The Treatment of Depression with Yoga and Walking

描述(由申请人提供)：严重抑郁障碍(MDD)影响多达17%的人口，并且在多达40%的个人中没有得到有效的治疗。有证据表明，负面情绪与副交感神经系统(PNS)活动减少有关，这是通过迷走神经张力来衡量的。瑜伽练习和迷走神经刺激(VNS)都可以通过增加迷走神经张力来增加三叉神经节的活性。瑜伽疗法和迷走神经刺激都被证明可以改善抑郁症和癫痫的症状。核磁共振波谱(MRS)显示，在MDD和癫痫患者中，大脑中的γ-氨基丁酸(GABA)水平较低，当同样的受试者接受药物治疗时，GABA水平升高，症状减轻。利用MRS，我们的团队已经证明，在60分钟的瑜伽训练后，丘脑的GABA水平会上升，而且GABA水平的增加与情绪的改善有关。我们的假设是，三叉神经节和GABA系统的低活动与抑郁症状有关，瑜伽干预将刺激三叉神经节传入脑干核团，从而观察到相关的GABA水平增加和抑郁症状减少。目的：1.测量和比较MDD和非抑郁健康受试者(ND)丘脑、脑岛和海马/杏仁核复合体三个解剖结构的GABA水平。2：对MDD受试者进行四次MRS扫描：基线(扫描1)；在12周的瑜伽或步行干预后(扫描2)；在扫描2之后，受试者将立即完成60分钟的干预(瑜伽或步行)；然后是扫描3，扫描2和2天后再次进行(扫描4)。3：在研究过程中，使用心理工具测量情绪的变化，并使用呼吸性窦性心律失常(RSA)测量三叉神经节的活动。假设：在所有感兴趣区(即丘脑、脑岛和海马/杏仁核复合体)中，MDD组的基线GABA水平将低于ND组。IIa和IIb：在被分配到瑜伽组的MDD受试者中，紧张性GABA水平将在组内发生变化(扫描2-扫描1)。当比较MDD瑜伽组和MDD步行组时，组间的补充性GABA水平会有差异。IIIA和IIIB：MDD瑜伽组的急性GABA水平将在组内发生变化(扫描3-扫描2)。当比较MDD瑜伽组和MDD步行组时，组内急性GABA水平会有差异。IV：恢复期GABA水平不会有变化(扫描4-扫描2)。V&VI：在扫描时获得的GABA水平、情绪评分和RSA将是相关的，因此GABA水平的增加与情绪的改善、抑郁的减少和焦虑的减少相关。在干预过程中，瑜伽组的情绪会比步行组有更大的改善。 与公共健康相关：这项研究将探索瑜伽和步行治疗轻中度抑郁症的方法。在为期12周的治疗中，两种干预措施都将测量与干预相关的神经化学、自主神经系统功能和情绪状态的变化。

DESCRIPTION (provided by applicant): Major Depressive Disorder (MDD) affects up to 17% of the population and is not treated effectively in up to 40% of individuals. There is evidence tha negative emotions are related to decreased activity in the parasympathetic nervous system (PNS) as measured by vagal tone. Both yoga practices and vagal nerve stimulation (VNS) can increase PNS activity by increasing vagal tone. Both yoga treatments and VNS have been shown to improve symptoms in depression and epilepsy. Using magnetic resonance spectroscopy (MRS), brain gamma-aminobutryic acid (GABA) levels have been shown to be low in subjects with MDD and epilepsy, and when the same subjects are treated with pharmacologic agents, GABA levels increase and symptoms decrease. Using MRS, our group has shown that thalamic GABA levels rise after a 60-minute yoga session and that increases in GABA levels are associated with improved mood. Our hypothesis is that low activity in the PNS and GABA systems is associated with depressive symptoms, and that a yoga intervention will stimulate the PNS afferents to brain stem nuclei, such that associated increases in GABA levels and decreased depressive symptoms will be observed. Aims: 1: To measure and compare baseline GABA levels in MDD and non-depressed healthy subjects (ND) in three anatomic structures, the thalamus, insula and hippocampal/amygdala complex. 2: To obtain four MRS scans in MDD subjects: Baseline (Scan 1); After 12- week yoga or walking interventions (Scan 2); Immediately after Scan 2, subjects will complete a 60-minute intervention (yoga or walking); Followed by Scan 3, and again two days after Scans 2 & 3 (Scan 4). 3: To measure changes in mood using psychological instruments and PNS activity using respiratory sinus arrhythmia (RSA) over the course of the study. Hypotheses: I: Baseline GABA levels will be lower in the MDD group compared to the ND group in all ROIs (i.e., thalamus, insula and hippocampal/amygdala complex). IIa & IIb: There will be a within-group change in tonic GABA levels (Scan 2-Scan 1) in the MDD subjects assigned to the yoga group. There will be a between-group difference in tonic GABA levels when comparing the MDD yoga group with the MDD walking group. IIIa & IIIb: There will be a within-group change in acute GABA levels (Scan 3-Scan 2) in the MDD yoga group. There will be a between-group difference in acute GABA levels when comparing the MDD yoga group with the MDD walking group. IV: There will be no change in recovery GABA levels (Scan 4 - Scan 2). V & VI: GABA levels, mood scales and RSA obtained at the time of scanning will be correlated, such that increasing GABA levels are associated with improved mood, decreased depression and decreased anxiety. VII: There will be a greater improvement in mood over the course of the interventions in the yoga group compared to the walking group. PUBLIC HEALTH RELEVANCE: This study will explore the use of yoga and walking to treat mild to moderate depression. Changes in neurochemistry, autonomic nervous system function and mood states associated with the interventions will be measured in both interventions over a 12-week treatment.