Tai Chi Intervention for Chinese Americans With Depression

Aim #1: To evaluate the feasibility and safety of conducting a RCT of Tai Chi for Chinese
American adults with MDD who are not on antidepressant medications. The investigators
hypothesize that: a) the investigators can develop a Tai Chi intervention and
depression-related measurement protocol for Chinese Americans with MDD; b) the investigators
will be able to recruit non-pharmacologically treated Chinese Americans with MDD to
participate in a randomized controlled Tai Chi study; c) participants will be compliant with
the Tai Chi intervention and all testing protocols; d) the Tai Chi intervention will be safe
and study staff will be able to effectively monitor participants' depressive symptoms and
assure their safety during the study.

Aim #2: To collect preliminary data on the efficacy of a 12-week Tai Chi group intervention
for Chinese Americans with MDD who are not on antidepressant medications to determine the
effect size needed for a definitive RCT. The investigators hypothesize that at the
conclusion of 12-weeks, Tai Chi participants, as compared to control subjects, will
demonstrate a) greater improvement in depressive symptoms (Hamilton Depression Severity
Index-17, Beck Depression Inventory), b) greater improvement in functional status, general
health, and well being (Clinical Global Impressions Scale, The SF-36 Health Survey (SF-36®)
for social functioning, Exercise Self-Efficacy, Mindfulness), and c) greater social support
(Multidimensional Scale of Perceived Social Support).

Aim #3: To characterize participants' experience in a trial of Tai Chi for Chinese Americans
with MDD in order to optimally design a subsequent, more definitive study. Using mixed
methods (qualitative and quantitative analyses), the investigators will identify the
ethnocultural experience of Tai Chi among Chinese Americans with MDD, assess whether they
view Tai Chi a more culturally acceptable alternative to conventional antidepressant
therapy, explore the facilitators and barriers to adherence to the Tai Chi training
protocol, identify characteristics of responders and non-responders to the Tai Chi
intervention, and assess participants' willingness/intention to continue practice of Tai Chi
beyond the study period. The investigators hypothesize that a) characteristics such as
severity of illness, age, co-morbidities, and education level may distinguish responders
from non-responders; b) participants with greater levels of class attendance and home
practice will exhibit greater improvements in depressive symptoms; and c) participants who
continue to practice Tai Chi after the 12-week training will maintain clinical improvements
in depressive symptoms and a lower rate of relapse at the end of 3 additional months of
follow-up compared to those who do not continue Tai Chi practice.

Inclusion Criteria:

- Self-identified as being of Chinese ethnicity and fluent in Mandarin and/or Cantonese

- 18-80 years of age

- Satisfy DSM-IV criteria for MDD

- Baseline score of 14-20 on the 17-item Hamilton Rating Scale for Depression
(HAM-D-17)

- No regular (≥ 3 times/week for ≥ 2 months) Tai Chi training/practice or other forms
of mind-body intervention in the past 6 months

Exclusion Criteria:

- Primary psychiatric diagnosis other than MDD

- History of psychosis, mania, or severe cluster B personality disorder, active ETOH or
substance abuse/dependency disorder in the past 6 months

- Unstable medical conditions as judged by investigators

- Use or plan to use confounding treatments, including antidepressants and CAM
treatments thought to have beneficial effects on mood, such as St. John's Wort,
S-Adenosyl methionine (SAMe), omega-3 fatty acids, light therapy, conventional
psychotherapy, mind-body interventions (e.g. Qigong, mindfulness training, muscle
relaxation training, etc.)

- Current active suicidal or self-injurious potential necessitating immediate treatment

- Women who are pregnant