Executive Summary : | Major depression is a prevalent psychiatric disorder affecting 3-5 of the global population, with 30-50 patients clinically improving it. However, recurrence or progression is common in this disabling condition. This research proposal aims to explore the role of neurobiological markers in predicting the efficacy of yoga as an add-on antidepressant therapy in patients with medically resistant Major depression. The study will use a comprehensive battery of clinical, behavioral, and investigative modalities, including clinical and cognitive assessments, cortical excitability and plasticity measures, neurocardiac regulation, serum levels of glutamate, brain-derived neurotropic factor BDNF, and antibodies to N-methyl D-aspartate NMDA receptors. The study will recruit 60 patients from the in-and out-patient departments of NIMHANS, with a total sample size of 501060. Exclusion criteria include patients aged 18 and 50 years of age, on any antipsychotic, anticholinergic, or cardiac medication, co-morbid cardiac or neurological disorders that can increase the risk of TMS related complications or are a contraindication for yoga/Ayurveda treatment, pregnant/postpartum patients, disturbances of other organ systems or systemic disorders that could affect cardiac autonomic functions or participants' ability to cooperate during investigations, patients with suicidal risk or need for electroconvulsive therapy, and co-morbid substance dependence in the last six months or substance abuse in the last one month as per ICD-10, except nicotine. The study will involve two groups: Yoga as an add-on therapy, where moderate cases of depression will be recruited with HDRS around 17, and Treatment as usual as prescribed by the treating physician. 30 healthy age and gender matched controls will be assessed for the effects of three months of yoga therapy on various measures such as cardiac autonomic, motor cortical excitability and plasticity, and biochemical measures of plasticity BDNF, Serum Glutamate, and antibodies against NMDAR. |