Friday Q&A: Depression, Medication, and Meditation

The Gray Tree by Piet Mondrian

Q: I am an avid follower of Yoga for Healthy Aging and have benefitted greatly from the wisdom imparted on this site. Perhaps you can shed some light on the following question: I am taking several medications for depression and anxiety. I would like to start a meditation practice but am unsure about the interactions between psychotropic medications and meditation. Can you offer me some advice with this?

A: Your question is timely and important. As you know, today we turn toward combining the wisdoms of the East and the West. More and more people are managing their moods and physical states by using meditation and body /mind systems to deal with anxiety and depression. There is a newly emerging discipline called “yoga therapy,” which specializes in different forms of treatment.

Meditation is powerful, as you know. But one problem of meditating when you have depression is that the meditation itself can turn on you and become a litany of self-blame and despair. You might think you’re meditating and helping yourself, but you’re not; you’re ruminating, digging yourself into a deeper and deeper hole. So the biggest contraindication to meditating is severe unregulated depression, and this must be respected because the rumination picks up steam and can drive you into the depths. So it’s wise to wait until you’ve achieved balance before beginning a meditation program. 

You’re wise to ask about the interactions between psychotropic medications and meditation. Most research indicates that it is safe to meditate and medicate both, but until the medication has been carefully titrated and shown to work over a period of time, it is safer to allow yourself to come to your center before beginning anything new. Of course, there are no hard and fast rules; this varies from one individual to the next.

To play it safe, here is what I would do. First off, I would consult with my doctor to check that my moods have stabilized and that meditation is okay. Does your doctor practice Integrative Medicine? That might prove to be an important piece in your decision making process.

Then, if I decided to begin a daily medication practice, I would consult a meditation specialist, an expert teacher, and work closely with that person to make sure that I got on the right track and stayed there. Meditation is a simple practice, so simple that it can be hard to learn. You and your teacher will work together to find the methods that are best for you as an individual. The rewards of a daily meditation practice accrue slowly, but over time they add up and they help you learn to know yourself and to accept yourself deeply. This deep acceptance of self in the moment, whoever that self might be, plays a big part in helping with depression.

Since you’re a regular reader of  Yoga for Healthy Aging, I guess that you probably are already involved in yoga, which is another form of meditation. Yoga is often called a moving meditation. You might consider consulting with a yoga therapist who specializes in mood disorders, someone who will help you find the best yoga moves for you and teach you meditation and pranayama or breath work practices. Different movements have different emotional effects, too, as can the length of time the different positions are held. 

You might benefit from reading Amy Weintraub's book Yoga for Depression. Amy has a training program where she works with therapists to teach them yoga skills. Or you might look for a yoga therapist on the International Association of Yoga Therapists (IAYT) website, where there is a list of therapists, organized by location. 

I’m talking a lot about yoga because you’re a reader of Yoga for Healthy Aging, but maybe you would rather choose another kind of meditation practice. There are different schools for you to check out, and the essential factor is: do you like it? Does it appeal to your taste? Investigate, try different approaches. What is your gut feeling? 

You might start your research by reading a few books like The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness (Book & CD), by Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn, or A Path with Heart by Jack Kornfeld. You could check out a Zen Center. There’s lots of choices, and I’m always happy to say it’s a big world! Whatever your choice, I wish you success. And thanks for asking.

—Lynn


Lynn Anjali Somerstein, PhD, NCPsyA, LP, RYT, is a licensed psychotherapist and yoga therapist in private practice, specializing in anxiety, depression and PTSD. She is also the author of numerous articles about yoga, anxiety, attachment issues and psychotherapy. Lynn is grateful to her many teachers at the Integral Yoga Institute and the National Psychological Association for Psychoanalysis who offered her extensive and deep training in yoga, yoga therapy, and psychoanalysis. See lynnsomerstein.com for more information about Lynn. 

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Yoga for Biploar Disorder: A Conversation Between Lynn Somerstein and Stephen Lewis

by Lynn Somerstein, PhD, RYT, LP

Two Flowers in Conversation by Shitao

Stephen Lewis, LMHC, NCC, E-RYT and I became acquainted several years ago when we were introduced by a mutual friend, who knew we were both interested in yoga and psychotherapy. We’ve had many conversations since then about the effects yogic practice has on mental health, including its usefulness working with Bipolar Disorder. We’re both psychotherapists and yoga therapists in private practice in New York City, and we integrate mind-body techniques, especially yoga and mindfulness, into our psychotherapy work. We’re also both committed to promoting a wellness lifestyle and to removing the stigma often associated with mental health problems.

Lynn: Steven, I began doing yoga over 50 years ago, when I was still in high school. I learned it from a book, since there were no yoga studios near where I lived, and I loved it right away. I was a jumpy teenager and it calmed me down. What first drew you to yoga?

Stephen: My journey started about 15 years ago. At that time and for the four years that followed, yoga was primarily a physical practice for me as well as one that helped me relax and feel centered.

Lynn: Yes, typically people are first drawn to yoga as a physical practice. I was, too. And then if you stick with it, things deepen.

Stephen: It was when I started practicing on a daily basis that I began to experience the more profoundly positive effects of yoga. In reading about the yogic lifestyle and yoga psychology I became excited by the idea of immersing myself in the practice of yoga.

Lynn: When I was in my twenties I started studying yoga at the Integral Yoga Institute, and forty years later I’m still immersed in advanced studies there. There is so much to learn!

Stephen: I went to the Kripalu Center for Yoga and Health, practicing seva (selfless service) as a karma yogi, and I noticed the transformative effects a holistic yoga lifestyle had on me and those around me. I became certified as a yoga instructor at Kripalu and then was drawn to travel to India, the birthplace of yoga. In Varanasi I felt called to integrate yoga and psychotherapy. When I returned to America, I took steps to do just that.

Lynn: I also felt a deep need to integrate yoga and psychotherapy. I found that the combination of the two has a calming, centering effect on people in my therapy practice—and on me, too! Among other things, yoga is about deep energy work. It is effective for people with anxiety, PTSD, and depression, and I think it can help people with Bipolar Disorder, although so far there is not much research on it.

Stephen: When it comes to scientific research, the jury is still out in regards to whether yoga can be helpful for those with Bipolar Disorder. As of this date, very few studies have been published on the question and those few leave much to be desired in terms of their quality. 

Lynn: The International Association of Yoga Therapists has a small bibliography about yoga and BD. People with BD often need to take medication and always need to live a structured life as free from stress as possible, attend to nutrition, and get enough sleep and exercise. Psychotherapy helps, too. Clearly, a yogic lifestyle encourages a wellness approach by teaching people to have deep sensitivities to their needs, and giving them the means to meet their needs in healthy and appropriate ways.

Stephen: It’s important to concentrate on a calming, centering yoga practice.

Lynn: But sometimes neither yoga nor medication seem to work. For example, some years ago I worked with a young man with Bipolar Disorder. He was on medication but it was quite difficult to titrate, and he had many relapses, which is why he came to me for treatment. He said he was powerless in the face of his disease, and that he felt like a werewolf. We worked together for several months to try to ground and balance his energy using talk therapy, pranayama, and calming asana, but we weren’t successful. People often describe the “highs” that are associated with Bipolar Disorder as enjoyable, but they certainly weren’t to this man. When he relapsed he was supercharged and miserable. His body and face were painfully taut, his eyes protruded; he said he felt like a slave to some malevolent force. His disease was unusually virulent.

However, often people with BD can find the right combination to achieve balanced lives, and a yoga lifestyle coupled with psychotherapy and medication, if needed, can be very helpful. Some of the yoga practices that help are breath work, asana, and restorative techniques. But it is important to work with a yoga therapist who has specialized training in talk therapy and who understands how to help people in recovery, people with mood disorders, or people who have been traumatized. 

Stephen, how do you help people with BD?

Stephen: I use calming and balancing pranayama, including nadi shodhana (alternate nostril breathing), yogic/3-part/dirga breathing, and bhramari (bee’s breath).

Lynn: Like me. What about asana?

Stephen: Cat/Cow warm ups, gentle backbends and forward bends can promote balance. Backbends tend to open the heart and can instill a sense of openness, energy, and positivity. Forward bends can help people feel safe, grounded, and calm. Managing this balance in a slow and mindful way can act as model for maintaining balance in mood states. Twists tend to cleanse and neutralize, and are helpful to intersperse throughout a practice.

Lynn: Are there any particular poses or practices that you feel should be avoided at certain times? Or at all times?

Stephen: Extremes are best to be avoided, as balance is the key in using yoga for Bipolar Disorder. When it comes to pranayama (breathing exercises), we should be careful with intense practices that are prolonged and energizing, such as kapalabhati, breath of fire, or Sudharshan Kriya Yoga (SKY). Asana practices that are fast, vigorous, or practiced in a heated environment can aggravate or push people towards imbalance. Some examples of this are intense vinyasa classes, hot yoga, power yoga, Kundalini and Bikram yoga.

Lynn: Interesting that the kinds of yoga to be avoided are some of the most popular kinds of yoga today and just what an energetic young person might be drawn to. People don’t understand the powerful effects of yoga.

Stephen: Maybe so. Forms such as Hatha, Kripalu, Iyengar, Ishta, Anusara, Integral and Restorative Yoga are preferred for those with Bipolar Disorder, but we all need to manage our physical and mental energy so we can maintain and restore balance.

Stephen Lewis, LMHC, NCC, E-RYT, specializes in Integrative (Holistic) Psychotherapy, with years of training and experience in a wide range of techniques such as Mindfulness and Meditation, Cognitive Behavioral Therapy (CBT), Yoga Therapy, Dialectical Behavioral Therapy (DBT), and Hypnosis, amongst others. I earned my Masters degree at NYU and was trained at Bellevue Hospital. See stephenflewis.com for more information about Stephen. 


Lynn Anjali Somerstein, PhD, NCPsyA, LP, RYT, is a licensed psychotherapist and yoga therapist in private practice, specializing in anxiety, depression and PTSD. She is also the author of numerous articles about yoga, anxiety, attachment issues and psychotherapy. Lynn is grateful to her many teachers at the Integral Yoga Institute and the National Psychological Association for Psychoanalysis who offered her extensive and deep training in yoga, yoga therapy, and psychoanalysis. See lynnsomerstein.com for more information about Lynn. 

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