A randomized controlled longitudinal naturalistic trial testing the effects of automatic self transcending meditation on heart rate variability in late life depression: study protocol

Zareen Amtul, Amanda Arena, Hussein Hirjee, Zaineb U Khan, Pramudith M Maldeniya, Ronnie I Newman, Amer M Burhan, Stephen Wetmore, Akshya Vasudev, Zareen Amtul, Amanda Arena, Hussein Hirjee, Zaineb U Khan, Pramudith M Maldeniya, Ronnie I Newman, Amer M Burhan, Stephen Wetmore, Akshya Vasudev

Abstract

Background: The prevalence and socioeconomic cost of late life depression (LLD) is on the rise, while the response rate to antidepressant trials remains poor. Various mind-body therapies are being embraced by patients as they are considered safe and potentially effective, yet little is known regarding the effectiveness of such therapies to improve LLD symptoms. Among the mind-body therapies currently in practice, the results of our pilot study have shown that a particular meditation technique called Sahaj Samadhi Meditation, which belongs to the category of meditation termed automatic self-transcending meditation (ASTM) may have some promise in improving cardiovascular autonomic disturbances associated with LLD as well as ameliorating symptoms of depression and anxiety.

Methods/design: Patients between the ages of 60 and 85 with LLD will be randomized either to ASTM plus treatment as usual (TAU) or TAU alone to assess changes in cardiovascular autonomic parameters, neuropsychological symptoms of depression and anxiety as well as quality of life. The instructional phase of the intervention consists of 4 consecutive days of meditation training, after which participants are encouraged to meditate twice daily for twenty minutes each time at home. The intervention also includes once weekly follow up sessions for the subsequent 11 weeks. The planned study has one and a half year recruitment period. Participants will be assessed at baseline and at 4, 8, 12 and 24 weeks post intervention.

Discussion: This study should provide a unique data source from a randomized, controlled, longitudinal trial to investigate the effects of a form of ASTM on cardiovascular autonomic and neuropsychological health in LLD.

Trial registration: Clinicaltrials.gov NCT02149810, date registered: 05/28/2014.

Figures

Figure 1
Figure 1
Participant flow chart.

References

    1. Steffens DC, Skoog I, Norton MC, Hart AD, Tschanz JT, Plassman BL, Wyse BW, Welsh-Bohmer KA, Breitner JC. Prevalence of depression and its treatment in an elderly population: the Cache County study. Arch Gen Psychiatry. 2000;57:601–607. doi: 10.1001/archpsyc.57.6.601.
    1. Alexopoulos GS. Depression in the elderly. Lancet. 2005;365:1961–1970. doi: 10.1016/S0140-6736(05)66665-2.
    1. Stahl SM, Grady MM. Differences in mechanism of action between current and future antidepressants. J Clin Psychiatry. 2003;64(Suppl 13):13–17.
    1. Vasudev A, O’Brien JT, Tan MP, Parry SW, Thomas AJ. A study of orthostatic hypotension, heart rate variability and baroreflex sensitivity in late-life depression. J Affect Disord. 2011;131:374–378. doi: 10.1016/j.jad.2010.11.001.
    1. Gorman JM, Sloan RP. Heart rate variability in depressive and anxiety disorders2. Am Heart J. 2000;140:77–83. doi: 10.1067/mhj.2000.109981.
    1. Roth R. Maharishi Mahesh Yogi’s Transcendental Meditation. Washington DC: Primus; 1994.
    1. Trivedi MH, Rush AJ, Wisniewski SR, Nierenberg AA, Warden D, Ritz L, Norquist G, Howland RH, Lebowitz B, McGrath PJ, Shores-Wilson K, Biggs MM, Balasubramani GK, Fava M. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163:28–40. doi: 10.1176/appi.ajp.163.1.28.
    1. Kelly K, Posternak M, Alpert JE. Toward achieving optimal response: understanding and managing antidepressant side effects. Dialogues Clin Neurosci. 2008;10:409–418.
    1. Purohit MP, Wells RE, Zafonte R, Davis RB, Yeh GY, Phillips RS. Neuropsychiatric symptoms and the use of mind-body therapies. J Clin Psychiatry. 2013;74:e520–e526. doi: 10.4088/JCP.12m08246.
    1. Toane EB. The transcendental meditation program. Can Med Assoc J. 1976;114:1095–1096.
    1. Travis F, Pearson C. Pure consciousness: distinct phenomenological and physiological correlates of “consciousness itself”. Int J Neurosci. 2000;100:77–89. doi: 10.3109/00207450008999678.
    1. Alexander CN, Langer EJ, Newman RI, Chandler HM, Davies JL. Transcendental meditation, mindfulness, and longevity: an experimental study with the elderly. J Pers Soc Psychol. 1989;57:950–964. doi: 10.1037/0022-3514.57.6.950.
    1. Barnes VA, Orme-Johnson DW. Prevention and treatment of cardiovascular disease in adolescents and adults through the transcendental meditation ((R)) program: a research review update. Curr Hypertens Rev. 2012;8:227–242. doi: 10.2174/157340212803530411.
    1. Eppley KR, Abrams AI, Shear J. Differential effects of relaxation techniques on trait anxiety: a meta-analysis. J Clin Psychol. 1989;45:957–974. doi: 10.1002/1097-4679(198911)45:6<957::AID-JCLP2270450622>;2-Q.
    1. Paul-Labrador M, Polk D, Dwyer JH, Velasquez I, Nidich S, Rainforth M, Schneider R, Merz CN. Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Arch Intern Med. 2006;166:1218–1224. doi: 10.1001/archinte.166.11.1218.
    1. Nidich S, Toomey M, Myers H, Rainforth M, Grandinetti A, Salerno J, Gaylord-King C, Schneider R. 31st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine. Rapid Communications. WA: Seattle; 2010. Change in Symptoms of Depression in Minority Subjects at Risk for CVD: Randomized Controlled Mind-Body Intervention Trials.
    1. Schneider RH, Alexander CN, Staggers F, Orme-Johnson DW, Rainforth M, Salerno JW, Sheppard W, Castillo-Richmond A, Barnes VA, Nidich SI. A randomized controlled trial of stress reduction in African Americans treated for hypertension for over one year3. Am J Hypertens. 2005;18:88–98. doi: 10.1016/j.amjhyper.2004.08.027.
    1. First MB, Gibbon M, Spitzer RL, Williams JBW. User’s Guide for the Structured Clinical Interview for DSM-IV-TR Axis I Disorders - Research Version - (SCID-I for DSM-IV-TR) New York: Biometric Research Department, New York State Psychiatric Intitute; 2002.
    1. Geriatric Mental Health Program 2011.
    1. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62. doi: 10.1136/jnnp.23.1.56.
    1. Miller MD, Paradis CF, Houck PR, Mazumdar S, Stack JA, Rifai AH, Mulsant B, Reynolds CF. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992;41:237–248. doi: 10.1016/0165-1781(92)90005-N.
    1. Washburn RA, Smith KW, Jette AM, Janney CA. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol. 1993;46:153–162. doi: 10.1016/0895-4356(93)90053-4.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17:37–49. doi: 10.1016/0022-3956(82)90033-4.
    1. Pachana NA, Byrne GJ, Siddle H, Koloski N, Harley E, Arnold E. Development and validation of the Geriatric Anxiety Inventory. Int Psychogeriatr. 2007;19:103–114. doi: 10.1017/S1041610206003504.
    1. Raphael D, Brown I, Renwick R, Cava M, Weir N, Heathcote K. Measuring the quality of life of older persons: a model with implications for community and public health nursing. Int J Nurs Stud. 1997;34:231–239. doi: 10.1016/S0020-7489(97)00010-2.
    1. Vanderkooy JD, Kennedy SH, Bagby RM. Antidepressant side effects in depression patients treated in a naturalistic setting: a study of bupropion, moclobemide, paroxetine, sertraline, and venlafaxine. Can J Psychiatry. 2002;47:174–180.
    1. Burke WJ, Roccaforte WH, Wengel SP. The short form of the geriatric depression scale: a comparison with the 30-item form. J Geriatr Psychiatry Neurol. 1991;4:173–178. doi: 10.1177/089198879100400310.
    1. Trijsburg RW, Van ’t Spijker A, van Dam QD, Duivenvoorden HJ. De Helping Alliance Questionnaire (HAQ-II) Tijdschr Psychother. 1999;25:56–65. doi: 10.1007/BF03061895.
    1. Licht CM, De Geus EJ, Van DR, Penninx BW. Association between anxiety disorders and heart rate variability in the Netherlands Study of Depression and Anxiety (NESDA) Psychosom Med. 2009;71:508–518. doi: 10.1097/PSY.0b013e3181a292a6.
    1. Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004;4:26. doi: 10.1186/1471-2288-4-26.
    1. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–191. doi: 10.3758/BF03193146.
    1. Jasson S, Medigue C, Maison-Blanche P, Montano N, Meyer L, Vermeiren C, Mansier P, Coumel P, Malliani A, Swynghedauw B. Instant power spectrum analysis of heart rate variability during orthostatic tilt using a time-/frequency-domain method. Circulation. 1997;96:3521–3526. doi: 10.1161/01.CIR.96.10.3521.
    1. Malliani A, Lombardi F, Pagani M. Power spectrum analysis of heart rate variability: a tool to explore neural regulatory mechanisms. Br Heart J. 1994;71:1–2. doi: 10.1136/hrt.71.1.1.
    1. American College of Cardiology Cardiovascular Technology Assessment Committee Heart rate variability for risk stratification of life-threatening arrhythmias. J Am Coll Cardiol. 1993;22:948–950. doi: 10.1016/0735-1097(93)90217-O.
    1. Calear AL, Christensen H. Review of internet-based prevention and treatment programs for anxiety and depression in children and adolescents. Med J Aust. 2010;192:S12–S14.
    1. Orme-Johnson D. Medical care utilization and the transcendental meditation program. Psychosom Med. 1987;49:493–507. doi: 10.1097/00006842-198709000-00006.
    1. Herron RE, Hillis SL. The impact of the transcendental meditation program on government payments to physicians in Quebec: an update. Am J Health Promot. 2000;14:284–291. doi: 10.4278/0890-1171-14.5.284.
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:

Source: PubMed

3
Suscribir