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Antidepressent efficacy and hormonal effects of Sudhashrna Kriya Yoga (SKY) in alcohol dependent individuals.

Brief report
Antidepressant efficacy and hormonal effects of Sudarshana Kriya
Yoga (SKY) in alcohol dependent individuals
A. Vedamurthachar, Nimmagadda Janakiramaiah, Jayaram M. Hegde, Taranath K. Shetty,
D.K. Subbakrishna, S.V. Sureshbabu, B.N. Gangadhar
National Institute of Mental Health and Neurosciences, Bangalore, India
Received 24 November 2005; received in revised form 5 April 2006; accepted 7 April 2006
Available online 5 June 2006
Background: Sudarshana Kriya Yoga (SKY) has demonstrable antidepressant effects. SKY was tested for this effect in inpatients of
alcohol dependence.
Methods: Following a week of detoxification management consenting subjects (n = 60) were equally randomized to receive SKY
therapy or not (controls) for a two-week study. SKY therapy included alternate day practice of specified breathing exercise under
supervision of a trained therapist. Subjects completed the Beck Depression Inventory (BDI) before and after the two weeks of this
intervention. Morning plasma cortisol, ACTH and prolactin too were measured before and at the end of two weeks.
Results: In both groups reductions in BDI scores occurred but significantly more so in SKY group. Likewise, in both groups
plasma cortisol as well as ACTH fell after two weeks but significantly more so in SKY group. Reduction in BDI scores correlated
with that in cortisol in SKY but not in control group.
Limitations: Antidepressant effects of SKY were demonstrated in early abstinence that also had substantial spontaneous
improvement. It is not known if this effect contributes to sustained abstinence.
Conclusion: Results extend the antidepressant effects of SKY in alcohol dependence subjects. Reduction in stress-hormone levels
(cortisol and ACTH) along with BDI reductions possibly support a biological mechanism of SKY in producing beneficial effects.
© 2006 Elsevier B.V. All rights reserved.
Keywords: Alcohol dependence; Depression; Yoga
1. Introduction
Treatments aiming at reducing craving or achieving
abstinence in alcohol dependent individuals have met with
varied, yet limited success. Relapse rates are close to 50%
(Boothby and Doering, 2005). Depression is the com-
monest comorbid condition in these individuals (Manwell
et al., 2004; Hasin et al., 2005). Symptoms of depression
often manifest in acute withdrawal. Such mood symptoms
may well persist even after the acute phase of withdrawal
potentially making way for relapse (Trevisan et al., 1998).
Accordingly, there is evidence for successful use of an
antidepressant in detoxification phase itself (Hasin et al.,
2002; Liappas et al., 2005). Sudarshana Kriya Yoga
(SKY), a breathing therapy developed by the Spiritual
Guru Sri Sri Ravishankar (1994) of the Art-of-Living
Foundation, demonstrated significant antidepressant
effects (Janakiramaiah et al., 1998, 2000).
Hormonal changes occur with clinical affective states.
Depression is associated with stress and as a result
elevated levels of cortisol and ACTH (Kiive et al., 2004,
Journal of Affective Disorders 94 (2006) 249 253
Corresponding author.
E-mail address: (B.N. Gangadhar).
0165-0327/$ - see front matter © 2006 Elsevier B.V. All rights reserved.
Wetterling and Junghans, 2000). Stress associated with
alcohol withdrawal and/or the coexisting depression is
known to activate brain corticotrophin-releasing factor
(CRF) systems (Bruijnzeel et al., 2004). CRF is released
during alcohol withdrawal and stress in central nucleus
of amygdala (Merlo Pich et al., 1995). Activation of CRF
neurotransmission is suggested to bring about adaptive
changes leading to drug/alcohol seeking behaviour
(Koob, 1999). SKY has also showed significant neuro-
endocrinological effects in patients with depression.
SKY produced prolactin elevation acutely and after two
weeks of practice lowered serum corti sol responses to
SKY (Janakiramaiah et al., 1998; Sudarshan, 1999). The
latter effect may reflect antidepressant as well as anti-
stress effects of SKY. We tested therefore, the effects of
SKY therapy on mood symptoms and hormone levels in
patients with alcohol dependence immediately foll owing
acute detoxification period.
2. Methods
2.1. Subjects
Sixty consecutive male subjects (age 1855 years)
with alcohol dependence syndrome (DSM-IV) formed the
sample. All individuals were admitted for the first time in
the de-addiction center of National Institute of Mental
Health and Neurosciences (NIMHANS), Bangalore, for
detoxification and signed an informed consent statement.
Those, having severe physical illness like cardiac illness,
hypertension, uncontrolled diabetes, epilepsy, respiratory
disease, neurological illness, head injury or organic mental
illness, high suicidal risk, dependence on any drug other
than tobacco and alcohol were excluded from the study.
So also were those with history of mania and schizophre-
nia and mental retardation. Each subject underwent a
detailed medical and psychiatric assessment including the
measurement of severity of alcohol dependence (Stock-
well et al., 1983) by a team of qualified psychiatrists.
2.2. Detoxification
Standard detoxification program that included only
benzodiazepines and B-complex was initiated from the
day of admission and completed by day-7. Subjects were
then randomly assigned to one of two groups for a two-
week study: (a) SKY therapy (b) continued inpatient care
only; to be referred to as SKY and Control groups
respectively. Only for treating sleep symptoms, the
treating physician uninvolved in this study, used
benzodiazepines. Before the intervention, the two groups
were comparable on the parameters given in Table 1.
2.3. SKY therapy
The Sudarshana Kriya Yoga (SKY) is a specific
breathing technique (Pranayama) (Su=proper, Darsha-
na=vision, Kriya=purifying action) based on ancient
Vedic tradition (Sri Sri Ravishankar, 1994). SKY sessions
were held in the mornings one hour or later after breakfast.
The SKY consisted of three distinctive breathing periods
(Pranayama): 1. Ujjayi pranayama: Consists of slow deep
breathing. Each cycle includes breathing in, holding,
breathing out and holding. 2. Bhastrika pranayama con-
sists of forced inhalation and exhalation 20 times. Ujjayi
and Bhastrika pranayama requires about 1215 min.
3. Cyclical breathing consists of slow, medium, and fast
cycles of breathing practiced for a total duration of 30 min.
These three procedures are done in sitting posture
Table 1
Socialdemographic and illness characteristics: comparison between
SKY and Control subjects
Variable Group Significance
(n = 30)
(n = 30)
Age (yr) 35.60
t = 0.99; pN 0.05
Married* 25 23 χ
= 0.30; p N 0.05
Employed* 25 21 χ
= 1.99; p N 0.05
Urban:rural* 16:14 18:12 χ
= 0.47; p N 0.05
Alcohol expense
t = 0.47; pN 0.05
duration (yr)
t = 0.34; pN 0.05
score 33.20
t = 0.98; pN 0.05
BDI-pre 39.7
= 10.28, p b 0.001;
= 1654.33, p b 0.001;
= 25.4, p b 0.001BDI-post 9.6
Cortisol-pre 8.3
= 6.89, p b 0.001;
=47.6, p b 0.001;
= 7.24, p b 0.001Cortisol-post 3.6
ACTH-pre 284.0
= 4.64, p b 0.001;
= 120.8, p b 0.001;
= 23.9, p b 0.001ACTH-post 191.5
Prolactin-pre 5.7
= 3.13, p N 0.05;
= 143.67, p b 0.001;
= 34.2, p b 0.001Prolactin-post 12.2
Cortisol (μg/dl), ACTH (pg/ml) and prolactin (ng/ml).
Cell contents refer to Mean (SD) except *numbers.
F1 group effect, df = 1, 58; F
occasion effect, df = 1, 58; and
interaction, df = 1, 58.
Severity of Alcohol Dependence Questionnaire (Stockwell et al.,
250 A. Vedamurthachar et al. / Journal of Affective Disorders 94 (2006) 249253
(Sukhasana) with eyes closed. This was followed by Yoga
Nidra (lying in a tranquil state) for about 20 min
(Janakiramaiah et al., 1998, 2000).
2.4. Sample collection and test procedure
Five ml of venous blood was collected in heparinized
syringe at 9 AM on day-7 (pre) and day-21 (post). The
(fasting) samples were collected before the treatment
session on both days. The sample was immediately cen-
trifuged to separate plasma. The plasma samples were
coded and stored at 70 °C for hormonal assays. Plasma
prolactin and cortisol were assayed using commercially
available kits (Abbot Diagnostics). ACTH levels were
measured using Radio Immuno Assay (RIA) kits (DSL-
USA). The lab person nel were unaware of the clinical
details. All subjects completed the Beck's Depression
Inventory (BDI) (Beck et al., 1961) at the end of first
week after admission (pre, day-7) and two weeks later
(post, day-21).
2.5. Statistical analysis
The socio-demographic profile and clinical charac-
teristics were analyzed using univariate statistical
methods. The pre-treatment values at day-7 (pre) were
compared in both groups using independent samples
t test. The post treatment values and the change over
two assessments at day-21 (post) of the both groups were
compared using Repeated Measures ANOVA. At day-7
SKY and control groups did not differ on BDI scores or
on the any hormone levels (Table 1). Percentage changes
in BDI scores between pre- and post assessments as well
as similar change in ACTH and Cortisol levels were
computed. These were subjected to angular transforma-
tion and Pearson's correlation was computed between
the BDI score and the horm one levels. The value of
statistical significance level was fixed at 0.05.
3. Results
BDI scores significantly dropped at post-assessment
and the drop was more in the SKY group. Drop also
occurred in the plasma cortisol as well as ACTH levels
differentially; being more in SKY group. Cortisol values
dropped in all SKY individuals and in only 22 of the
controls (χ
= 9.2, df =1; p = 0.005). In the total sample
the percent drop in BDI correlated positively with that of
ACTH (r = 0.53, p b 0.001) an also that of cortisol
(r = 0.52, p b 0.001). Percentage drop in ACTH and
cortisol too were correlated (r = 0.35, p = 0.14). When
examined separately the correlation between percentage
drop in BDI and that in cortisol was significant (r = 0.52,
p = 0.003) for the SKY group only. Prolactin values
increased (though nonsignificantly) in the total sample
with SKY individuals having higher increase. These
results are presented in Table 1 and Fig.1. No individual
developed seizure either in SKY or control group in the
two-week treatment period.
4. Discussion
In this study the effect of SKY in reducing the depres-
sive symptoms in alcohol dependent subjects in early
abstinence was tested. Depression scores as well as
ACTH and cortisol levels dropped in the two weeks of the
study with or without SKY though, the drop was more so
in the SKY group. Reduction in depression scores cor-
related with the reduction in plasma cortisol levels in the
SKY group but not in the control group.
These findings extend the antidepressant efficacy of
SKY reported earlier (Janakiramaiah et al., 1998, 2000;
Rohini et al., 2000). Adding SKY in the early period of
detoxification management was not associated with
additional risk of seizures. Liappas et al. (2005) suggest
the advantages of adding an antidepres sant during this
period to reduce depressive symptoms. This study sug-
gests that SKY can be a potential yet safe antidepressant
therapy. Depression s cores continued to fall af ter
detoxification in the tw o weeks of study that may reflect
benefits of abstinence and further relief from withdrawal
state. It is arguable that SKYonly augmented this benefit.
Benefits of SKY as antidepressant treatmen t should
therefore be tested after longer abstinence in selected
patients continuing to manifest clinical depression.
Fig. 1. Relation between BDI score and plasma Cortisol reductions
over two weeks.
SKY (n =30); Control (n = 22): plasma cortisol
levels rose in eight controls (not represented in the illustration); in all
these individuals the BDI score reduction was less than 70%.
251A. Vedamurthachar et al. / Journal of Affective Disorders 94 (2006) 249253
In our earlier studies we found elevations in prolactin,
but not cortisol, acutely following SKY session but not a
sham-SKY session (Janakiramaiah et al., 1998). In this
study we measured resting values of these hormones
before starting SKY and two weeks after the daily-
treatment sessions. Accordingly, the hormone changes
observed cannot be compared across studies. Prolactin
levels although changed, did not significantly differ
between groups. If the blood samples had been collected
shortly after the last session, effects SKY on prolactin
elevation could have been confirmed. On the other hand,
ACTH and cortisol levels were reduced after the two
weeks of intervention in SKY group. Acute stress of
physical exercise is associated with elevation in cortisol but
this returns to baseline at 90 min post-exercise (Kiive et al.,
2004). Therefore, the cortisol and ACTH changes noted in
this study cannot be attributed to acute stress of the SKY.
Instead, it can be argued that SKY has lowered the stress
and hence ACTH and cortisol levels thereof. The change in
the two hormone levels was correlated and hence this may
suggest a common mechanism. Reduction in BDI scores
too correlated with the reduction in these hormone levels.
This was significant for the SKY group and not so for the
control. This further supports a more specific anti-stress
effect of SKY that brought down depression scores as well
as the two hormone levels. Changes in hormone levels
provide a more objective evidence of beneficial effects of
SKY. Brown and Gerbarg (2005) suggest that vagal nerve
stimulation would occur with SKY and this brings out the
mental and hormonal effects.
One of the limitations in this study was absence of a
control treatment procedure. The SKY subjects were
exposed to additional time of a professional (the yoga
therapist). Did this contribute to placebo effects in low-
ering the depression scores? In an earlier study (Janakir-
amaiah et al., 2000), the antidepressant effects of SKY
compared with imipramine and in patients with diagnosis
of melancholia, a condition less likely to respond to
placebo effect (Nelson et al., 1990). The placebo effect is
also less likely to produce a change in hormone levels.
The reductions in depression and cortisol too were
correlated. Although the placebo effect cannot be totally
excluded, the findings of this study suggest that such is
less likely. There is also an inherent difficulty in designing
a control treatment for a procedure such as SKY. Is it the
therapist's contact, some rhythms of breathing, physical
exertion or even participating in a group exercise? It re-
mains to be seen if SKY therapy in the early detoxification
stage confers extended benefit in maintaining abstinence/
control over alcohol consumption for longer periods.
There is indirect support from earlier studies that continued
SKYpractice extends antidepressant effects. It is likely that
continued SKY practice, by its antidepressant effects, also
improves abstinence in patients with alcohol dependence.
5. Conclusion
In this randomised controlled trial, SKY demonstrated
significant antidepressant effects when offered to alcohol
dependent subjects after the acute phase of detoxification.
The findings support the view that SKY may lower plasma
levels of ACTH and cortisol. The antidepressant effects
correlated with lowering of serum cortisol. Whether SKY
practice facilitates extended control over alcohol con-
sumption is a promising area for research.
The author is thankful to Director , NIMHANS for
encouragement and Financial support. The author is also
thankful to Sri Sri Ravishankarji, Founder , the Art of Living
International Foundation, Bangalore, for his support.
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... It also effectively improved abstinent rate and attenuated withdrawal and anxiety symptoms in individuals with substance use disorders in general (Wang, Wang, Wang, Li, & Zhou, 2014). In particular, yoga efficiently facilitated the treatment of AUD and showed beneficial effects on recovery (Raina, Chakraborty, & Basist, 2001), depression levels (Vedamurthachar et al., 2006), enhanced quality of life (Sareen, 2007) and reduced, but not statistically significant alcohol consumption (Hallgren, Romberg, Bakshi, & Andr easson, 2014). ...
Problem Exercise programs may increase abstinence rate in patients with alcohol use disorder (AUD). However, adherence to exercise programs is influenced by acute affective responses during the activity and preferences regarding the type of exercise. Thus, the aim of the present study was to assess the effects of two different exercise types on affective responses, cravings and heart rate variability (HRV). Method Sixteen inpatients with diagnosed AUD were recruited during regular withdrawal treatment and took part in a randomized cross-over trial. Fifteen participants completed three 60-min interventions: a Nordic-walking condition (NW), a Yoga-Gymnastics condition (YG) and a passive control condition (PC). Affective responses, cravings and HRV were assessed before, during, immediately after, as well as 10 and 180 min after each intervention. Results Repeated measures ANOVAs revealed a significantly higher increase in perceived activation during NW vs. PC (partial eta² = 0.34) as well as during YG vs. PC (partial eta² = 0.33). Affective valence significantly increased during NW vs. YG (partial eta² = 0.34). For cravings and HRV, no significant differences between treatment conditions were found. Conclusions Results demonstrated that an acute exercise bout improved affective responses in inpatients with alcohol use disorder and indicated preferences towards NW compared to YG regarding affective valence during exercise. However, there were no differences after the interventions. Related to results of current literature, exercise bouts may provide some short-term motivation for abstinence in therapeutic settings and help preventing alcohol relapse through establishing alternative behavioural patterns.
... Therefore, we investigated the impact of a breathing-based meditation, Sudarshan Kriya yoga, in Afghanistan or Iraq veterans with PTSD symptoms. We selected Sudarshan Kriya yoga because it has effectively reduced PTSD symptoms in tsunami survivors ( Descilo et al., 2009), increased self-reported optimism and well-being in college students (Kjellgren, Bood, Axelsson, Norlander, & Saatcioglu, 2007), decreased selfreported anxiety in those with general anxiety disorder ( Katzman et al., 2012), and decreased self-reported depression in those with melancholic depression ( Janakiramaiah et al., 2000) as well as in alcohol-dependent inpatients (Vedamurthachar et al., 2006). Studies have shown that it improves emotion regulation in yoga practitioners (Gootjes, Franken, & Van Strien, 2011), reduces impulsive behavior in adolescents (Ghahremani, Oh, Dean, Mouzakis, Wilson, & London, 2013), curbs tobacco consumption and improves immune function in cancer patients ( Kochupillai et al., 2005), lowers blood lactate and increases antioxidant levels in Sudarshan Kriya practitioners ( Sharma et al., 2003), and increases rapid gene expression in a non-clinical population (Qu, Olafs- rud, Meza-Zepeda, & Saatcioglu, 2013). ...
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Given the limited success of conventional treatments for veterans with posttraumatic stress disorder (PTSD), investigations of alternative approaches are warranted. We examined the effects of a breathing-based meditation intervention, Sudarshan Kriya yoga, on PTSD outcome variables in U. S. male veterans of the Iraq or Afghanistan war. We randomly assigned 21 veterans to an active (n = 11) or waitlist control (n = 10) group. Laboratory measures of eye-blink startle and respiration rate were obtained before and after the intervention, as were self-report symptom measures; the latter were also obtained 1 month and 1 year later. The active group showed reductions in PTSD scores, d = 1.16, 95% CI [0.20, 2.04], anxiety symptoms, and respiration rate, but the control group did not. Reductions in startle correlated with reductions in hyperarousal symptoms immediately postintervention (r = .93, p < .001) and at 1-year follow-up (r = .77, p = .025). This longitudinal intervention study suggests there may be clinical utility for Sudarshan Kriya yoga for PTSD.
Aim This article proposes a review of effect of exercise on psychosocial factors in patients with chronic disease within a transversal analysis and evidence-based medicine/psychology approach. Actuality Instead heterogeneity of methodologies and programs, four categories of effects linked to health may be distinguished, global subjective perceptions, psychological resources, behavioral indicators and social indices. The results show several benefits with periodic, dosed and individualized practice. Studies note an improvement of mental health, a decrease of side effect of treatments, a contribution for acceptance, an improvement of self-management, and a decrease of unscheduled care. Adverse effects are rare. Perspectives Further studies need to be conducted to better determine biopsychological pathways, cognitive function impacts and survey to increase level of evidence. Interventional studies are needed. Conclusion Evidence increases about the benefits of periodic, dosed and individualized practice of exercise on psychosocial factors linked to health in patients with chronic disease during treatments and after.
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The effects of major depressive disorder (MDD) on the course of substance dependence may differ depending on the temporal relationship of depression to dependence. We investigated the effects of MDD on the outcome of substance dependence under 3 circumstances: (1) lifetime onset of MDD prior to lifetime onset of dependence onset, (2) current MDD occurring during a period of abstinence, and (3) current MDD during substance use that exceeded the expected effects of intoxication or withdrawal. A sample of 250 inpatients with DSM-IV cocaine, heroin, and/or alcohol dependence were followed up at 6, 12, and 18 months. The Psychiatric Research Interview for Substance and Mental Disorders (PRISM) was used to make DSM-IV diagnoses. Using Cox proportional hazards models, stable remissions (those lasting at least 26 weeks) from DSM-IV cocaine, heroin, and/or alcohol dependence and from use were studied, as well as subsequent relapses of dependence and use. Patients with current substance-induced MDD were less likely to remit from dependence (adjusted hazards ratio, 0.11) than patients with no baseline MDD. A history of MDD prior to lifetime onset of substance dependence also reduced the likelihood of remission relative to the absence of such a history (adjusted hazard ratio, 0.49). Major depressive disorder during sustained abstinence predicted dependence relapse (adjusted hazards ratio, 3.07) and substance use after hospital discharge compared with those without abstinence MDD (adjusted hazards ratio, 1.45). The timing of depressive episodes relative to substance dependence served as an important factor in the remission and relapse of substance dependence and substance use.
The limitations of current methods of treatment for dysthymic disorder justify experimentation with new alternatives. Techniques of yoga hold promise. A brief package; Sudarshan Kriya exerts demonstrable effects on brain functioning and may have effects akin to ECT in depression. Sudarshan Kriya Yoga (SKY) was used to treat 46 hospital out-patients (22 males) of dysthymic disorder. Over 3 months, they had to practice it everyday for half-an hour and avoid any medication. They were assessed initially, at one and 3 months on interviews video-rated and self-report scales. In a subsample of mates (n=12), plasma prolactin and cortisol levels were obtained before and after the first full SKY session. 37 patients completed the treatment through three months and 25 (68%) of them remitted. A higher proportion of those practising SKY regularly remitted. Significant elevation of plasma prolactin, but not cortisol occurred after the first SKY session. SKY has demonstrable biological effects and is therapeutic in dysthymic disorder.
The clinical value of assessing degree of alcohol dependence is discussed in relation to goals of treatment. Further information is then provided on the use, reliability and validity of an instrument designed for this purpose -the SADQ. ‘Norms’ for SADQ scores from three samples of problem drinkers are given. Data indicating that individual items, sections and also the total scores of the SADQ have consistently high test-retest reliability coefficients are presented. A study is described in which a degree of construct validity is established by relating SADQ scores to one important component of the alcohol dependence syndrome [2]-narrowing of drinking repertoire. In addition, it is shown that SADQ scores have low, but significant, correlations with indicators of withdrawal severity for individuals treated at a Detoxification Unit. SADQ scores failed to correlate with indices of liver functioning. These results are discussed and it is concluded the SADQ is a quick, reliable and valid instrument.
We examined the value of the melancholic distinction for predicting response to 1 week of hospitalization without antidepressant drugs and to a 4-week fixed plasma level desipramine (DMI) trial in patients with unipolar non-psychotic major depression. Both DSM-III and III-R criteria were tested. Response to hospitalization (HDRS less than or equal to 12) was much less common in DSM-III melancholic than in non-melancholic patients (1 of 19 vs. 18 of 37, chi 2 = 8.69, df = 1, P less than 0.001) and severity did not account for this association. DSM-III-R melancholia criteria were also associated with poor hospital response but slightly less predictive. Melancholic patients, however, diagnosed with either set of criteria, were not more likely to respond to drug treatment on any of the measures examined.
The clinical value of assessing degree of alcohol dependence is discussed in relation to goals of treatment. Further information is then provided on the use, reliability and validity of an instrument designed for this purpose - the SADQ. 'Norms' for SADQ scores from three samples of problem drinkers are given. Data indicating that individual items, sections and also the total scores of the SADQ have consistently high test-retest reliability coefficients are presented. A study is described in which a degree of construct validity is established by relating SADQ scores to one important component of the alcohol dependence syndrome [2] - narrowing of drinking repertoire. In addition, it is shown that SADQ scores have low, but significant, correlations with indicators of withdrawal severity for individuals treated at a Detoxification Unit. SADQ scores failed to correlate with indices of liver functioning. These results are discussed and it is concluded the SADQ is a quick, reliable and valid instrument.
The neuropeptide corticotropin-releasing factor (CRE) and related neuropeptides not only mediate hormonal responses to stressors but also have a neurotropic role in the central nervous system to mediate behavioral responses to stressors. CRF antagonists effectively block CRF responses and have effects opposite those of CRF in many stress-related situations. Recent advances suggest that in addition to CRF itself there is another CRF-related neuropeptide, urocortin, that may be involved in stress-related responses, particularly those involving appetite. At least two CRF receptors have been discovered to date, CRF-1 and CRF-2. CRF may be involved in various aspects of the addiction cycle associated with drugs of abuse. CRF appears to be activated during stress-induced reinstatement of drug taking as well as acute withdrawal from all major drugs of abuse. CRF is hypothesized to be part of an allostatic change leading to vulnerability to relapse during prolonged abstinence from drugs of abuse.
Sudarshan Kriya Yoga (SKY) is a procedure that involves essentially rhythmic hyperventilation at different rates of breathing. The antidepressant efficacy of SKY was demonstrated in dysthymia in a prospective, open clinical trial. This study compared the relative antidepressant efficacy of SKY in melancholia with two of the current standard treatments, electroconvulsive therapy (ECT) and imipramine (IMN). Consenting, untreated melancholic depressives (n=45) were hospitalized and randomized equally into three treatment groups. They were assessed at recruitment and weekly thereafter for four weeks. Significant reductions in the total scores on Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HRSD) occurred on successive occasions in all three groups. The groups, however, did not differ. Significant interaction between the groups and occasion of assessment occurred. At week three, the SKY group had higher scores than the ECT group but was not different from the IMN group. Remission (total HRSD score of seven or less) rates at the end of the trial were 93, 73 and 67% in the ECT, IMN and SKY groups, respectively. No clinically significant side effects were observed. Within the limitations of the design (lack of double blind conditions), it can be concluded that, although inferior to ECT, SKY can be a potential alternative to drugs in melancholia as a first line treatment.
Epidemiologic surveys show a high lifetime co-morbidity with psychiatric disorders (e.g., depression and anxiety) in alcoholics. However, alcoholics frequently complained about psychopathologic symptoms, particularly during alcohol withdrawal. There is some evidence that symptomatology decreases spontaneously with prolonged abstinence. Thus, the question arises whether high levels of psychopathology could be accounted for by withdrawal effects. This study was aimed at examining the impact of the alcohol withdrawal severity (assessed by the AWS scale) on psychopathologic symptoms. The psychopathologic profile of 110 alcoholics as measured by the Symptom Checklist-90 revised (SCL-90-R) was compared to that of 253 patients with adjustment, anxiety or depressive disorders (according to ICD-10 criteria). No relationship between the severity of alcohol withdrawal and psychopathology could be found which might hint at two different neurobiological processes underlying these phenomena. The comparison with patients suffering from depression or anxiety disorders revealed that the global symptom severity of alcoholics undergoing withdrawal was similar, but recovery was achieved more rapidly than in the other groups. On the other hand, the self-rated psychopathologic symptom profile of alcoholics was rather similar to that of patients with adjustment disorders. While about one-quarter of the alcoholics reported severe psychopathology on admission, only about 10% showed symptomatology at discharge about three weeks later, predominantly depression or anxiety. These results underline the notion that much of the psychopathology described by alcoholics decreases within 2-3 weeks after withdrawal without specific treatment.