Total years in practice: 1

Publish Date
July 07, 2019
Patient
28 Years, Female, Asian
Medical Condition
Chronic Fatigue Syndrome, Depression, Indigestion
Therapies
Ayurveda,Yoga
Medical History

The World Health Organization defines depression as a common mental disorder, with clinical features as depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy  and power of concentration . According to WHO, depression is expected to account for more lost years of healthy life than any other disease by 2030, except for HIV/AIDS . The ‘Diagnostic and Statistical Manual of Mental Disorders – V’ describes symptoms of Major Depressive Disorder (MDD) as: a depressed mood, suicidal ideation, fatigue or loss of energy, psychomotor agitation, and insomnia, persisting for most of the day, nearly every day for a period of two weeks. In Ayurveda, “Prasannatmendriya manah” is quoted as definition of health. Different factors which affect mental health are wrong behavior related to Kaya, Vaak and Manas.

Depression has become an unwanted companion casting a shadow on every aspect of our lives. It remains as a social stigma in terms of prevalence and suffering, dysfunction, morbidity and economic burden.

Clinically as per symptoms, depression is correlated with  vishada, avasada, manodhukhaja unmada and kaphaja unmada. 

A 28 years female client presented with following complaints: 

  • Generalized Diet issues 

  • Constipated hard stools

  • Lethargy & generalized weakness in the body

  • Depressed mood

  • Diminished ability to concentrate

  • Hyposomnia

  • Tearfulness without any reason and over-eating.

HOW CAN AYURVEDA BE A BOON FOR SUCH CASES IN TREATING DEPRESSION WITH THE USE OF HERBS & PANCHAKARMA PROCEDURES. 

See this case of depression as to how I treated my patient with optimum use of herbs, diet, yoga and Ayurvedic therapies.

 AETIOLOGY:

  • Family history 

  • Trauma or stress in personal or professional life 

  • Pessimistic personality with low esteem 

  • Certain medical ailments have depression as add on feature such as Parkinson's disease, cancer, schizophrenia etc.

  • Side effect of certain medications such as steroids, anti-hypertensive drugs, etc.

  • Psychological disorders such as anxiety disorder, eating disorders etc.

PATHOGENESIS:

Ayurveda mentions the following causes for depression:

  1. Lack of coordination between Dhi (learning), Dhriti (retention) and Smriti (long term memory)

  2. Imbalance of prana shakti 

  3. Pragyapradha (violation of natural ethics)

As per our classical references, the causative factor in mental disease (mano-vikara) is mainly an increase and imbalance in the mansika doshas i.e. ‘Rajas’ and ‘Tamas’. These two states are described to ‘Icchha ‘(Desire) and ‘Dwesh’ (Repulsion) which are mainly triggered by stress. Imbalance of rajas and aggravation of tamas at the psychic level are important pathological factors. Imbalances of the three doshas are representative of different cognitive and somatic symptoms:

VATA

PITTA

KAPHA 

Vitiation: destroys mental sense and gives rise to grief


Manifestation:  anxiety and hyperactivity

Vitiation: mental states of excessive fear, lust and grief


Manifestation: passivity and lethargy

Vitiation: lethargy, anxiety and in-discrimination


Manifestation: strong emotions, anger.


 

CLINICAL FEATURES: 

  • Mood variations 

  • Disturbed sleep, eating patterns 

  • Weight gain/loss issues

  • Feeling of low esteem 

  • Somatic complaints 

  • Short temper, a feeling of anxiety 

  • Tearfulness for no reason, an unrealistic sense of failure 

DIFFERENTIAL DIAGNOSIS:

  • Anxiety disorder 

  • Personality disorder

  • Hypothyroidism 

  • Vitamin B deficiency 

  • Nutritional deficiency

  • Metabolic disease as diabetes


Case Management

AYURVEDIC MANAGEMENT APPROACH:


PREVENTION 

LINE OF TREATMENT 

SHASTRIYA FORMULATIONS 

SATWAVAJAYA CHIKITSA  

  • High fibre diet 

  • Regular yoga & meditation 

  • Avoid loneliness 

  • Continuance of medications 

  • Avoid frequent meals and overeating


NIDANA PARIVARJANA 

  • Avoid the aetiological factors mentioned above.

SHODHAN CHIKITSA 

  • Snehapana 

  • Virechan 

  • Nasya 

  • Shirovasti 

  • Shirodhara 

  • Shiro-abhyang

  • Shiro-pichu 

  • Brahmi vati 

  • Mahakalyanak ghrita 

  • Brahmi ghrita 

  • Kalyana ghrita 

  • Kushmand ghrita 

  • Saraswatarista 

  • Ashwagandharista 

  • Brahma rasayan 

  • Chandanadi tailam

  • Himasagara tailam 

  • Narayana tailam 

  • Brahmi tailam 

  • Rajat bhasma 

  • Yama 

  • Niyama 

  • Padmasana 

  • Savasana 

  • Surya-namaskar 

  • Bhujangasana 

  • Paschimottasana 

  • Sarvangasana 

  • Pranayam 

  • Meditation 


  • SHODHAN CHIKITSA:

    • Snehapana(internal oelation) : Kalyanak ghrita 10ml with saindhav for 5 days , for early oelation process  , empty stomach.

    • Sarvang abhyang : Full body massage with ksheerbala oil followed by sarvang swedana (full body steaming)

    • Nasya : Brihana nasya with puarana ghrita ( old cow ghee) in a dose of 4 drops in each nostril for 5 days.

    • Shirodhara : With medicated oil ( Chandanadi tail+  Ksheer Bala tailam ) for first 3 days , then ksheerdhara/jaladhara for 40 min daily for 8 days .

    • Shiro-abhyang : Head massage with Brahmi oil mixed in almond oil  daily .

    • Shirolepa 


    YOGIC PRACTICE SEQUENCE FOLLOWED:

    • Sookshma vyayama (warming up exercise)

    • Asana 

    • Pranayama 

    • Deep relaxation technique 

    • Sattvic mantra chanting 

    • Meditation 



    COUNSELLING SESSIONS:

    • Talk therapy: words and nurturance, primarily focusing on cognitive behavioral therapy, which strives to bring awareness of thoughts, feelings

    • Daily talking to loved ones for at least half an hour 

    • Drinking copper charged water in the morning 

    • Pen down thoughts before going to bed 

    • Practice making friends or association with new people 


    OBSERVATION:

    • Improvement in her mood

    • Concentration is improved

    • Interested in job and professional outcomes 

    • Normal deep sleep pattern achieved 


    CONTENTS OF ORAL MEDICATION WITH THEIR PROPERTIES:

    Medhya drugs promote mental development and act as mental rejuvenator. Medhya drugs for manovsada with their action and chemical constituents:

    NAME

    PHYTOCHEMISTRY 

    ACTION 

    AYURVEDA APPROACH 

    Rasa       Guna Virya     Vipaka Karma 

    Brahmi

     (Bacopa monniera)

    Brahminocide

     Brahmocide

    Anxiolytic effect 

    Acts on anxiety  Menhancer

    Antidepressant action

    Tikta 

    Laghu 

    Ushna 

    Katu 

    Kapha-vata shamak 

    Jyothishmathi( Celastrus paniculatus)

    Celapagin 

    Celapanigin 

    Celapanin 

    Peniculatin 

    Improves the cognitive abilities  

    Induces natural sleep

    Katu 

    Tikta 

    Tikshn

    Ushna 

    Katu 

    Vata-kapha shamak 

    Vacha

    ( Acorus Calamus)

    Calamenone

    Calamendiol

    Isocalamendiol

    Flavinoids 

    Lectins 

    Phenols 

    Saponins 

    Tranquilizer 

    Neuroprotective effect

     Antioxidant 

     Antimicrobial 

    Anti-convulsant

    Anti-spasmodic

    Diuretic

    Antipyretic 

    Katu 

    Tikta 

    Laghu  Tikshn  

    Ushna 

    Katu 

    Kapha-vata shamak 

    Tagara

    (valeriana wallichii)

    Maliol 

    Valerone 

    Nerolidol 

    Limonene 

    Borneol 


    Anxiolytic

    Antidepressant


    Katu 

    Tikta 

    Kasaya 

    Laghu 

    Snigdha 

    Ushna 

    Katu 

    Vata-kapha shamak 

    Ashwagandha(Withania Somnifera)

    Isopelletierine 

    Anaferine 

    Saponins 

    Withanolides 

    Anxiolytic

     Adaptogen

     Memory enhancing

     Depression

    Promotes restorative sleep



    Tikta katu madhur 

    Laghu snighda 

    Ushna 

    Madhur 

    Kapha-vata shamak 

    Yastimadhu

    (Glycyrrhiza Glabra)

    Liquoric acid 

    Glycyrrhizin 

    Glycyrrhizinic acid

    Flavonone 

    Pinocembrine 

    Prunetin 

    Anti-depression

     Brain Tonic and increases the circulation into CNS

    significantly improving learning ability and memory.


    Madhur 

    Guru 

    Snighda 

    Sheeta 

    Madhur 

    Vata-pitta shamak 

    Sankhapushpa (Convolvulus pluricaulis)

    Rhamnose 

    Convolamine 

    Ceryl alcohol 

    Shankhpushpine 

    Convosine 

    Maltose 

    Hydroxy cinnamic acid 



    Anti depression 

      Anxiolytic 

      In vivo study noted higher cholinergic function after oral administration of Clitoria Ternatea, Suggesting the mechanism for memory enhancement is via Acetylcholine.


    Tikta 

    Snigdha 

    Picchila 

    Sheeta 

    Madhur 

    Vata-pitta shamak 




    Benefits of Medhya herbs


     Medhya herbs in particular and they do not have a broad-spectrum action. As per Acharya Shusruta, the benefits derived from Medhya herbs and their applied aspects are listed below. 

     1.Shruta Nigadi (Power of retention after hearing once) 

    2. Smrutiman (Endowed with good memory)  

     3. Grantham Ipsitam utpadayati (Develops enthusiasm in reading habit) 

    4. Nastam cha Pradurbhavati (Power to recollect the forgotten) 

    5. Dvirucchaaritam shatamapi avadharayati (Capable of retaining words spoken only twice) 



    DIET & LIFESTYLE :

    FOODS TO AVOID 

    FOODS IN FAVOUR 

    Caffeine 

    Alcohol 

    Refined foods 

    Processed oil

    Whole milk, cream, desi ghee, butter etc

    Sweet of all kinds like puddings etc

    Cream, chocolate, cakes, cookies etc

    Organ meats like kidney, brain, mutton etc

    Egg yolk, liver

    Deep fried foods 

    Mayonnaise sauce, white sauce 

    Tinned products 

    Dry fruits except almonds, walnuts 

    Alcohol and aerated drinks 

    Pickles in oils

    Commercial popcorn 

    Junk foods



    VEGETABLES 


    Artichokes      chilli

    Asparagus      onions

    Lettuce            celery

    Bitter melon   

    Mushrooms    beets

    Mustard greens

    spinach

    Eggplant           

    Green pepper 

    carrots

    Swiss chard      

    Squash              Okra 

    Zucchini

    Bok choy  

    FRUITS 


    Apple             kiwi

    Cranberry     pear

    Dried fruits

    Raisins 

    Strawberry

    GRAINS 


    Whole grains 

    Walnuts, almond

    Basmati rice

    Buckwheat 

    Corn 

    Rye 

    Roasted grains



    OILS:


    (small amounts) coconut oil

    Almond       soy

    Mustard     canola

    sunflower


    GENERAL 


    Wheat flour with bran or multi grains flour

    All pulses

    Chicken, fish, egg white

    Green leafy vegetables

    Lemon water 

    Soup & vegetable juices

    Bitter gourd 

    Jamun / black plum

    Sprouted fenugreek seeds

    Amla

    Buttermilk

    Oats, museli , wheat flakes 

    Soya milk (natural flour)

    Flax seed 2 tsp 



    REFERENCES:

    1. World Health Organization.  The world health report. 2001, Mental  Health: New Understanding, New Hope. Geneva. 2001.

    1. DSM-V: diagnostic and statistical manual of mental disorders (5th ed.), American Psychiatric Association, Washington, D.C. (2013), pp. 161-271

    1. https://www.nhp.gov.in/Manovasada(Depression)_mtl

    2. https://www.researchgate.net/publication/317014347_DEPRESSION-AN_AYURVEDIC_OUTLOOK_INTRODUCTION

    3. Charak samhita with Ayurveda Dipika Commentary of Chakrapni Dutta, Ed. Yadavji Trikarma ji Acharya , Chaukhmba Surbharti Prakashan, Varanasi, Charak Samhita Shareer sthana Chapter 1 Verse 100-103

    4. https://easyayurveda.com/2012/12/05/jyotishmati-medicinal-qualities-ayurveda-benefits-and-dose/

    5. https://easyayurveda.com/2016/10/13/tagara-valeriana-wallichii/

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