Lavretsky H, Epel ES, Siddarth P, et al. A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity. Int J Geriat Psychiatry. 2013;28(1):57-65.
A randomized, placebo controlled trial. This was an 8-week pilot study of daily yogic meditation versus relaxation in mildly depressed, elderly caregivers of dementia patients. The intervention group practiced Kundalini yoga with Kirtan Kriya meditation for 12 minutes daily; the placebo group listened to a prescribed relaxation CD for the same length of time. Measures of depression, mental health, cognitive function, and telomerase activity were assessed.
Of 65 screened participants, 49 were found to have mild depression and were recruited to the study. Of these, 39 (average age 60.3 years old) completed the study and were used for statistical analysis. Of these 39, 23 were in the intervention group (23 women, no men) and 16 in the placebo group (14 women, 2 men).
The primary outcome measure was mental health, using the Hamilton Rating Scale for Depression (HamD) and the Mental Health Composite Summary Score (MCS) using the Medical Outcomes Study SF 36-Item Health Survey. Secondary outcome measures for cognition included Mini-Mental Status Exam (MMSE), California Verbal Learning Test II (CVLT II), Trail Making A (to test attention and speed of information processing), and Trail Making B to test executive function. Changes in telomerase levels between the 2 groups were analyzed, as was the association between telomerase levels and changes in depressive symptoms.
The meditation group had significantly greater improvements in depression, mental health, and telomerase activity. Of those in the meditation group, 65.3% had at least 50% improvement using HamD scale for depression versus 31.2% in the relaxation group. Using the Mental Health Composite Summary score, 52% of those in the meditation group had at least 50% improvement in depressive symptoms compared to only 19% in the relaxation group. These comparisons both reached statistical significance (P<0.05). Cognitive function scores for MMSE and Trail Making B also were significantly improved in the meditation group (P=0.0003 and P=0.005, respectively). The meditation group also showed a 43% improvement in telomerase activity, versus only 3.7% improvement in the relaxation group (P=0.05)
Depression is associated with “accelerated aging,” because depressed persons have a higher incidence of cardiovascular disease, cerebrovascular disease, osteoporosis, diabetes, and dementia.1 Telomerase enzyme activity in leukocytes is a marker of biological aging and has been proposed as a “psychobiomarker” due to its correlation with chronic emotional stress.2 This pilot study adds to the substantial body of evidence suggesting yoga and/or meditation is therapeutic for mental health and longevity.3–5 It also contributes to the emerging body of evidence on the use of telomerase activity to track the biological changes involved in the improved sense of well-being attained from meditation.
Perhaps the most remarkable aspect of the pilot study reviewed here is that the intervention was so easily accomplished. Twelve minutes daily is a very feasible therapy, even for those busily caring for a loved one with dementia. Also of note is that the control group was given music to listen to and advised to relax for 12 minutes per day. This was a well-chosen control that suggests that the practice of meditation had therapeutic effects much greater than the obvious relaxation it provided. Lastly, the duration of the study was only 8 weeks. In that time, more than half of those in the intervention group had significant improvement in their depressive symptoms. This is as good, if not better, than many medications currently used for treating depression.
This is not the first trial to show that yogic meditation improves mood and telomerase activity. In another trial of a more intensive meditation practice, participants (n=30) who underwent 6 hours of meditation daily for 3 months were compared to a matched control group (n=30).6 After 3 months, telomerase activity was significantly higher in participants versus controls (P<0.5). There were also increases in perceived control, decreases in “neuroticism”, and increases in mindfulness and purpose in life in the intervention group (P<0.1).
Telomerase activity may turn out to be the best means of measuring the effects of the physical, mental/emotional and even spiritual aspects of a healthy lifestyle.
It is estimated that 50% of caregivers of those with dementia have depression.7 Of course, one assumes caregivers of loved ones with any condition are prone to high emotional stress. Interestingly, it is not the situation itself, but whether there is a strong perception of stress or not in the caregiver. In 2004 Epel and colleagues published a study on premenopausal women who had at least one chronically ill child (n=39) versus a control group of women with healthy children (n=19).2 Perceived stress, whether caring for an ill child or not, was associated with shortened telomeres and lower telomerase activity. There were also increased oxidation markers in those with the highest perceived stress. The authors hypothesized that one reason for the shortened telomeres may be the increase in oxidation that results from psychological stress. Regardless of the mechanism, the effect was profound. Those with the highest levels of perceived stress had telomeres reflective of a decade or more of additional aging compared to those with low stress.
As research continues in this area, other mind-body therapies will likely be studied. For example, a study of 64 participants with chronic fatigue syndrome underwent a qi gong intervention versus a wait list group who did not participate.8 Telomerase activity was significantly (P<0.5) increased and chronic fatigue symptoms diminished in the qi gong group. Dietary interventions, such as the Ornish Diet and the Mediterranean diet, have also demonstrated increased telomerase activity.9,10
As Epel has aptly put it, “Telomere length captures the interplay between genetics, life experiences and psychosocial and behavioral factors … psychological stress resilience, healthy lifestyle factors, and social connections have been associated with longer telomere length and it appears that these factors can protect individuals from stress-induced telomere shortening.”11 The therapeutic effect of social connections and a means of dealing with stress such that it renders one “resilient” seemed, until now, very difficult to prove. Telomerase activity may turn out to be the best means of measuring the effects of the physical, mental/emotional, and even spiritual aspects of a healthy lifestyle.
- Wolkowitz OM, Epel ES, Reus VI, Mellon SH. Depression gets old fast: do stress and depression accelerate cell aging? Depression and Anxiety. 2010; 27(4): 327-338.
- Epel ES, Blackburn EH, Lin J, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci U S A. 2004; 101(49): 17312-17315.
- Shapiro D, Cook IA, Davydov DM, Ottaviani C, Leuchter AF, Abrams M. Yoga as a complementary treatment of depression: effects of traits and moods on treatment outcome. Evid Based Complement Alternat Med. 2007; 4(4): 493-502.
- Sharma V, Das S, Mondal S, Goswami U, Gandhi A. Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from major depression. Indian J Physiol Pharmacol. 2006; 50(4): 375-383.
- Brown RP and Gerbarg PL. Yoga Breathing, Meditation, and Longevity. Ann N Y Acad Sci. 2009; 1172: 54-62.
- Jacobs TL, Epel ES, Lin J, et al. Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology. 2011; 36(5): 664-681.
- Lavretsky H. Stress and depression in informal family caregivers of patients with Alzheimer’s disease. Aging Health. 2005;1(1): 117-133.
- Ho RT, Chan JS, Wang CW, et al. A randomized controlled trial of qigong exercise on fatigue symptoms, functioning, and telomerase activity in persons with chronic fatigue or chronic fatigue syndrome. Ann Behav Med. 2012; 44(2): 160-170.
- Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol. 2008; 9:(8) 1048-1057.
- Boccardi V, Esposito A, Rizzo MR, Marfella R, Barbieri M, Paolisso G. Mediterranean diet, telomere maintenance and health status among elderly. PloS one. 2013; 8(4): e62781.
- Puterman E, Epel E. An intricate dance: Life experience, multisystem resiliency, and rate of telomere decline throughout the lifespan. Soc Personal Psychol Compass. 2012; 6(11): 807-825.