Tai Chi Is a Biological Treatment for Depression

[[{"type":"media","view_mode":"media_crop","fid":"40389","attributes":{"alt":"© KUCO/shutterstock.com, Tai Chi, depression","class":"media-image media-image-right","id":"media_crop_6921050655268","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4132","media_crop_rotate":"0","media_crop_scale_h":"151","media_crop_scale_w":"150","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"© KUCO/shutterstock.com","typeof":"foaf:Image"}}]]“Mind-body medicine” is frequently used to describe the balancing effects between mind and body of nonpharmacological behavioral interventions applied to stress-related psychiatric disorders-including MDD. Recent studies find powerful biological changes associated with mind-body interventions comparable to those associated with conventional antidepressants or psychotherapies.

Helen Lavretsky, MD, of the UCLA Semel Institute for Neuroscience and Human Behavior is interested in the neurobiological mechanisms of mindful exercise, such as Tai Chi and yoga. She discussed her work at the recent 2015 APA symposium “Anti-inflammatory and Antidepressant Effects in Older Adults With Chronic Stress and Mood Disorders.” Lavretsky studies the effects of various interventions on depression or stress in older adults. She is a certified yoga instructor who uses the technique for clinical treatment of depression or caregiver stress. She is particularly interested in complementary and integrative treatments that use the power of a patient’s mind and intention to get well, includ- ing resilience-building interventions (eg, well-being therapy, learned optimism training, yoga and meditation).

Tai Chi Chih refers to a set of 20 movements, learned over 8 weeks, that are a form of “mindful exercise.” The beneficial effects of Tai Chi Chih include lowering blood pressure and weight. “Chi” refers to the intrinsic universal energy present in all individuals. Tai Chi Chih is derived from Tai Chi Chuan, a Chinese martial art used both for exercise and for health benefits.

Tai Chi Chih is an intervention that Lavretsky has studied in several different trials. In one investigation, she and her colleagues examined Tai Chi Chih to augment the antidepressant escitalopram in 112 individuals with major depression, aged 60 or older.¹ Following 6 weeks of treatment with 10 mg of escitalopram, 73 partial responders were randomized to an additional 10 weeks of either Tai Chi Chih or health education, both for 2 hours per week. Lavretsky and her team performed evaluations for depression, anxiety, resilience, health-related quality of life, cognition, and inflammation at the start of the study and 16 weeks later.

Participants in the Tai Chi Chih group were more likely to have reductions in depression symptoms and to experience depression remission. They also had greater improvement of physical functioning, and they performed better on cognitive tests. Moreover, those in the Tai Chi Chih group had greater declines in levels of C-reactive protein (CRP) than those in the control group. The study showed both behavioral and biological benefits of augmenting an antidepressant with Tai Chi Chih.

According to Lavretsky, the downside of Tai Chi is that because it is a physical exercise, it is “not easy for everybody.” However, for those patients who are willing to put in the time and effort, it seems to be a beneficial add-on to depression treatment.

Another study focused on the effects of yogic meditation when performed by the caregivers of those with dementia.² Caregiving for a person with a chronic illness, and in particular dementia, often results in excessive stress and potentially, depression. Thirty-nine caregivers with mild symptoms of depression participated in the study. The study subjects, with an average age of 60, were divided into 2 groups: one group practiced a form of meditation known as Kirtan Kriya, the other group listened to relaxing music-for 12 minutes a day for 8 weeks. The researchers measured depressive symptoms as well as mental and cognitive function at the beginning and end of the study.

The group that practiced meditation had significantly lower levels of depressive symptoms and greater improvement in mental health and cognitive functioning than the group that listened to relaxing music.

What was particularly interesting was that the meditation group showed 43% improvement in telomerase activity versus only 3.7% improvement in the group that listened to relaxing music. This is particularly tantalizing information for those interested in successful aging and life prolongation-suggesting that a lifestyle intervention can change telomere length and perhaps reduce the impact of stress on biological aging. In her 2015 APA presentation, Lavretsky noted that these are “very promising results for future studies of medita-tion versus drugs versus behavioral interventions.”

Michael Irwin, MD, of the UCLA Cousins Center for Psychoneuroimmunology spoke at the 2015 APA symposium “Sleep Disturbance and Inflammation Reciprocally Contribute to Depression: Implications for the Treatment and Prevention of Depression in Older Adults.” He discussed his research on sleep, depression, and inflammation. Through his work, Irwin has found that “sleep disturbance is an early prodromal symptom of depression.” Sleep problems are associated with inflammatory responses in depression, including higher CRP levels and high levels of the cytokine interleukin-6. In fact, according to Irwin, sleep disturbances drive inflammation in depression. In addition, Irwin noted that “sleep disturbance is a robust predictor of depression recurrence.”

Like Lavretsky, Irwin is also interested in the possible benefits of Tai Chi. Along with Lavretsky and other researchers, Irwin³ conducted a study that compared cognitive- behavioral therapy (CBT) with Tai Chi for insomnia and inflammation in the elderly. In this study, he included a control group that attended an educational sleep seminar. A total of 123 adults, aged 55 to 85, participated; 112 completed the initial trial (4 months) and 108 completed the follow-up to the study (16 months).

Of all the interventions, CBT was the most effective for insomnia and for improving sleep quality, fatigue, and depressive symptoms. Participants who received CBT had lower levels of CRP at the 16-month follow-up. Tai Chi was more effective than the sleep seminar for improving sleep quality, fatigue, and depressive symptoms, but not insomnia. CBT was best for depressive symptoms and sleep problems, although Tai Chi was more effective than the sleep seminar. The effect of CBT on reducing CRP levels again shows that a behavioral intervention can have potent positive effects on biology.

What is perhaps most interesting about this research is its application to current ideas about depression and its link to inflammation across the life span, especially in aging adults. As Irwin noted in his presentation, the research provides evidence for the idea that “targeting with a behavioral treatment can reduce inflammation” possibly providing a biological explanation for the effects of interventions such as Tai Chi and meditation on alleviating symptoms of depression.

References:

1. Lavretsky H, Alstein LL, Olmstead RE, et al. Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial. Am J Geriatr Psychiatry. 2011; 19:839-850.

2. Lavretsky H, Epel ES, Siddarth P, et al. A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity. Int J Geriatr Psychiatry. 2013;28:57-65.

3. Irwin MR, Olmstead R, Carrillo C, et al. Cognitive behavioral therapy vs Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial. Sleep. 2014;37:1543-1552.