Meditation and Depression

Graph showing positive effect of Transcendental Meditation (not Mindfulness Meditation) on relief of depression

I hang out a lot on the Dharma Overground discussion list, usually checking it once a day as part of my nightly tour of Web sites I’m interested in. Now and then, someone posts a note that goes something like this:

Hi, I’m new on this site, just found out about meditation. I’ve had depression for a number of years and want to see whether meditation can help to relieve it. Does anybody know…

Often the initial post will sit there unanswered for a while, but sometimes a regular will come on and post something like this:

Welcome to the site. I had the same problem as you for many years. It went away after I started meditating regularly, and so far, it hasn’t come back…

Recently, I posted a response to an initial query that went something like this:

Welcome to the site. My advice is to work with a therapist and if the therapist suggests medication, give it a try. If the initial medication doesn’t work, then there are others. If no medication works, then maybe your genetics is such that drugs won’t help and talk therapy, maybe with some meditation under the guidance of teacher might work.

A couple other people responded as in the previous paragraph. You can read the thread here.

Now, my reason for giving this advice has to do with my experience regarding meditation and depression. Even though I have never had a diagnosis of depression, I experienced major depression after a meditation retreat that I had to leave early in 1996 (you can read about it in my memoir) in which my entire plan for the rest of my life collapsed over the period of about a month. This is what many in the Dharma Overground community and elsewhere call “The Dark Night”. The experience I had is not particularly uncommon but also it is not a forgone conclusion that everybody goes through it. For someone who already has depression, however, starting a serious meditation practice that then leads to further, perhaps deeper depression could be devastating.

So, being a fan of fact based analysis, I got to thinking: what does the research literature say about meditation and depression? Anybody who knows how psychological research works knows that anecdotal reports, such as that cited above by the list posters, are excellent for pointing toward a possible cause-effect relationship, but to really prove it, you need a rigorous statistical study. So I turned to Google Scholar and googled “mediation depression”.

I came across this article on the Web site of the Journal of the American Medical Association. The article is a meta-analysis, which means that it sorts through the primary literature looking at various studies that meet criteria and summarizes the results from those studies. The analysis runs only up until 2012, about when the current popular interest in mindfulness was just starting. The studies surveyed were restricted to those that were randomized clinical trials with controls for placebo effects. Randomized trials are more or less the gold standard when trying to measure cause and effect, and placebo controls are necessary to ensure that the effect is in fact coming from the presumptive cause, and not simply a result of the subject being convinced that they are getting an active treatment, when in fact they are part of the control group. The authors reviewed 47 studies having a total of 3,515 participants.

The results showed that mindfulness meditation had a moderate effect in reducing anxiety, depression, and pain for up to 6 months, but low effect at reducing stress and improving mental health related quality of life. The authors found no evidence that meditation helped with improving mood and attention, reducing or eliminating substance abuse, promoting healthy eating habits, helping with weight control, or improving sleep. In addition, even for depression and anxiety, meditation was no better than other active treatment regimens such as drugs, behavioral (usually cognitive behavioral) therapy, or exercise such as yoga. The authors then go on to note that many of the studies reporting positive effects are uncontrolled or don’t control for placebo effects, and the people conducting the studies often are themselves meditators or have had positive experience with meditation or may have some other vested interest or belief in the effectiveness of meditation for relieving psychological problems.

What to make of this? One way to look at it is that, even though the pharmacological companies have heavily marketed antidepressants for years, they are really not any more effective than meditation, yoga, or talk therapy for helping relieve depression. There is some evidence that genetics may influence the effectiveness of selective serotonin inhibitors (SSIs, the component of many antidepressants). Other studies haven’t found any relationship between a person’s genetics and SSI effectiveness. The same might be true of meditation, that is people with particular genes might benefit more from meditation and talk therapy than from SSIs.* A recent study connected relief from depression to use of probiotics. The digestive tract is known to have many serotonin receptors and the microbiome is currently an active area of research that is turning out to have surprising effects on physical and psychological health. This study has yet to be replicated.

Anyway, based on what I know now, I think I would change my advice to someone who was looking for relief of major depression. The most important point is that you need to work with a therapist, and, if you try meditation, with a qualified (in other words trained) teacher. The reason is that you need to have someone who has the training to give you an objective opinion about whether a particular treatment is affecting your emotional state. Since meditation generally costs little and seems to be about as effective as drugs, starting with meditation is a good way to go. Also exercise, like yoga, and maybe probiotics all are relatively inexpensive and have been shown to help. If you are working with a therapist, then you will probably also be doing some behavioral therapy, and I’ve known some meditation teachers who include that in their approach. Your support network can give you objective feedback. And finally, if nothing else works, try drugs. They are expensive and don't work any better than much cheaper methods.

*I speculated to that effect in the DhO thread, having seemed to recall an article I had recently seen, but upon further searching I could not find the article. 

Image source: https://medicalxpress.com/news/2010-04-depression-transcendental-meditation.html