The influence of Hatha yoga as an add-on treatment in major depression on hypothalamic-pituitary-adrenal-axis activity: a randomized trial

J Psychiatr Res. 2014 Jun;53:76-83. doi: 10.1016/j.jpsychires.2014.02.022. Epub 2014 Mar 11.


Objectives: The impact of Hatha yoga as add-on treatment to quetiapine fumarate extended release (QXR) or escitalopram (ESC) in depressed patients on hypothalamic-pituitary-adrenal (HPA) axis activity was assessed.

Methods: 60 inpatients suffering from major depressive disorder (MDD) according to DSM-IV were randomized for a 5 week treatment with Yoga or not (control group) and with either QXR (300 mg/day) or ESC (10 mg/day). Serial dexamethasone/corticotropin releasing hormone (DEX/CRH) tests were performed to assess HPA axis function. The Hamilton Depression Rating Scale (21-HAMD) was used weekly.

Results: A more pronounced down regulation of the HPA axis activity due to yoga could not be detected. The stepwise long term cortisol reduction was seen in both medication groups, irrespectively of yoga add-on treatment. In addition, cortisol improvers in week 1 of therapy (reduction in cortisol peak value within the DEX/CRH test) reached significant greater amelioration of depressive symptoms after 5 weeks.

Conclusions: Our results suggest that antidepressant agents down regulate HPA axis function to a greater extent than additional Hatha yoga treatment. Moreover, an early reduction of HPA system hyperactivity after one week of pharmacological treatment seems to raise the possibility of a favorable treatment response.

Keywords: Cortisol; DEX/CRH-test; Depression; Escitalopram; Quetiapine; Yoga.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antidepressive Agents / therapeutic use*
  • Area Under Curve
  • Citalopram / therapeutic use
  • Corticotropin-Releasing Hormone / blood
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / rehabilitation*
  • Dexamethasone
  • Dibenzothiazepines / therapeutic use
  • Drug Delivery Systems
  • Female
  • Humans
  • Hydrocortisone / blood
  • Hypothalamo-Hypophyseal System / physiopathology*
  • Male
  • Middle Aged
  • Muscle Stretching Exercises / methods*
  • Outcome Assessment, Health Care
  • Pituitary-Adrenal System / physiopathology*
  • Quetiapine Fumarate
  • Yoga
  • Young Adult


  • Antidepressive Agents
  • Dibenzothiazepines
  • Citalopram
  • Quetiapine Fumarate
  • Dexamethasone
  • Corticotropin-Releasing Hormone
  • Hydrocortisone