Adjunctive yoga versus bibliotherapy for bipolar depression: A pilot randomized controlled trial

Although yoga has been recommended as a mood management strategy for bipolar disorder (BD), there are no published studies on yoga for the treatment of BD symptoms. The aim of this pilot study was to develop an adjunctive hatha yoga intervention for bipolar depression, and to evaluate its preliminary feasibility, acceptability, and safety in a 10-week randomized controlled trial. Eighteen adults with bipolar I/II depression were recruited and randomized to yoga (n = 10) or self-directed bibliotherapy (n = 8), both delivered as adjuncts to community pharmacotherapy for BD. Yoga participants were invited to attend at least one of two weekly yoga classes for 10 weeks, following a structured yoga manual. Statistical analyses focused on change in depression severity, assessed post-treatment by a blind rater. Participants also completed assessments of mania symptoms, quality of life (QoL), and treatment satisfaction. Although between-groups analysis yielded no significant difference in depression outcomes by condition, within-group analyses of those assigned to yoga revealed medium effects for improvements in depression symptoms (Cohen's d = 0.66) and QoL (Cohen's d = 0.69). Manic symptom severity remained low throughout the yoga program, in contrast to slight increases in the control arm (F(1,13) = 7.25, p 0.021). Participants attended an average of only 4.80 (SD = 5.12) yoga classes, yet overall satisfaction with yoga was rated as fairly high and 6 of 10 participants reported practicing yoga at home. We conclude that yoga for bipolar depression merits future research, with a focus on alternative avenues of delivery (e.g., internet) that may not require weekly class attendance.