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      Improvement in neurocognitive functions and serum brain-derived neurotrophic factor levels in patients with depression treated with antidepressants and yoga

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          Abstract

          Context and Aims:

          Impairment in cognition is well-known in patients with major depressive disorder. This study examined the effect of yoga therapy with or without antidepressants and antidepressants alone on certain neuropsychological functions in patients with depression. Correlation between changes in neuropsychological test performance and serum brain-derived neurotrophic factor (BDNF) levels was also explored.

          Materials and Methods:

          Antidepressant-naïve/antidepressant-free outpatients with depression received antidepressant medication alone ( n = 23) or yoga therapy with ( n = 26) or without ( n = 16) antidepressants. Depression was assessed using the Hamilton Depression Rating Scale. Neuropsychological tests included digit-span forward and backward, Rey Auditory Verbal Learning Test, and Trail Making Tests (TMT-A and B). These tests were administered before and 3 months after the treatment in patients, and once in healthy comparison subjects ( n = 19).

          Statistical Analysis:

          Baseline differences were analyzed using independent sample t-test, Chi-square, and one-way ANOVA. Paired t-test was used to analyze the change from baseline to follow-up. Pearson's correlation was used to explore the association of change between 2 variables.

          Results:

          Patients had impaired performance on most neuropsychological tests. After 3 months, there was significant improvement – patients’ performance was comparable to that of healthy controls on majority of the tests. Significant inverse correlation was observed between increase in BDNF levels and improvement in TMT “A” duration in Yoga-alone group ( r = −0.647; P = 0.009).

          Conclusions:

          To conclude that, Yoga therapy, alone or in combination with medications, is associated with improved neuropsychological functions and neuroplastic effects in patients with depression.

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          Most cited references30

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          The role of neurotrophic factors in adult hippocampal neurogenesis, antidepressant treatments and animal models of depressive-like behavior.

          Major depressive disorder (MDD) is characterized by structural and neurochemical changes in limbic structures, including the hippocampus, that regulate mood and cognitive functions. Hippocampal atrophy is observed in patients with depression and this effect is blocked or reversed by antidepressant treatments. Brain-derived neurotrophic factor and other neurotrophic/growth factors are decreased in postmortem hippocampal tissue from suicide victims, which suggests that altered trophic support could contribute to the pathophysiology of MDD. Preclinical studies demonstrate that exposure to stress leads to atrophy and cell loss in the hippocampus as well as decreased expression of neurotrophic/growth factors, and that antidepressant administration reverses or blocks the effects of stress. Accumulating evidence suggests that altered neurogenesis in the adult hippocampus mediates the action of antidepressants. Chronic antidepressant administration upregulates neurogenesis in the adult hippocampus and this cellular response is required for the effects of antidepressants in certain animal models of depression. Here, we review cellular (e.g. adult neurogenesis) and behavioral studies that support the neurotrophic/neurogenic hypothesis of depression and antidepressant action. Aberrant regulation of neuronal plasticity, including neurogenesis, in the hippocampus and other limbic nuclei may result in maladaptive changes in neural networks that underlie the pathophysiology of MDD.
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            Low brain-derived neurotrophic factor (BDNF) levels in serum of depressed patients probably results from lowered platelet BDNF release unrelated to platelet reactivity.

            Recent reports have suggested a role for brain-derived neurotrophic factor (BDNF) in psychiatric disorders. Decreased serum BDNF levels have been reported in major depression, but the cause of this decrease has not yet been investigated. The goal of this study was to assess blood BDNF and a platelet activation index, PF4. Forty-three drug-free patients (27 female, 16 male) diagnosed with major depression and 35 healthy control subjects (18 female, 17 male) were assessed for plasma, serum, and blood BDNF content. Brain-derived neurotrophic factor and PF4 were assayed with enzyme-linked immunosorbent assay methods, and severity of depression was evaluated with the Montgomery-Asberg Depression Rating Scale. Serum and plasma BDNF levels were decreased in depressed patients compared with control subjects. In whole blood, BDNF levels were unaltered in the depressed subjects compared with control subjects. The serum/blood BDNF ratio was lower in patients with major depression. Increased plasma but not serum PF4 levels were observed in depressed subjects compared with control subjects. Our results suggest that an alteration of serum or plasma BDNF is not due to the change in blood BDNF but rather is probably related to mechanisms of BDNF release. Secretion of BDNF seems to be independent of platelet reactivity; other mechanisms are therefore probably involved and need to be elucidated.
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              Yoga for depression: the research evidence.

              Yoga-based interventions may prove to be an attractive option for the treatment of depression. The aim of this study is to systematically review the research evidence on the effectiveness of yoga for this indication. Searches of the major biomedical databases including MEDLINE, EMBASE, ClNAHL, PsycINFO and the Cochrane Library were conducted. Specialist complementary and alternative medicine (CAM) and the IndMED databases were also searched and efforts made to identify unpublished and ongoing research. Searches were conducted between January and June 2004. Relevant research was categorised by study type and appraised. Clinical commentaries were obtained for studies reporting clinical outcomes. Five randomised controlled trials were located, each of which utilised different forms of yoga interventions and in which the severity of the condition ranged from mild to severe. All trials reported positive findings but methodological details such as method of randomisation, compliance and attrition rates were missing. No adverse effects were reported with the exception of fatigue and breathlessness in participants in one study. No language restrictions were imposed on the searches conducted but no searches of databases in languages other than English were included. Overall, the initial indications are of potentially beneficial effects of yoga interventions on depressive disorders. Variation in interventions, severity and reporting of trial methodology suggests that the findings must be interpreted with caution. Several of the interventions may not be feasible in those with reduced or impaired mobility. Nevertheless, further investigation of yoga as a therapeutic intervention is warranted.
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                Author and article information

                Journal
                Indian J Psychiatry
                Indian J Psychiatry
                IJPsy
                Indian Journal of Psychiatry
                Medknow Publications & Media Pvt Ltd (India )
                0019-5545
                1998-3794
                Jan-Mar 2018
                : 60
                : 1
                : 32-37
                Affiliations
                [1]Department of Health and Yoga, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India
                [1 ]Department of Psychiatry, NIMHANS Integrated Centre for Yoga, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
                [2 ]Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
                Author notes
                Address for correspondence: Dr. Jagadisha Thirthalli, Department of Psychiatry, NIMHANS Integrated Centre for Yoga, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. E-mail: jagath@ 123456yahoo.com
                Article
                IJPsy-60-32
                10.4103/psychiatry.IndianJPsychiatry_154_17
                5914260
                300c4a7c-191e-4046-95e6-caf2e40003bd
                Copyright: © 2018 Indian Journal of Psychiatry

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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                Categories
                Original Article

                Clinical Psychology & Psychiatry
                antidepressants,brain-derived neurotrophic factor,cognition,depression,rey auditory verbal learning test,yoga

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