga nidra(8), the mind rests and is refreshed. The use of a carefully chosen sankalpa (personal resolution) during the practice will help the practitioner to grow in strength and self-esteem. Also, the decision to dedicate 30 minutes daily to this form of self-care is an important step in healing. It results in increased energy and reduced tiredness, and will probably be deemed enjoyable! Meditation Once the individual is practising hatha yoga to improve energy levels and achieve a better balance, then it becomes possible to begin looking at the causes of the depression, through the practice of meditation. (Sometimes depressed people want to learn meditation from the beginning, believing that it will solve their problems, but this is unlikely to be helpful because they are still too tamasic to practise meditation properly.) The meditation practice of antar mouna(9) has proved to be consistently helpful in understanding the causes of depression. In this practice, after the initial phases of body stillness and sense withdrawal, the practitioner observes the activities of the mind. This is different from 'thinking' because, within a quiet meditative state, one adopts the stance of witness...making no judgements about the thoughts which arise spontaneously in the mind, simply watching and familiarizing oneself with the mental content and processes. Later stages of the practice work with thoughts, fears and memories which cause distress to the practitioner, thus eventually disempowering them and liberating the energy which was being used to keep them outside conscious awareness. Thus the depression truly starts to lift, being eliminated from the root. Another meditative practice that is often beneficial in managing depression is trataka on a candle flame. The light of the flame stimulates the pineal gland. Understimulation of the pineal by light is now recognized in scientific circles as a significant contributor to seasonal affective disorder – SAD, or winter depression. Also, trataka develops willpower in the practitioner and this quality assists the depressed person in establishing regular practice, so necessary for recovery. Lifestyle There are many other considerations in helping people to overcome depressed states. Educating them in yogic diet is vital, since meat and eggs (especially) are very tamasic foods and therefore exacerbate depression. Sleep is a major topic – taking sufficient sleep, starting before midnight and rising early, may involve a real (and positive) change for some people. Self-awareness of how much sleep is needed is important; when people are depressed, they tend to sleep excessively, which compounds the problem. Lifestyle issues, such as the colours we wear and surround ourselves with; the vibrations of different types of music; our choice of television viewing; choice of the company we keep, are all major contributory factors in determining how we feel. Awareness of moon phases and menstrual cycles (especially the inter-relation between the two) can help people to realize that their mood swings are influenced by external forces. Careful diary keeping can help us to predict and accept cyclical mood variations and to organize our activities in order to optimize our sense of satisfaction and well-being. To summarize, the yogic approach to managing depression is to take the energetic view. By exploring and mastering the myriad ways in which it is possible to alter our energetic state, by understanding ways to manipulate our energies at will, we can reduce depressive states and gather the strength and willpower to embark on the next phase – that of examining and resolving the underlying causes of the depression. References (1) Saraswati, Swami Muktananda, 1983, Nawa Yogini Tantra, Bihar School of Yoga, Munger. (2) Saraswati, Swami Muktibodhananda, 1998, Hatha Yoga Pradipika, Bihar School of Yoga, Munger, p. 194. (3) Saraswati, Swami Satyananda, 1999, Asana Pranayama Mudra Bandha, revised edn, Bihar School of Yoga, Munger, pp. 477–480. See also Hatha Yoga Pradipika, pp.194–5. (4) Saraswati, Swami Satyananda, p. 476, pp 495–6. See also Hatha Yoga Pradipika, pp. 194–5. (5) Saraswati, Swami Satyananda, pp. 21–44. (6) Saraswati, Swami Niranjanananda, 1999, Prana Pranayama Prana Vidya, Bihar School of Yoga, Munger. (7) Saraswati, Swami Bodhananda, 1984, Moolabandha – the Master Key, Bihar School of Yoga, Munger. (8) Saraswati, Swami Satyananda, 1999, Yoga Nidra, 6th edn, Bihar School of Yoga, Munger. (9) Saraswati, Swami Satyananda, 1983, Meditations from the Tantras, Bihar School of Yoga, Munger, pp. 171–181.