YOGA TO DECREASE DEPRESSION 1 Yoga to Decrease Depression among Depressed Pregnant Women

Abstract

Depression is a prominent cause of global morbidity, and one of the most common medical conditions during pregnancy. Prenatal depression can lead to detrimental outcomes including preterm birth, low birth weight, and postpartum depression. Screening for depression is recommended at least once during the perinatal period. However, even after a diagnosis of depression, several barriers to treatment exist, including cost and patient opposition to treatment. This literature review examines the effectiveness of yoga practice in pregnant women who are depressed or have depressive symptoms. Five research articles published within the last five years were selected that support a yoga practice innovation for prenatal depression management. The utility of yoga is demonstrated in these articles in clinically depressed pregnant women and pregnant women with symptoms of depression or anxiety. A yoga practice protocol shown to be effective in prenatal depression was replicated, and based on that protocol, this paper proposes that clinics that care for depressed pregnant women employ an evidence-based yoga intervention spanning twelve weeks with a minimum of twice weekly yoga practice. Research has shown that yoga practice is safe, efficacious, practical, and decreases prenatal depressive symptoms. Future research should include the diverse demographics of socioeconomic status, prenatal care access, and ethnicity of depressed pregnant women to strengthen the data supporting yoga practice for prenatal depression management. YOGA TO DECREASE DEPRESSION 3 Yoga to Decrease Depression among Depressed Pregnant Women Introduction Depression is a leading cause of global morbidity, and one of the most common medical conditions during pregnancy (Centers for Disease Control and Prevention [CDC], 2013). According to the National Survey on Drug Use and Health, approximately 7.7% of pregnant women had at least one major depressive episode per year from 2005 to 2009 (Ko, Farr, Dietz, & Robbins, 2012). Unipolar major depression is a disorder characterized by symptoms lasting for at least two weeks, and including five of more of the following symptoms: depressed mood, loss of interest or pleasure in activities, insomnia or hypersomnia, change in appetite or weight, psychomotor agitation, low energy, poor concentration, thoughts of worthlessness, and recurrent thoughts about death (Buttaro, Trybulski, Bailey, & Sandberg-Cook, 2013). Even after a prenatal depression diagnosis, several barriers to treatment exist including cost, patient opposition to treatment, and stigma (CDC, 2013). Untreated depression can lead to poor lifestyle behaviors including poor nutrition, smoking, drinking, and suicidal behavior (Farr & Bish, 2013). Unhealthy behaviors linked to depression create a hostile environment for both the pregnant woman and the fetus. Subsequently, depression during pregnancy can lead to various deleterious outcomes. These outcomes include preterm birth, low birth weight, pregnancy-induced hypertension, and postpartum depression (Farr & Bish, 2013). A mental health evaluation is a new area of focus for obstetricians, midwives, and women’s health and family nurse practitioners. In May 2015, the American College of Obstetricians and Gynecologists began recommending screening women for depression during pregnancy; depression can be diagnosed by various tools such as the Edinburgh Postnatal Depression Scale (The American College of Obstetricians and YOGA TO DECREASE DEPRESSION 4 Gynecologists [ACOG], 2015). Preconception counseling and prenatal counseling should include emotional health education and education about the consequences of poor mental health to provide optimal outcomes for both the mother and the fetus. This education could include information on yoga which can provide the pregnant woman with tools to manage her emotional health and reduce symptoms of depression (Field, Diego, Delgado, & Medina, 2013). Through research, treatment of prenatal depression with yoga has shown promising outcomes (Field, Diego, Delgado, & Medina, 2013; Field et al., 2012). Despite these research findings, it may not be a common practice to educate depressed pregnant women on yoga as it is not mentioned in clinical practice guidelines established by ACOG (2009) for treatment of depression in pregnant