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Recently a medical study indicated that practicing Taiji [1] can help to relieve depression among the elderly.  The study was published in the March 6, 2011 issue of the American Journal of Geriatric Psychiatry [2].  According to the study’s first author Dr. Helen Lavretsky, a UCLA professor-in-residence of psychiatry, “This is the first study to demonstrate the benefits of tai chi in the management of late-life depression.”   A summary of the study was published recently in Science Daily [3].

The Science Daily article said that two million people age 65 and older suffer from depression, and 50% of those living in nursing homes.  The suicide rate among white men over 85 is the highest in the country, six times the national rate.  The depression problem will get worse because the number of Americans over 65 will double and the number of those over 85 will triple.  How to help elderly with depression becomes an increasingly important issue.

Elderly people with depression are often treated with anti-depression drugs.  However, according to Dr. Lavretsky, nearly two-thirds of elderly patients who are taking prescribed medication fail to achieve relief.  The recent UCLA study combined Taiji with medication.  According to the Science Daily article:

• The study began with 112 adults age 60 or older with major depression who were treated with the drug escitalopram, a standard antidepressant, for approximately four weeks.
• 73 of these patients who showed partial improvement continued with the medication treatment, but were then also randomly assigned to 10 weeks of either a Taiji class for two hours per week or a health education class for two hours per week.
• All 73 patients were evaluated for their levels of depression, anxiety, resilience, health-related quality of life, cognition and immune system inflammation at the beginning of the study and again four months later (i.e., about three weeks after the 10-week Taiji or health education class.
• The level of depression among each patient was assessed using a common diagnostic tool known as the Hamilton Rating Scale for Depression, which involves interviewing the individual.  The questions are designed to gauge the severity of depression.  A cut-off score of 10/11 is generally regarded as appropriate for the diagnosis of depression (i.e., a patient with a score of 10/11 or higher is considered to have depression).
• The study found that for the group that was randomly assigned to the Taiji class, 94% achieved a score of less than 10, with 65% achieving remission with a score of 6 or less.
• For the group that was randomly assigned to the health education class, 77% achieved a score of 10 or less, with 51% achieving remission with a score of 6 or less.
• The differences between the two groups were considered to be statistically significant.  They conclude that the Taiji exercises clearly made a difference in helping to alleviate the patients’ depression.

The study also found that besides helping with depression, the Taiji group also resulted in improved quality of life, better memory and cognition, and more overall energy as compared to the health education group.

In this study, Taiji exercise was combined with taking the antidepressant drug escitalopram.  An important question and potential follow-on study is whether Taiji exercise alone can lead to significant reduction in depression.  If yes, this would be a tremendous breakthrough, because antidepressant drugs have all kinds of potential side effects, such as nausea, dizziness, tremors, sleep disturbances, weight gain, dry mouth, congenital defects, stroke, sexual dysfunction, and even increased depression.  In fact, there is already evidence that exercises alone can help to relieve depression.  In a recent article in Time magazine (http://www.time.com/time/printout/0,8816,1998021,00.html), Dr. Jasper Smits, a psychologist in Dallas, summarized several studies dating back to the last 20 years showing the positive correlation of exercise alone and improvement in depression.  For example, in 1999, a Duke University study led by Dr. James A. Blumenthal investigated 156 depressed older adults.  Some were given the antidepressant drug Zoloft, some 30 minutes of exercise three times a week, and some both.  After six months, the group who exercised without also taking Zoloft did better than the other two groups.  Furthermore, the group that took Zoloft and exercised had a higher rate of relapse into depression than did the group that merely exercised.  Dr. Blumenthal speculated that taking an antidepressant drug might actually undermine self-esteem.  The study (http://www.ncbi.nlm.nih.gov/pubmed/10547175?dopt=Abstract) concluded “An exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons. Although antidepressants may facilitate a more rapid initial therapeutic response than exercise, after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD (major depressive disorder).”

Dr. Smit was surprised that his colleagues consider his approach (of exercise alone) to be novel, and was even more surprise that more people weren’t working in this area when he got into it, given that several previous studies already suggested the value of such an approach.  He asked “why don’t doctors hand out prescriptions for exercise before sending patients to the drug store?  Why are so few researchers developing such programs?”  The answer is maybe that the pharmaceutical companies (and therefore the medical community as a whole) don’t benefit financially from exercise programs, but they do on medications.  In spite of the many negative side effects previously mentioned and a lot of evidence suggesting that antidepressant drugs often don’t work, Americans currently still spend around $10 billion a year for antidepressant drugs.

If an exercise program can help with depression for older adults, then a Taiji exercise program could be the best exercise program, because of its soft and slow movements.  It is an exercise that has essentially no adverse physical impacts on the body, and one doesn’t have to be in good physical health to do the exercise.

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[1] Taiji is also spelled as Tai Chi.

[2] Helen Lavretsky (M.D.), Lily L. Alstein (Ph.D.), Richard E. Olmstead (Ph.D.), Linda M. Ercoli (Ph.D.), Marquertie Riparetti-Brown (B.S.), Natalie St. Cyr (B.A.), Michael R. Irwin (M.D.), “Complementary Use of Tai Chi Chih Augments Escitalopram Treatment of Geriatric Depression,” American Journal of Geriatric Psychiatry, 2011; : 1 DOI: 10.1097/JGP.0b013e31820ee9ef.  The abstract of this article can be seen at (may need to copy and paste the link):

http://journals.lww.com/ajgponline/pages/articleviewer.aspx?year=9000&issue=00000&article=99664&type=abstract.

[3] http://www.sciencedaily.com/releases/2011/03/110316131122.htm.  I want to thank Rachel Steinberg, Executive Director of the Senior Citizens Center of East Brunswick, NJ for showing me this article.  Another reference for this research is:  http://newsroom.ucla.edu/releases/tai-chi-beats-back-depression-199019.