***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES The impact of Hatha yoga as add-on treatment to quetiapine fumarate extended release ( QXR ) or escitalopram ( ESC ) in depressed patients on hypothalamic-pituitary-adrenal ( HPA ) axis activity was assessed . METHODS 60 in patients suffering from major depressive disorder ( MDD ) according to DSM-IV were r and omized for a 5 week treatment with Yoga or not ( control group ) and with either QXR ( 300 mg/day ) or ESC ( 10 mg/day ) . Serial dexamethasone/corticotropin releasing hormone ( DEX/CRH ) tests were performed to assess HPA axis function . The Hamilton Depression Rating Scale ( 21-HAMD ) was used weekly . RESULTS A more pronounced down regulation of the HPA axis activity due to yoga could not be detected . The stepwise long term cortisol reduction was seen in both medication groups , irrespectively of yoga add-on treatment . In addition , cortisol improvers in week 1 of therapy ( reduction in cortisol peak value within the DEX/CRH test ) reached significant greater amelioration of depressive symptoms after 5 weeks . CONCLUSIONS Our results suggest that antidepressant agents down regulate HPA axis function to a greater extent than additional Hatha yoga treatment . Moreover , an early reduction of HPA system hyperactivity after one week of pharmacological treatment seems to raise the possibility of a favorable treatment response Background : The dem and for clinical ly efficacious , safe , patient acceptable , and cost-effective forms of treatment for mental illness is growing . Several studies have demonstrated benefit from yoga in specific psychiatric symptoms and a general sense of well-being . Objective : To systematic ally examine the evidence for efficacy of yoga in the treatment of selected major psychiatric disorders . Methods : Electronic search es of The Cochrane Central Register of Controlled Trials and the st and ard bibliographic data bases , MEDLINE , EMBASE , and PsycINFO , were performed through April 2011 and an up date d in June 2011 using the keywords yoga AND psychiatry OR depression OR anxiety OR schizophrenia OR cognition OR memory OR attention AND r and omized controlled trial ( RCT ) . Studies with yoga as the independent variable and one of the above mentioned terms as the dependent variable were included and exclusion criteria were applied . Results : The search yielded a total of 124 trials , of which 16 met rigorous criteria for the final review . Grade B evidence supporting a potential acute benefit for yoga exists in depression ( four RCTs ) , as an adjunct to pharmacotherapy in schizophrenia ( three RCTs ) , in children with ADHD ( two RCTs ) , and Grade C evidence in sleep complaints ( three RCTs ) . RCTs in cognitive disorders and eating disorders yielded conflicting results . No studies looked at primary prevention , relapse prevention , or comparative effectiveness versus pharmacotherapy . Conclusion : There is emerging evidence from r and omized trials to support popular beliefs about yoga for depression , sleep disorders , and as an augmentation therapy . Limitations of literature include inability to do double-blind studies , multiplicity of comparisons within small studies , and lack of replication . Biomarker and neuroimaging studies , those comparing yoga with st and ard pharmaco- and psychotherapies , and studies of long-term efficacy are needed to fully translate the promise of yoga for enhancing mental health CONTEXT Yoga is increasing in popularity , with an estimated 15 million practitioners in the United States , yet there is a dearth of empirical data addressing the holistic benefits of yoga . OBJECTIVE To compare the physical and mental benefits of an exercise-based yoga practice to that of a more comprehensive yoga practice ( one with an ethical/spiritual component ) . DESIGN Students with mild to moderate depression , anxiety , or stress and who agreed to participate were assigned to one of three groups : integrated yoga , yoga as exercise , control . PARTICIPANTS A total of 81 undergraduate students 18 years and older at a university in the southeastern United States participated in the study . MAIN OUTCOME MEASURES Depression , anxiety , stress , hope , and salivary cortisol . RESULTS Over time , participants in both the integrated and exercise yoga groups experienced decreased depression and stress , an increased sense of hopefulness , and increased flexibility compared to the control group . However , only the integrated yoga group experienced decreased anxiety-related symptoms and decreased salivary cortisol from the beginning to the end of the study . CONCLUSIONS Yoga , practice d in a more integrated form , ie , with an ethical and spiritual component , may provide additional benefits over yoga practice d as an exercise regimen Major depressive disorder ( MDD ) is a common , debilitating chronic condition in the United States and worldwide . Particularly in women , depressive symptoms are often accompanied by high levels of stress and ruminations , or repetitive self-critical negative thinking . There is a research and clinical imperative to evaluate complementary therapies that are acceptable and feasible for women with depression and that target specific aspects of depression in women , such as ruminations . To begin to address this need , we conducted a r and omized , controlled , mixed- methods community-based study comparing an 8-week yoga intervention with an attention-control activity in 27 women with MDD . After controlling for baseline stress , there was a decrease in depression over time in both the yoga group and the attention-control group , with the yoga group having a unique trend in decreased ruminations . Participants in the yoga group reported experiencing increased connectedness and gaining a coping strategy through yoga . The findings provide support for future large scale research to explore the effects of yoga for depressed women and the unique role of yoga in decreasing rumination We had previously reported decreased serum brain-derived neurotrophic factor ( BDNF ) levels in depressed patients . In the present study , we tested the hypothesis that antidepressant treatment would normalize serum BDNF levels , at least in a subgroup of patients . Major depressed patients ( 15 females and 11 males ) diagnosed according to DSM-IV criteria and healthy controls ( 13 females and 13 males ) participated in this study . Serum BDNF was assayed with the ELISA method for depressed and remitted patients and the severity of depression was evaluated with the Montgomery-Asberg Depression Rating Scale . An analysis of variance showed that treatment had an effect [ F(1 , 24 ) = 4.46 , p = 0.045 ] on the normalization of serum BDNF levels . We also found a correlation between the severity of depression ( r = 0.51 , p = 0.008 ) , the pretreatment BDNF levels ( r = 0.62 , p = 0.001 ) and the difference in serum BDNF levels after antidepressant treatment . These results suggest that antidepressant treatment has a positive effect on serum BDNF levels and support the hypothesis of neurotrophic factor involvement in affective disorders The aim of this study was to assess the acceptability and feasibility of Vinyasa yoga as an adjunctive treatment for depressed patients who were not responding adequately to antidepressant medication . The authors also planned to ask participants for qualitative feedback on their experience of the class and to assess change over time in depression and in possible mediating variables . The authors recruited 11 participants in 1 month for an 8-week open trial of yoga classes . They found that 10 participants completed follow-up assessment s , 9 of 10 were positive about their experience , and all provided feedback about what was and was not helpful about yoga , as well as barriers to class attendance . Over the 2-month period , participants exhibited significant decreases in depression symptoms and significant increases in an aspect of mindfulness and in behavior activation . This pilot study provided support for continuing to investigate Vinyasa yoga as an adjunct treatment for depression . The next step required is a rigorous r and omized clinical trial 
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In addition , preliminary studies suggest that alterations in cortisol , BDNF , and HRV may play a role in how yoga exerts its clinical effect .
DISCUSSION The results suggest that body-oriented yoga could work through some of the theoretically predicted mechanisms .