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Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression

  • Emily Ionson (a1), Jayneel Limbachia (a2), Soham Rej (a3), Klajdi Puka (a4), Ronnie I. Newman (a5), Stephen Wetmore (a6), Amer M. Burhan (a7) and Akshya Vasudev (a8)...

Late-life depression (LLD) is a disabling disorder and antidepressants are ineffective in as many as 60% of cases. Converging evidence shows a strong correlation between LLD and subsequent risk of cardiovascular disease. There is a need for new, well-tolerated, non-pharmacological augmentation interventions that can treat depressive symptoms as well as improve heart rate variability (HRV), an important prognostic marker for development of subsequent cardiovascular disease. Meditation-based techniques are of interest based on positive findings in other samples.


We aimed to assess the efficacy of Sahaj Samadhi meditation (SSM), an underevaluated, standardised and manualised meditation intervention, on HRV and depressive symptoms.


Eighty-three men and women aged 60–85 years, with mild to moderate depression and receiving treatment as usual (TAU) were randomised to either the SSM or TAU arm. Those allocated to SSM attended 4 consecutive days of group meditation training, using personalised mantras followed by 11 weekly reinforcement sessions. HRV and Hamilton Rating Scale for Depression (HRSD; 17-item) score were measured at baseline and 12 weeks.


All time and frequency domain measures of HRV did not significantly change in either arm. However, there was significant improvement in the SSM arm, compared with TAU, on the HRSD (difference in mean, 2.66; 95% CI 0.26–5.05; P = 0.03).


Compared with TAU, SSM is associated with improvements in depressive symptoms but does not significantly improve HRV in patients with LLD. These results need to be replicated in subsequent studies incorporating a group-based, active control arm.

Declaration of interest

R.I.N. is the Director of Research and Health Promotion for the Art of Living Foundation, Canada and supervised the staff providing Sahaj Samadhi meditation. S.R. has received research funding from Satellite Healthcare for a mindfulness meditation trial in patients on haemodialysis. The remaining authors report no financial or other relationship relevant to the subject of this article.

Corresponding author
Correspondence: Akshya Vasudev, A2-607, Victoria Hospital, London Health Sciences Centre, London, ON N6A5W9, Canada. Email:
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1World Health Organization (WHO). Depression. WHO, 2018 (
2Luppa, M, Sikorski, C, Luck, T, Ehreke, L, Konnopka, A, Wiese, B, et al. Age- and gender-specific prevalence of depression in latest-life--systematic review and meta-analysis. J Affect Disord 2012; 136(3): 212–21.
3World Health Organization (WHO). 10 Facts on Ageing and Health. WHO, 2018 (
4Manetti, A, Hoertel, N, Le Strat, Y, Schuster, J-P, Lemogne, C, Limosin, F. Comorbidity of late-life depression in the United States: a population-based study. Am J Geriatr Psychiatry 2014; 22(11): 1292–306.
5Gleason, OC, Pierce, AM, Walker, AE, Warnock, JK. The two-way relationship between medical illness and late-life depression. Psychiatr Clin North Am 2013; 36(4): 533–44.
6Brown, L, Karmakar, C, Gray, R, Jindal, R, Lim, T, Bryant, C. Heart rate variability alterations in late life depression: a meta-analysis. J Affect Disord 2018; 235: 456–66.
7Nelson, JC, Delucchi, K, Schneider, LS. Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence. Am J Geriatr Psychiatry 2008; 16(7): 558–67.
8Kok, RM, Reynolds, CF III. Management of depression in older adults: a review. JAMA 2017; 317(20): 2114–22.
9Nezafati, MH, Vojdanparast, M, Nezafati, P. Antidepressants and cardiovascular adverse events: a narrative review. ARYA Atheroscler 2015; 11(5): 295304.
10Walton, KG, Schneider, RH, Nidich, SI, Salerno, JW, Nordstrom, CK, Bairey Merz, CN. Psychosocial stress and cardiovascular disease part 2: effectiveness of the transcendental meditation program in treatment and prevention. Behav Med 2002; 28(3): 106–23.
11Brook, RD, Appel, LJ, Rubenfire, M, Ogedegbe, G, Bisognano, JD, Elliott, WJ, et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association. Hypertension 2013; 61(6): 1360–83.
12Vasudev, A. WPA XVII World Congress Of Psychiatry: Sahaj Samadhi Meditation, a Type of Automatic Self Transcending Meditation, Improves Autonomic Dyscontrol in Late-Life Depression. World Psychiatric Association, 2017 (
13Lecrubier, Y, Sheehan D, V, Weiller, E, Amorim, P, Bonora, I, Harnett Sheehan, K, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry 1997; 12(5): 224–31.
14Zimmerman, M, Martinez, JH, Young, D, Chelminski, I, Dalrymple, K. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord 2013; 150(2): 384–8.
15Folstein, MF, Folstein, SE, McHugh, PR. ‘Mini-Mental State’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189–98.
16Hillebrand, S, Gast, KB, de Mutsert, R, Swenne, CA, Jukema, JW, Middeldorp, S, et al. Heart rate variability and first cardiovascular event in populations without known cardiovascular disease: meta-analysis and dose-response meta-regression. Eurospace 2013; 15(5): 742–9.
17Busner, J, Targum, SD. The Clinical Global Impressions Scale: applying a research tool in clinical practice. Psychiatry 2007; 4(7): 2837.
18Pachana, NA, Byrne, GJ, Siddle, H, Koloski, N, Harley, E, Arnold, E. Development and validation of the Geriatric Anxiety Inventory. Int Psychogeriatr 2007; 19(1): 103–14.
19Washburn, RA, Smith, KW, Jette, AM, Janney, CA. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 1993; 46(2): 153–62.
20Raphael, D, Brown, I, Renwick, R, Cava, M, Weir, N, Heathcote, K. Measuring the quality of life of older persons: a model with implications for community and public health nursing. Int J Nurs Stud 1997; 34(3): 231–9.
21Vanderkooy, JD, Kennedy, SH, Bagby, RM. Antidepressant side effects in depression patients treated in a naturalistic setting: a study of bupropion, moclobemide, paroxetine, sertraline, and venlafaxine. Can J Psychiatry 2002; 47(2): 174–80.
22Parmelee, PA, Thuras, PD, Katz, IR, Lawton, MP. Validation of the Cumulative Illness Rating Scale in a geriatric residential population. J Am Geriatr Soc 1995; 43(2): 130–7.
23Lohr, S, Schochet, PZ, Sanders, E. Partially nested randomized controlled trials in education research: a guide to design and analysis. Natl Cent Educ Res 2014; 3129: 179.
24Nijjar, PS, Puppala, VK, Dickinson, O, Duval, S, Duprez, D, Kreitzer, MJ, et al. Modulation of the autonomic nervous system assessed through heart rate variability by a mindfulness based stress reduction program. Int J Cardiol 2014; 177: 557–9.
25Toni, G, Belvederi Murri, M, Piepoli, M, Zanetidou, S, Cabassi, A, Squatrito, S, et al. Physical exercise for late-life depression: effects on heart rate variability. Am J Geriatr Psychiatry 2016; 24(11): 989–97.
26Chu, I-H, Wu, W-L, Lin, I-M, Chang, Y-K, Lin, Y-J, Yang, P-C. Effects of yoga on heart rate variability and depressive symptoms in women: a randomized controlled trial. J Altern Complement Med 2017; 23(4): 310316.
27Pocklington, C. Review article depression in older adults. BJMP 2017; 10(1): a1007.
28Sgoifo, A, Carnevali, L, Alfonso, MdlA, Amore, M. Autonomic dysfunction and heart rate variability in depression. Stress 2015; 18(3): 343–52.
29Kaufman, ES, Bosner, MS, Bigger, JTJ, Stein, PK, Kleiger, RE, Rolnitzky, LM, et al. Effects of digoxin and enalapril on heart period variability and response to head-up tilt in normal subjects. Am J Cardiol 1993; 72(1): 95–9.
30Istenes, I, Körei, AE, Putz, Z, Németh, N, Martos, T, Keresztes, K, et al. Heart rate variability is severely impaired among type 2 diabetic patients with hypertension. Diabetes Metab Res Rev 2014; 30(4): 305–12.
31Nicolini, P, Ciulla, MM, De Asmundis, C, Magrini, F, Brugada, P. The prognostic value of heart rate variability in the elderly, changing the perspective: from sympathovagal balance to chaos theory. Pacing Clin Electrophysiol 2012; 35(5): 622–38.
32Lenze, EJ, Mulsant, BH, Blumberger, DM, Karp, JF, Newcomer, JW, Anderson, SJ, et al. Efficacy, safety, and tolerability of augmentation pharmacotherapy with aripiprazole for treatment-resistant depression in late life: a randomised, double-blind, placebo-controlled trial. Lancet 2015; 386(10011): 2404–12.
33Wetherell, JL, Hershey, T, Hickman, S, Tate, SR, Dixon, D, Bower, ES, et al. Mindfulness-based stress reduction for older adults with stress disorders and neurocognitive difficulties: a randomized controlled trial. J Clin Psychiatry 2017; 78(7): e73443.
34Wuthrich, VM, Rapee, RM. Randomised controlled trial of group cognitive behavioural therapy for comorbid anxiety and depression in older adults. Behav Res Ther 2013; 51(12): 779–86.
35Lavretsky, H, Alstein, LL, Olmstead, RE, Ercoli, LM, Riparetti-Brown, M, Cyr, NS, et al. Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial. Am J Geriatr Psychiatry 2011; 19(10): 839–50.
36Lutz, A, Slagter, HA, Dunne, JD, Davidson, RJ. Attention regulation and monitoring in meditation. Trends Cogn Sci 2008; 12(4): 163–9.
37Lutz, A, Greischar, LL, Rawlings, NB, Ricard, M, Davidson, RJ. Long-term meditators self-induce high-amplitude gamma synchrony during mental practice. Proc Natl Acad Sci USA 2004; 101(46): 16369–73.
38Sedlmeier, P, Eberth, J, Schwarz, M, Zimmermann, D, Haarig, F, Jaeger, S, et al. The psychological effects of meditation: a meta-analysis. Psychol Bull 2012; 138(6): 1139–71.
39Quintana, DS. Statistical considerations for reporting and planning heart rate variability case-control studies. Psychophysiology 2017; 54(3): 344–9.
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Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression

  • Emily Ionson (a1), Jayneel Limbachia (a2), Soham Rej (a3), Klajdi Puka (a4), Ronnie I. Newman (a5), Stephen Wetmore (a6), Amer M. Burhan (a7) and Akshya Vasudev (a8)...
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