This story reports on a review of studies which found that yoga has “positive effects on mild depression and sleep problems, and it improves the symptoms of psychiatric disorders like schizophrenia and ADHD among patients using medication.” Unfortunately, that’s about all the story had to say about the review. If you want to know how much improvement yoga can produce, or what symptoms are most affected, or what type of yoga works best, you’re out of luck. Ditto if you’re looking for information on costs and harms, or if you were hoping for an independent take on the findings.The story did clearly call out some limitations of the included studies, but we wish it had mentioned some other critical caveats.
Although medications are the first line treatment for many psychiatric disorders, they are not always effective and can produce bothersome side effects that cause many people to stop taking them. Yoga, like many other nonpharmacologic treatment approaches (massage, meditation, relaxation exercises, etc), shows promise for treating some of these conditions, but the supporting evidence is not strong. Much more research will be needed to prove that it’s as effective as drugs or psychotherapy. And while it’s conceivable that yoga might one day become accepted as a stand-alone treatment for mild psychiatric illness, it seems unlikely that yoga will ever represent a stand-alone therapy for individuals with more severe disease.
It is important for readers to know what is likely to help and what is likely a waste of time or harmful. If an approach is ineffective, then readers need to know this to avoid delay in finding effective treatments.
The story did not discuss costs. Yoga is relatively cheap (roughly $10 to $20 per class in the Northeast city where one of our reviewers lives) compared with other forms of treatment, but it isn’t covered by insurance. So the costs can still add up, especially for those with limited incomes who are already paying for other medical care.
The story’s description of benefits is unacceptably vague. It reports that the yoga has “positive effects on mild depression and sleep problems, and it improves the symptoms of psychiatric disorders like schizophrenia and ADHD among patients using medication.”
But which symptoms or outcomes specifically does yoga improve? And by how much? Which of the dozens forms of yoga out there should patients look for? These key details are not provided. And without them the story is far less useful than it could be for people trying to make decisions about their treatment.
And if the journal article on which the story is based didn’t make this clear – or if the scientists’ methods were questionable – then the entire basis for the story itself is questionable.
While it’s not an invasive treatment and seems to be safe for most people, yoga can cause harm. The story, however, doesn’t address this possibility or state whether the studies included in the review assessed potential adverse effects of treatment.
The story does make some attempt to assess the quality of the evidence, noting specifically that “the vast majority of studies looking at the benefits of yoga are all small studies.” The story goes on to caution that yoga isn’t a replacement for medication, and that “we still need to do further, large-scale studies before we are ready to conclude that people with mental illnesses can turn to yoga as a first-line treatment.”
Welcome as these caveats are, we don’t think they are enough to convey just how preliminary this evidence is, and just how far we still are from knowing whether yoga is truly an effective treatment. For example, while the story notes that the review included 16 studies overall, it doesn’t explain that there were only a handful of studies looking at each particular condition (4 studies of depression, 3 for schizophrenia, and only 2 for ADHD). Moreover, most of these studies suffered from important limitations beyond their small size. These limitations were catalogued in detail in the study’s discussion section, and deserved greater attention in the story. Following are some examples:
There was no disease-mongering of psychiatric diseases. But there was also little context about the prevalence/impact of the conditions under study.
Researchers tend to be optimistic about the treatments they are studying, and the study author quoted in this story is no different. That’s why it’s always a good idea to include an objective perspective from an independent expert — something this story regrettably lacked.
The story suggests that yoga would be an attractive alternative to psychiatric medications, but it doesn’t mention that psychotherapy is a well-validated and effective nonpharmacologic treatment for many of the disorders discussed in the story. And other major categories of treatment for people with some of the disorders discussed include a range of medications, a range of self-help strategies, and for some conditions, somatic treatments such as transcranial magnetic stimulation.
Yoga classes are widely available, but there is no standardized curriculum. So it’s not clear if classes at the local community center will provide the same benefits observed in these studies. The story should have addressed this uncertainty.
The story did not make unsubstantiated claims about the novelty of yoga as a psychiatric treatment.
The story includes an interview with one of the study authors, and doesn’t pull any material directly from this press release. (But it also cites a Huffington Post article – odd to do so.) We’ll call it good enough for a satisfactory.
Systematic, Criteria-Driven
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