The British Journal of Psychiatry (2019) 214, 218–224. doi: 10.1192/bjp.2018.265 RETRACTED – Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression Emily Ionson*, Jayneel Limbachia*, Soham Rej, Klajdi Puka, Ronnie I. Newman, Stephen Wetmore, Amer M. Burhan and Akshya Vasudev Background Results Late-life depression (LLD) is a disabling disorder and antide- All time and frequency domain measures of HRV did not signifi- pressants are ineffective in as many as 60% of cases. Converging cantly change in either arm. However, there was significant evidence shows a strong correlation between LLD and subse- improvement in the SSM arm, compared with TAU, on the HRSD quent risk of cardiovascular disease. There is a need for new, (difference in mean, 2.66; 95% CI 0.26–5.05; P = 0.03). well-tolerated, non-pharmacological augmentation interven- tions that can treat depressive symptoms as well as improve Conclusions heart rate variability (HRV), an important prognostic marker for Compared with TAU, SSM is associated with improvements in development of subsequent cardiovascular disease. Meditation- depressive symptoms but does not significantly improve HRV in based techniques are of interest based on positive findings in patients with LLD. These results need to be replicated in subse- other samples. quent studies incorporating a group-based, active control arm. Aims Declaration of interest We aimed to assess the efficacy of Sahaj Samadhi meditation R.I.N. is the Director of Research and Health Promotion for the Art (SSM), an underevaluated, standardised and manualised medi- of Living Foundation, Canada and supervised the staff providing tation intervention, on HRV and depressive symptoms. Sahaj Samadhi meditation. S.R. has received research funding from Satellite Healthcare for a mindfulness meditation trial in Method patients on haemodialysis. The remaining authors report no Eighty-three men and women aged 60–85 years, with mild to financial or other relationship relevant to the subject of this article. moderate depression and receiving treatment as usual (TAU) were randomised to either the SSM or TAU arm. Those Keywords allocated to SSM attended 4 consecutive days of group medita- Late-life depression; automatic self-transcending meditation; tion training, using personalised mantras followed by 11 weekly non-pharmacological intervention; major depressive disorder; reinforcement sessions. HRV and Hamilton Rating Scale for heart rate variability. Depression (HRSD; 17-item) score were measured at baseline and 12 weeks. Copyright and usage © The Royal College of Psychiatrists 2018. Depression is now rated as the most disabling health condition stress-alleviating response.10 Additionally, ASTM may offer benefits worldwide,1 and affects up to 9.3% of community-dwelling elderly on cardiovascular health, as per recent recommendations published people.2 Between 2015 and 2050, the proportion of the global popu- by the American Heart Association, who concluded that transcen- lation aged ≥60 years will increase from 12 to 22%.3 This suggests dental meditation, a form of ASTM, may be considered for use in that the number of people with late-life depression (LLD) will clinical practice to lower blood pressure, whereas all other medita- more than double by 2050. Patients with LLD are significantly bur- tion techniques, including mindfulness, could not be recommended dened with psychiatric comorbidities such as anxiety disorders,4 as at this time.11 Such a reduction in blood pressure may be mediated well as a 1.5- to 2-fold increased risk of developing a subsequent via the baroreflex control of the vagal-sympathetic autonomic tone. ischemic heart event.5 The relationship between LLD and cardiovas- This autonomic tone can be easily measured by modern HRV cular disease is likely complex and bidirectional, which may be recording systems. mediated by impairment in the autonomic control of the heart.6 Sahaj Samadhi meditation (SSM) is a less well-known medita- Such a risk can be quantified by measuring heart rate variability tion technique also belonging to the ASTM category, which has (HRV), with a recent meta-analyses showing that low-frequency not yet been investigated in the LLD population. SSM may have a heart rate variability (LF HRV) is significantly lower in patients beneficial effect on depression symptoms as well as HRV,12 but with LLD.6 CurrentRETRACTED treatments for LLD, which include antidepres- this requires further validation. We describe the first randomised sants, have been found to be inadequate, with modest response rates controlled trial (RCT) of SSM versus treatment as usual (TAU) in of 44%7 and high rates of adverse events.8 Additionally, some patients suffering from LLD. We hypothesized that people in the antidepressants have been linked to worsening of autonomic SSM arm would have a significant improvement in HRV as well impairment associated with LLD.9 Non-pharmacological interven- as depressive symptoms, compared with the TAU arm. tions, particularly meditation-based and automatic self-transcend- ing meditation (ASTM) interventions, are of interest. This Method particular category of meditation offers ease of learning, and may have beneficial effects on depressive symptoms, likely through its Study design and participants We conducted a single-centre, assessor-blinded RCT comparing the * Joint first authors. effects of a 12-week SSM arm with TAU. Ethical approval was 218 Downloaded from https://www.cambridge.org/core. 26 Sep 2021 at 08:48:30, subject to the Cambridge Core terms of use. Meditation effects on HRV and depressive symptoms received from the Research and Ethics Board of Western University We excluded patients who were participating in other studies or (Ontario, Canada) in April 2014 (approval no. 104936). Informed who regularly practiced any other type of meditation, including consent was obtained from all participants after they had a clear mindfulness or breath-based techniques; had been diagnosed with understanding of study procedures. The study was registered at a stroke, transient ischemic attack, heart disease or a seizure in Clinicaltrials.gov (identifier: NCT02149810) on 18 July 2013. the past year; suffered a head injury within the past 6 months; After trial registration, beginning on 2 June 2014, we recruited 83 scored <24 on the Mini-Mental State Examination (MMSE);15 participants (Table 1) suffering from a mild to moderate major had experienced active suicidal thoughts and/or plan (as assessed depressive episode, as confirmed by an independent trained rater. by a clinical interview) at any stage of the study; or had other signifi- If there were any concerns about the presence or lack of this diag- cant mental health diagnoses (including substance dependence, nosis, clarification was sought from either of two experienced geri- post-traumatic stress disorder, obsessive–compulsive disorder and atric psychiatrist investigators (A.V. and A.M.B.). major neurocognitive disorder). Supportive psychotherapy, as pro- Recruitment strategy consisted of advertisements placed in vided by participants’ case managers and/or their geriatric psychia- community centres and libraries in London (Ontario, Canada) trists, was allowed. and surrounding areas, with the headline ‘A Meditation Study for ’ Seniors looking for Relief from Feeling Low and Depressed .We Randomisation, blinding and allocation concealment screened 270 potential participants from June 2014 to August 2016, through physician referrals and recruitment posters. Of Participants were randomised by an independent clerical staff using these, 95 met the study criteria and were enrolled and randomised. computer-generated randomisation. The outcome assessors and ’ A final sample of 83 participants completed the study procedures investigators were kept blind to the participants allocation status. (Fig. 1). The randomisation sequence code was kept safe in the clerical staffs’ locked cabinet for the duration of the trial. The only theoret- ical exception for the code to be broken was any serious adverse Inclusion/exclusion criteria event and need for subsequent participant withdrawal. The ran- domisation code was broken after the 12-week follow-up assess- – Inclusion criteria included men and women aged 60 85 years, with ment point for all study participants. An independent statistician a current major depressive episode of mild or moderate severity, as performed the statistical analyses. confirmed by the Mini Neuropsychiatric Interview13 and a Hamilton Rating Scale for Depression (HRSD; 17-item) score >8 and <22.14 Other inclusion criteria included being of stable physical Study intervention health status, with no severe cardiac episode in the past 12 months; SSM training was offered in groups of four or more participants being able to sit comfortably for 30–45 min without any major pain by certified teachers from our collaborating partner, the Art of or discomfort; being able to hear and follow verbal instructions with Living Foundation, under the supervision of their Research eyes closed; and being willing and able to attend four initial SSM Director (R.I.N.). The instructional phase consisted of four training sessions and 75% of follow-up appointments as an out- 90–120 min sessions on consecutive days. On day 1, participants patient. met with the instructor in a group format to learn about the Table 1 Demographic and clinical characteristics of the intervention (SSM) and control (TAU) group Intervention