It happened 11 years ago, but I remember the night I had my first full-fledged panic attack as if it were yesterday. I was sitting in the cramped balcony of the Marines Memorial Theatre in San Francisco with my then-boyfriend, watching a devastatingly sad and incredibly long play. By hour three my mood had plummeted. I fidgeted in my seat as I desperately wished that the performance would end. Then, suddenly, I felt my breath get stuck in my chest. I thought I was having an asthma attack. I put my hand on my heart and willed some air into my lungs, but it wouldn't go. I braced myself against the arms of my seat as I tried harder to suck the air in. Nothing. Even though my chest was completely expanded, it felt empty. Then I really started to panic; I became convinced that if I didn't take in a big breath soon, I was going to die.
With my heart pounding in my throat, I pushed through a row of irritated people and bolted out of the dark theater. As I stumbled down the stairs and onto the street, I felt faint and completely disconnected from my body.
The rest of the night is a series of blurry snapshots. I remember the stunned look on my boyfriend's face when he came out of the theater and saw me. I remember him dragging a woman out of a cab and ordering the driver to take us to the hospital. Then I recall a moment of comfort when, at the hospital, a nurse sat me down, put her hands on my shoulders, and said gently, "Just breathe, sweetheart. You can do it." In that moment, the terror dissipated and I felt a split second of relief as I realized that I was not going to die. But the relief was quickly replaced by overwhelming sadness. Sobs welled up from deep within. They didn't stop that night. They rarely ceased for several weeks.
When I returned home from the hospital later that night, my mental state worsened. Along with the anxiety that I still felt after the panic attack, I was joined by another visitor: depression. In the weeks that followed, I was completely unable to soothe myself. I cried constantly and felt detached from the world. I awoke every morning dreading opening my eyes and grew frightened of crowded places like movie theaters, airplanes, and buses. Then one day I was afraid to leave my apartment. The thought of looking up at the vast expanse of sky above while being surrounded by strangers was too much. I'd heard about this condition, agoraphobia, but I couldn't believe it was happening to me. At that point I knew I needed to find help, and I did.
This might be the part of the story where you think I'm going to say that yoga saved me. That I traveled to India and meditated for 40 days in an ashram, which helped me find the true meaning of life and live happily ever after. I wish I could say that, but it was antidepressants and psychotherapy that initially helped me manage my anxiety and depression. When I did start practicing yoga three years later, it helped me feel happier—more whole and connected. Yoga didn't "cure" me, but it has transformed my life over time. In the past eight years, yoga helped me create new thought patterns, feel self-love, and return to the present moment when my mind wanders off into a fearful future. It's also taught me to trust that life is good, whether or not things are going well. All this just from practicing asana? Well, not exactly. Practicing yoga has altered my inner landscape in many ways. I offer some of them here not as a definitive guide—depression and anxiety are complicated and different for everyone, and it's important to get a personalized diagnosis and treatment plan—but in the hope that someone else might find support and solace too.
Know Your Depression
For me, anxiety and depression have always gone hand in hand. Over the years I've noticed that a panic attack or prolonged periods of anxiety can trigger depression in me. Although no one knows why, most anxiety disorders—including panic disorder, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and phobias—are accompanied by depression, according to the National Institute of Mental Health.
Asana practice helps counteract anxiety-driven depression because it reduces stress hormones like cortisol and adrenaline, inducing what's known as the relaxation response. Once the relaxation response kicks in, many people feel that instead of trying to escape their feelings, they can stay with them, which is essential to identifying the psychological factors that trigger their anxiety and depression. But the path to getting to this relaxed place varies by individual.
Patricia Walden, a senior Iyengar Yoga teacher, and the physician Timothy McCall, author of Yoga as Medicine, who together teach workshops on yoga and depression, categorize depression based on the gunas—rajas, tamas, and sattva—which, according to ancient yogic texts, are three types of energy that manifest as behavioral patterns. Rajas is often characterized as dynamic and excitable; tamas by inertia, sloth, fear, or confusion; and sattva as pure "beingness" and lucidity, a state of equilibrium. Walden and McCall refer to an agitated, anxiety-infused depression as "rajasic" and a more lethargic, despondent depression as "tamasic."
If you're feeling rajasic, that is, agitated, anxious, and fearful, you might assume that the best yoga practice for you would be one made up of calming poses such as forward bends or restorative poses. But if your mind and energy are out of control, being completely still and willing yourself to relax may make you feel worse. In those situations, Walden recommends starting your practice with dynamic, invigorating poses such as Adho Mukha Vrksasana (Handstand), Virabhadrasana II (Warrior II), or Sun Salutations to burn off nervous energy and to give your buzzing mind something to focus on. If those poses are too difficult, Walden suggests that beginners try Adho Mukha Svanasana (Downward-Facing Dog). If you find Downward-Facing Dog too stimulating, use a bolster or block under the head. From there, supported backbends such as Viparita Dandasana can then lift the spirits without overly stimulating the nervous system, provided you focus on your breathing and don't aggressively work the pose. Walden recommends backbends because they open the chest, which is essential for relieving both anxiety and depression. For depression, Walden suggests focusing on the inhalation, which draws life force into the body; for anxiety, it's best to focus on the exhalation, which promotes a calm, peaceful mind.
Once you feel more balanced and calm, restorative poses such as Supta Baddha Konasana (Reclining Bound Angle Pose) or Viparita Karani (Legs-up-the-Wall Pose) can offer much-needed rest. Walden also recommends keeping your eyes open in Savasana (Corpse Pose), since closing them can often intensify feelings of restlessness and anxiety.
Strengthen Yourself With Awareness
In addition to its physiological benefits, yoga teaches awareness, an invaluable skill for people who struggle with anxiety or depression. If I'd had more awareness that night in the theater, I could have responded differently to my body's cues and perhaps been able to stave off a full panic attack. I would have noticed my shallow breathing—often a sign of anxiety—and tried yoga breathing techniques to help me focus and calm down. Or I might have noticed earlier in the day that I was exhausted and in no condition to be in such a stimulating environment. I might have even observed the effects of some deeper issues going on—at that time my job was miserable, my relationship was unstable, and I was sad being far away from family without a sense of home. If I'd been able to recognize any of those things, I could have made different choices along the way and perhaps reduced my suffering.
Usually, the first way Westerners learn to build awareness in yoga is by practicing the poses. But the myriad instructions heard in class aren't just designed to improve your poses. They give your busy mind something to focus on and therefore keep you in the present moment. For people with anxiety, this is a particular blessing. "When you're anxious, you can't focus on anything because you feel overwhelmed," says Judith Hanson Lasater, Ph.D., P.T., who wrote 30 Essential Yoga Poses. "Having something concrete to focus on, like a pose or your breath or a mantra, is very settling."
Complex instructions also force you to tune in to the subtle shifts occurring in your body. As you become more aware of these changes, you'll begin to notice subtle alterations in your mind and in your mood, too. You'll feel in a tangible way how the body and mind are connected. "By building awareness of your body, you start to notice the content of your mind," McCall says. "You see what's going on in your mind as you're doing each pose. Maybe you're beating yourself up. Maybe you're as proud as a peacock. Maybe you just want to escape."
As you continue to hone moment-to-moment awareness of your body, breath, emotions, and thoughts in your yoga practice, you'll bring that awareness to your daily life. "When you're paying attention, you're more in touch with your thoughts and feelings as they arise in the moment, which is half the battle of resolving them," Lasater says. In other words, when you're able to identify that something is wrong, you can address that particular issue in the moment, rather than ignoring it and unleashing it later in some painful way, which Lasater calls "being at the mercy of your energy."
So, what's the key to not being at the mercy of your energy? It's learning what's behind it (your awareness practice helps with this) and staying present with what's going on, even when you want to escape. That night in the theater, I wanted nothing more than to flee. I became convinced that once I got out of that building, I would feel better. But I didn't feel better. The truth is that for weeks, wherever I went, I wanted to jump out of my own skin. I learned from that experience that running from difficult emotions rarely works—eventually they catch up with you in all kinds of ways. But at that time I didn't yet have the skills to stay and breathe, and feel my painful emotions.
Sometimes though, panic or anxiety simply strikes, without being due to some deep-seated emotional conflict—you can suddenly feel hot and claustrophobic in an airplane when there are five hours to go before you land. It's equally important in those moments to observe your reaction from a neutral stance, stay with it, and watch as it passes away.
Yoga practice teaches the kind of acceptance you need to handle those situations, too. You'll undoubtedly have times when you want to come out of a pose because it's uncomfortable, it seems too hard, or it brings up difficult emotions. But yoga teaches you to notice how you feel and to use your breath to accept your current situation, even if it makes you uncomfortable, angry, sad, or agitated. As you learn to weather situations like these on your mat, you'll see that as quickly as difficult emotions arise, they also change and fade away.
You'll also be less fearful when similar feelings—whether physical or emotional—surface in your daily life. In fact, you'll gain confidence and know that you have the fortitude to cope with the array of emotions that course through you. Developing the ability to stay with pain can ultimately diffuse panic and depression, or allow you to get to the root of the difficulty. The ability to stay with pain will eventually allow it to subside.
Lasater believes that depression arises when a person tries to deny feelings such as anger or sadness and that learning to truly feel these difficult emotions is what weakens them until they pass away. "We develop a lot of strategies for escaping anxiety or sadness—overeating, drinking, even exercise—because we're a sadness-denying society," she says. "But when you learn to sit still in yoga or meditation, you become a container for your feelings. The discipline is not to interact with them, and they will pass away. Sitting with them really is the cure."
Michael Tompkins, who is a cognitive- behavioral therapist at the San Francisco Bay Area Center for Cognitive Therapy, concurs. "When one accepts panic instead of trying to push it away, it collapses," he says. Most people who experience panic or depression are so frightened by it that they focus their energy on never having such an experience again—which only makes things worse, Tompkins says. He uses the analogy of a riptide: If you try to swim against it, it pulls you under. But if you float with it and wait until it drops off, then you can bring yourself back to shore.
Look Within, Know Love
One of the most disorienting symptoms of depression is feeling disconnected from yourself and the world around you. But part of nondualist yoga philosophy is the belief that there is no separation between one's self and the rest of the universe. Our tendency to see ourselves as separate is an illusion that the mind and the ego create. Nondualism can be an elusive concept because we experience so much duality day to day, but even the smallest glimpse of it can forever change the way you see yourself in relation to others.
This seed was planted for me during a teacher-training course that Sarah Powers led several years ago. She was explaining the importance of meditation and implored us to sit daily. "When you meditate, you'll see your true nature," she said. "You'll know that you are perfect just as you are, because you are made from love."
At the time this sounded hokey. The possibility of being acceptable exactly as I was seemed unfathomable. Plus, I was terrified of exploring my inner demons alone and in silence. I raised my hand and asked, "What if you look inside and you don't see the goodness? What if it's just not there?" She answered, "You'll never know unless you try." Then she added, "Don't be afraid."
I was afraid and I didn't try. Not that day, that month, or even that year. It took three more years before I wholeheartedly surrendered to meditation. Then one day, in the midst of a meditation retreat, I felt it. The quietest, gentlest happiness. I suddenly felt as though I were a part of nature. It felt like tiny flowers were blooming in my heart. It felt as though I was surrounded by soft, shady trees. I felt a warm glow emanating from deep in my stomach, the same place that so often felt knotted and tight. It wasn't an explosive or ecstatic onrush of happiness. It was smaller and more comforting. And it dawned on me in that moment that I was completely fearless. I was anxiety-free. I finally understood the quote by yoga teacher and author Erich Schiffmann that has spurred me in my practice since the very beginning: "The release from fear is what finally precipitates the full flowering of love. In this state you will love what you see in others, and others will love you for having been seen. This is the softened perception of the world that yoga promotes."
That experience helped me trust in the flow of life. Suddenly, I knew that I with my quirks and neuroses, and my upstairs neighbor with his annoying habits, and even the people in the world who commit hateful acts are all made from love. I learned that when you connect with the deepest part of yourself, you realize that you are connected to everyone else, too.
I still have days, weeks, or months when I struggle with anxiety. I even have days when I fear that depression could once again come knocking on my door. But after years of getting to know myself better, I've come to have some appreciation for those emotions. Paradoxically, experiencing anxiety and depression has made me less afraid of life: I've been tested and I've made it through. It's also made me more sensitive to other people's struggles. I'm a better listener, I'm more compassionate, and I am much better at laughing at myself, which is a huge relief. I'm also convinced these experiences served as a moment of awakening that helped me find yoga, which has made me happier than I ever thought I could be. So even if you are in the midst of your toughest struggle yet, know that it will change; trust that it will give you deeper access to yourself. Someday you may even be grateful for it.
Yoga Practice for Depression
1. Adho Mukha Svanasana (Downward-Facing Dog Pose), variation
Effects: Combats anxiety and energizes the body.
Lie on your stomach with your palms by the sides of your chest with your fingers well spread. Come onto your hands and knees. Set your knees directly below your hips and your hands slightly forward of your shoulders. Place one or two folded blankets in line with your breastbone. The blankets should be high enough to support your head, but low enough so that you can lengthen your neck. Come back to your hands and knees. Turn the toes under, and exhale as you raise your buttocks high in the air, moving your thighs up and back. Keep your elbows straight as you lift your buttocks up and release the crown of your head onto the support. The action of the arms and legs serves to elongate your spine and release your head. Hold for 30 seconds to 1 minute, breathing deeply.
2. Paschimottanasana (a) to Halasana (b) (Seated Forward Bend to Plow Pose)
Effects: Brings relief from despondency or anxiety, energizes your whole body, and makes you feel more alive.
Do not do this sequence if you have neck problems, high blood pressure, or heart problems; if you are menstruating or pregnant; or if you have diarrhea or feel nauseated.
Sit on one or two folded blankets with your legs stretched out in front of you. Take a full, deep breath. Inhale and lift up through your sternum and head, making your spine slightly concave. Exhale and extend your torso over your legs. Rest your head just beyond your knees and your hands on the floor if you can. Do not allow your buttocks to lift off the blankets.
Come out of the forward bend, curling your back and pulling your knees up, and then roll backward into Plow. Raise your hands overhead to meet your feet. If you feel neck strain, support your back with your hands. Go back and forth between the two poses 10 to 15 times.
3. Adho Mukha Svanasana (Downward-Facing Dog Pose), variation
Repeat Downward-Facing Dog. Hold for 30 seconds to 1 minute.
4. Prasarita Padottanasana (Wide-Angle Standing Forward Bend), variation
Effects: Calms jittery nerves and combats fatigue.
Place a folded blanket or a bolster in front of you. Step your feet wide apart (about 4 feet or so), keeping the outer edges parallel. Keep your thighs well lifted. Exhale and bend forward from your hips, placing your hands on the floor between your feet. Lift your hips toward the ceiling as you draw your shoulder blades away from the ears. Head should be in the same position as if you were doing Handstand. Look up and extend your trunk forward, arching your back slightly so that the back is slightly concave from your tailbone to the base of your skull. Stay this way for 5 to 10 seconds. Then exhale, bend your elbows, and release the crown of your head onto the support. Stay here for 1 minute, breathing deeply. To come out, return to the concave back position, bring your hands to your hips, and raise your trunk.
Intermediate or advanced yoga students can do Salamba Sirsasana (Supported Headstand) instead, which is energizing, balances the emotions, and rejuvenates the brain.
5. Dwi Pada Viparita Dandasana (Two-Legged Inverted Staff Pose), variation
Effects: Opens the chest, lifts the spirits, and invigorates the body.
Put a firm blanket on a chair placed with its back about 2 feet from a wall. Sit backward on the chair, facing the wall, with your feet through the chair back and your buttocks at the chair's edge. The chair should be far enough away that your feet can press into the wall when your legs are outstretched. Holding the back of the chair, arch back so that your shoulder blades are at the front edge of the chair seat. Take your feet to the wall, legs slightly bent, and place your arms between the legs of the chair to hold the back legs or rails. Lengthen your legs, pressing the chair away from the wall, and roll your thighs in toward each other. If you have neck problems, rest your head on a bolster. Breathe quietly for up to a minute, and then come out of the pose.
6. Urdhva Dhanurasana (Upward-Facing Bow Pose), variation
Effects: Improves circulation, stimulates the nervous system, and generates a feeling of well-being.
Position two blocks against the wall, shoulder-width apart. Lie on your back with your head between the blocks, your knees bent, your feet hip-width apart, and your heels close to your buttocks. Bend your elbows and place your hands alongside your head with your fingers pointing toward your feet.
As you exhale, raise your hips and chest, straighten your arms, and stretch your legs. Lift your tailbone and move the backs of your thighs toward your buttocks. Hold for 5 to 10 seconds if you can. If not, come in and out of it two or three times. To come out, bend your knees and elbows and slowly lower your body to the floor.
7. Balasana (Child's Pose)
Effects: Releases spinal muscles after backbends and calms your nerves.
Kneel on the floor with your big toes touching and your knees slightly wider than your hips. Bend forward and stretch your arms and trunk forward. Rest your head on the floor or a blanket.
8. Salamba Sarvangasana (Shoulderstand)
Effects: Relieves irritability. Balances the emotions by quieting and nourishing the nervous system. Also, balances the endocrine system.
Do not do this pose (or Halasana) if you have neck or shoulder problems, have high blood pressure, or are menstruating.
Lie on two folded blankets supporting your neck and shoulders, with your arms stretched out alongside your body. Exhale, bend your knees, and raise your legs toward your chest. Pressing your hands into the floor, swing your bent legs over your head. Then support your back with your hands, with your fingers turning in toward the spine. Raise the hips and thighs even farther, straightening the legs as they come up. The top of the sternum should move toward the chin. Keep the elbows in toward each other, pressing the palms and fingers into the back as much as possible, and feel that the whole body is long and straight. If you have trouble keeping your elbows in, secure a strap around both arms just above the elbows. Stay here for several minutes.
9. Halasana (Plow Pose)
Effects: One of the most quieting poses for the nervous system; relieves irritability.
Continue to support your back with your hands and lower your legs over your head, placing your toes on the floor behind you. Firm your thighs to create space between your face and your legs. Stay here, breathing deeply and slowly for several minutes or as long as you're comfortable. To come out, slowly roll down one vertebra at a time. Rest with your back flat on the floor for several breaths.
At this point in the sequence you have several choices. If you feel calm and ready to rest, you can lie in Savasana (Corpse Pose) for 10 minutes or longer. If you still have anxiety or depression after this sequence, you can choose to do a restorative pose like Viparita Karani or you can do another set of invigorating poses to end on an energetic, positive note. If that's the case, repeat step 2, Paschimottanasana to Halasana, 10 to 15 times.
Andrea Ferretti is a senior editor at Yoga Journal. For additional ways that yoga can help with anxiety and depression, read Kriya Cure. Also, learn more about combining antidepressants and yoga see Sitting with Depression.