Let’s say you’ve been feeling really down lately and can’t seem to shake it. You go to your primary care physician and he recommends a prescription for an anti-depressant, or referral to a psychiatrist for further evaluation. It’s what you’d expect.
Now imagine walking away with a prescription for an over-the-counter herb coupled with yoga and meditation.
With the rise in integrative medicine and whole person care, this reality is getting closer. But before broad-based conventional medicine will even consider the thought, it’s going to take evidence-based science to prove the effectiveness of age-old therapies such as these.
Taking steps to provide that science is the exceptional team of Desert AIDS Project, the Chopra Foundation, and UC-San Diego which is launching a research study this fall on treating mild-to-moderate depression
and inflammation with mind-body practices. The study will examine the effects of yoga, meditation and the Ayurvedic herb ashwagandha on key biochemical and psychological indicators of health and wellbeing in persons living with HIV (PLWH). It is anticipated that the findings will demonstrate the value of taking a more comprehensive whole systems approach to patient care.
The partnership first began three years ago when The Clinton Foundation and Dr. Chopra’s team met to explore opportunities for humanitarian impact and Desert AIDS Project’s name was brought forward, says CEO David Brinkman who has been connected with Chopra’s work for his own personal development for more than a decade. Dr. Chopra guided the research protocol development with the aim of achieving the best possible outcomes for DAP patients, and hopefully all PLWH throughout the world.
“We are very excited about collaborating with Deepak Chopra’s organization and UCSD,” says DAP Director of Research Tulika Singh, MD, who is also associate chief medical officer at the federally qualified health center. “Currently there is little research that demonstrates whether incorporating complementary or holistic therapies can contribute to improved health outcomes and self-care in PLWH. And if we show that PLWH with all their stressors can do it, then others can, too.”
For the two-year study, DAP patients who wish to participate will be screened using the PHQ9 depression index scale. Those deemed to have mild-to-moderate depression currently not being treated with drugs or therapy will be assigned to three groups of 30 participants each. The first control group will have no yoga, meditation or herbal supplement interventions; a second group will participate in Hatha yoga and mantra meditation and will supplement with ashwagandha plant extract daily; the third will participate in Hatha yoga and mantra meditation but will not take the herb.
Ashwagandha was selected as it is one of the most studied Ayurvedic herbs with strong data behind it, a positive safety profile, and little concern about drug interaction. The herb has been shown to specifically reduce neuro-inflammation as it contains certain phyto-nutrients that cross the blood brain barrier, and neuro-inflammation is linked to depression. It is also a good adaptogen, which helps bodily systems adapt to stress and reduce the effects.
During the study, participants will continue with their prescribed anti-retroviral therapy (ART). Labs for the study will be incorporated into the quarterly labs patients already receive with 3 inflammatory markers and 3 HIV viral load markers measured, along with regular depression monitoring.
Participants in the mind-body control groups will take part in two yoga and two meditation classes weekly with additional practice on their own at home. The group practices will take place at Urban Yoga located within DAP and taught by Chopra Center-trained teachers. There is no cost to patients and participants will receive $100 gift cards when they have completed the study.
The thought is that these mind-body therapies may result in improved mental and physical well-being leading to improved biomarkers (increased levels of CD-4 cells, reduced viral loads, and reduced inflammation), improved mental health (reduced symptoms of depression), and enhancement of self-care management and adherence to treatment and medication regimens.
This research project is one of many mind-body studies conducted by Dr. Chopra’s organization, says Sheila Patel, MD, chief medical officer of Chopra Global and part of the Chopra Foundation research team. Dr. Patel is also the medical director of the Mind-Body Medical Group located at the Chopra Center in Carlsbad. “At the center, we integrate western medicine with Ayurvedic principles and lifestyle. We see a lot of people with acute problems and with this model, we not only help them heal with western medicine tools, we also teach them how to activate their natural healing mechanisms to help reverse disease and to stay healthy.”
“This is how all medicine should be,” she adds. “A lot of physicians feel that you can either do one or the other; but that is not the case. It’s a beautiful blend; they don’t contradict each other in fact, they complement each other.”
Both Singh and Patel come from conventional allopathic training and practice but were drawn to the whole systems model of integrative care. Both are also of Indian descent and were familiar with Ayurvedic philosophies and medicine from their parents. The work they are currently doing has brought them back to their roots.
“Growing up, we were ‘tortured’ every morning by yoga with dad before school,” says Singh. “As soon as I graduated from high school, I lost interest, but I have rediscovered my love for it with the Chopra Center training.” She standardly prescribes yoga and meditation to her clients and is creating a section on DAP’s medical records software to incorporate yoga, meditation and supplementation into prescribed elements for treatment plans. “So, when a doctor goes to order something, they will easily see these modalities and possibly think yoga and other complementary modalities instead of medication for pain or depression management.”
Patel completed residency and board certification in family medicine. “When I went into medicine, my real interest was to relieve suffering and to get to know my patients and follow them over time.” She worked in small communities and was able to do full-spectrum care from shifts in the ER to delivering babies. “We felt good about treating acute illness and getting patients out of the hospital, but when patients asked how to keep it from happening again, we didn’t have the tools to help them. So, it became very unsatisfying to me.”
She started researching integrative care and came to the Chopra Center almost 10 years ago to learn Ayurvedic principles via their CME program. “The idea of whole-systems health care really resonated with me and I was hooked.” A year later she came to work at the center in what she calls her dream job.
“We want to validate a lot of these practices so they can be more accepted into the medical community; so medical professionals can feel confident that what they are doing has some basis to it – not only that they are time-tested traditions – but also scientific validation to what we are doing.”
“People should have the opportunity to choose which treatment feels right for them,” she adds, “but modalities like yoga and meditation for stress and inflammation management are not even being presented currently. We have to start the discussion.”
The Chopra research team appreciates partners like DAP who have patients and medical practitioners open to integrative care.
“We are very blessed that so many in our valley are open to holistic therapies,” states Singh. “The objective for me and my patients is to make these modalities a lifestyle.”
“If we started yoga and meditation earlier with our children as they do in India, we may see less mental illness,” she feels. “Everyone should incorporate these practices into their lives.”
The team hopes to present their findings in 2022 at the HIV industry’s largest global forum, The Conference on Retroviruses and Opportunistic Infections (CROI), where Singh says, to her knowledge, nothing like this study has ever been presented. “From there, the protocol is certain to grow globally.”
Members of the research team will be appearing at The Earthing Movie Palm Springs screening on September 15 to present the study. For more information read our article.