Journal of Ayurveda Case Reports

CASE REPORT
Year
: 2021  |  Volume : 4  |  Issue : 2  |  Page : 50--53

Ayurvedic management to aid weaning of anti-depressants: A case report


S Akshatha, Suhas Kumar Shetty 
 Department of Manovigyana Evum Manasa Roga, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India

Correspondence Address:
Dr. S Akshatha
Department of Manovigyana Evum Manasa Roga, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka
India

Abstract

Depression has become a common psychiatric disorder affecting people of middle-aged group, especially due to their psychosocial issues. Although there are many Allopathic medicines available for its management but these are not free from their adverse/side effects. So people are now looking for alternative medicines to avoid adverse effect of chemical medications. A combined approach of various traditional treatment principles along with psychotherapy will help to overcome the stressors. A 45-year-old male patient, agriculture officer by profession, was admitted to the inpatient department for reducing the dose of antidepressants [sertraline (200 mg) and agomelatine (50 mg)] which he was taking for the last three years. The patient complained of sleeplessness or difficulty in maintaining sleep, loss of appetite, lack of interest in doing daily activities, racing of negative thoughts, and at times experiencing irrational fear. Based on signs and symptoms and Dosha vitiation that is Vata and Kapha, the case was diagnosed as Vishada (~major depressive disorder) with mild features of Chittodvega (~anxiety). On admission, the treatment protocol included Snehapana (~internal oleation) followed by Virechana (~therapeutic purgation), Satvavajaya chikitsa (~psychotherapy), and Shamana aushadhi (~palliative treatment). After the course of treatment, there was considerable improvement such as involving in daily activities, reduced negative thoughts, and improvement in sleep with the reduction in Hamilton's Depression Rating Scale score from 12 to 3. The dosage of antidepressants was tapered after one month of follow-up.



How to cite this article:
Akshatha S, Shetty SK. Ayurvedic management to aid weaning of anti-depressants: A case report.J Ayurveda Case Rep 2021;4:50-53


How to cite this URL:
Akshatha S, Shetty SK. Ayurvedic management to aid weaning of anti-depressants: A case report. J Ayurveda Case Rep [serial online] 2021 [cited 2021 Dec 4 ];4:50-53
Available from: http://www.ayucare.org/text.asp?2021/4/2/50/323903


Full Text



 Introduction



Depression is a widespread chronic medical illness that can affect thoughts, mood, and physical health.[1] Depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration are usually considered as the most typical symptoms of depression.[2]

According to the WHO, depression is the most common cause of disability globally and ranks as one of the leading causes of disability.[3] In the Ayurvedic literature, Vishada and Avasada are two conditions which are closely similar to depression. Vishada comprises a condition where laziness in body activities, speech, and depressive mood is observed. This indicates feeling of unwillingness to respond or retardation of physical and mental activities.[4]

The management is through general line of treatment explained for Manasika vikara (~psychiatric disorders), i.e. Daivavyapashraya (~spiritual healing), Yuktivyapashraya (~rational therapy), and Satvavajaya (~psychotherapy). Dhi (~intelligence), Dhairya (~confidence), and Atmadi vigyana (~knowledge of self) are indicated for the patients afflicted with predominant features of Bhaya (~fear), Dukha (~unhappy), and Kopa (~angry).[5]

 Patient Infromation



A 45-year-old male, officer by profession in the agriculture department, non-diabetic, non-hypertensive, complained of lack of interest in doing daily activities, hopelessness, repeated negative thoughts, loss of appetite, irrational fear, and suicidal thinking for three years, which was diagnosed as a major depressive disorder by the psychiatrist. Since then, the patient was under antidepressants. A daily single dose of sertraline (200 mg) and agomelatine (50 mg) at night after food was prescribed to him. On June 20, 2019, the patient came to the outpatient department (OPD) with complaints of sleeplessness or difficulty in maintaining sleep, loss of appetite, lack of interest in doing daily activities, racing of negative thoughts, and at times experiencing irrational fear. There was no history of psychiatric illness in family members.

 Clinical Findings



On examination, the patient weighed 68 kg and 5ft 6” of height. His vitals were within normal limits. On mental status examination, the patient was well cooperative, well groomed, talk excessively, and maintained eye contact during conversation. Memory was intact, with repeated thoughts about his occupational stress. There was no disturbance in his intelligence and was unable to make sudden decisions. History revealed that the patient had occupational stress, and his relationship with colleagues was not good. There were grudges in between family members with occasional family fights.

 Diagnostic Assessment



Based on the symptoms, the condition was diagnosed as Vishada with mild features of Chittodvega. On routine blood investigation, all parameters assessed were found to be normal. Assessment of the patient before and after the intervention was done using Hamilton's Depression Rating Scale (HAM-D or HDRS) [Table 1].{Table 1}

 Timeline



The treatment plan included Yuktivyapashraya chikitsa (~rational therapy), mainly Shodhana (~detoxification) and Shamana (~palliative) along with Satvavajaya chikitsa (~psychotherapy). The total duration of treatment was 12 days. On admission, for the first three days, Deepana (~stomachic) and Pachana (~digestants) have been done with Panchakola phanta and Sarvanga udwartana (~whole body massage with powder) and Sarvanga parisheka (~whole body sudation). Shirotaila pichu (~keeping a piece of cloth immerged in medicated oil over anterior fontanelle) with oil prepared with Amalaki (Emblica officinalis Gaertn.), Jatamamsi (Nardostachys jatamansi D.Don. DC), and Brahmi (Bacopa monnieri L.Wettst.). Yoga and Pranayama along with relaxation and counseling were also started. From the 4th day, Snehapana (~internal oleation) with Panchagavya ghrita has been started for six days in increasing dose. Sarvanga abhyanga (~whole body oil massage) with Moorchita tila taila and Bhashpa sweda (~steam bath) was administered for two days followed by Virechana (~therapeutic purgation) with Trivrut lehya 60 g[6] and Draksha kashaya 100 ml.[7] The patient had 16 Virechana vegas (~purgative bouts) and was advised to follow Peyadi samsarjana (~sequential special diet) for the next five days [Table 2]. Observations are placed in [Table 3].{Table 2}{Table 3}

 Follow-Up and Outcomes



The patient was advised to continue 10 ml of Panchagavya ghrita twice daily before food and 200 mg of Manasamitra vati twice daily after food. On the first follow-up (after 30 days), the patient was found to be active and cooperative, sleep pattern was improved, and frequency of episode of irrational fear with palpitation was reduced. The antidepressant agomelatine (50 mg) has been tapered to 25 mg once daily after one month of follow-up. By the end of the 2nd month, agomelatine was stopped and sertraline was tapered to 150 mg OD for two months and later tapered to 100 mg once daily. During follow-up period, the patient was advised to continue Panchagavya ghrita and Manasamitra vati. Yoga and Pranayama were also continued during the period. No withdrawal symptoms, relapses, or exacerbations of symptoms were seen. After six months, HAM-D score was reduced to 3.

The patient was putting on weight with drowsiness and reduced activities that are the side effects of antidepressants.[8] Ayurvedic treatment helped in reducing these symptoms, based on which the antidepressants were withdrawn. No withdrawal symptoms nor exacerbation of symptoms were noticed after the withdrawal of drugs.

 Discussion



Since the condition was chronic, accumulations of the Dosha were more. To tackle the vitiated Dosha in case of Bahudoshaja condition, Shodhana karma (~purification procedure) is the best line of treatment.[9] Before starting the main treatment, preparatory procedures such as Udwartana (~powder massage), Parisheka, and Deepana-Pachana have been given to rectify improper metabolism. Panchakola phanta was administered, which helped to improve digestive fire.[10] Udvartana helps in Kapha-meda vilayana.[11] Parisheka is one of the Swedana karma that helps to reduce the Sharira guruta (~heaviness of body). Dashamoola kwatha churna having Kashaya (~astringent) and Tikta (~bitter) Rasa; Laghu (~light) and Ruksha (~dryness) Guna which helps in Ama pachana (~digestion of toxins) and acts as Tridoshahara.[12] Poor diet, stress, lack of exercise, and improper sleep may alter microbial dysbiosis in the gastrointestinal (GI) tract resulting in causing depression.[2],[13] Various neuropeptides and hormones of the gut are found in the brain. Virechana might enhance the amount of these neuropeptides by cleansing the GI tract. As a result, the quantity of neuropeptides might rise that in turn might have affected the brain and modify its various functions.[14] Blood–Brain Barrier (BBB) has a lipophilic molecular structure. This makes the lipids and lipid-soluble drugs absorb easily through BBB. Hence, the drugs which are given in the form of Ghee can quickly be absorbed through this barrier. Traditionally prepared Ghee contains docosahexaenoic acid, an omega-3 long-chain polyunsaturated fatty acid,[15] that has shown a positive outcome in cognitive decline.[16] Ghee is known to have antioxidant property, which acts upon the degenerative brain cells and helps to repair them.[16] Yoga and Pranayama help in reducing the levels of cortisol.[17] Increased cortisol is related to brain changes in the hippocampus, prefrontal cortex, and amygdale which is present in depressive patients.[18],[19] The added effect of Satvavajaya chikitsa (~psychotherapy) that is Dhi chikitsa (~uplifting intelligence), Dhairya chikitsa (~boosting confidence and determination) and Atma vijnana (~self –realization), helps in assurance and replacement of emotions, regulation of thought process, reframing of proper ideas for proper guidance and advice for taking right decisions which finally results in controlling of Manas from Ahita artha.[20]

 Conclusion



A combined approach of Ayurveda therapeutic approaches along with psychotherapy is found to be effective in the management of depression and also helped in tapering the dose of antidepressants. There was significant improvement in physical symptoms, and active involvement in daily activities was noticed after treatment. All psychological symptoms were responded positively to the treatment along with improved sleep quality. There is a need to study this approach in larger sample size for generating evidences systematically.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Cui R. Editorial: A systematic review of depression. Curr Neuropharmacol 2015;13:480.
2Bhowmik D, Kumar KP, Srivastava S, Paswan S, Dutta AS. Depression-symptoms, causes, medications and therapies. Pharma Innov 2012;1:41-5.
3World Health Organization, Depression. Available from: https://www.who.int/health-topics/depression. [Last accessed on 2021 May 07].
4Acharya YT, editor. Sushruta Samhita of Sushruta, Kalpa Sthana. Ch. 3., Ver. 2. Varanasi: Chaukhamba Orientalia; 2019. p. 569.
5Acharya YT, editor. Charaka Samhita of Charaka, Sutra Sthana. Ch. 1., Ver. 58. Varanasi: Chaukhamba Orientalia; 2011. p. 16.
6Acharya Vagbhata, editor. Astanga Hridaya of Vagbhata. Kalpa Sthana. Ch. 2., Ver. 9. Varanasi: Chaukhamba Orientalia; 2014. p. 742.
7Acharya YT, editor. Charaka Samhita of Charaka, Sutra Sthana. Ch. 4., Ver. 16. Varanasi: Chaukhamba Orientalia; 2011. p. 34.
8Ali AM, Amin OH. So antidepressant drugs have serious adverse effects, but what are the alternatives? Nov Appro Drug Des Dev 2018;4:1-12.
9Acharya YT, editor. Charaka Samhita of Charaka, Sutra Sthana. Ch. 16., Ver. 13-16. Varanasi: Chaukhamba Orientalia; 2011. p. 97.
10Angadi R, editor. A Textbook of Bhaishajya Kalpana Vijnana. 2nd ed. Varanasi: Chaukhamba Surabharati Prakashan; 2016. p. 83.
11Acharya Vagbhata, editor. Astanga Hridaya of Vagbhata. Sutra Sthana. Ch. 2., Ver. 15. Varanasi: Chaukhamba Orientalia; 2014. p. 28.
12Hegde PL, Harini A. Textbook of Dravya Guna Vijnana. 1st ed. New Delhi: Chaukhamba Sanskrit Sansthana; 2014. p. 424.
13El Ansari W, Adetunji H, Oskrochi R. Food and mental health: Relationship between food and perceived stress and depressive symptoms among university students in the United Kingdom. Cent Eur J Public Health 2014;22:90-7.
14Mangal G, Sharma OP, Sharma RS. Pharmacokinetics of Vamana and Virechana Karma. J Ayurveda 2010;4:67-78.
15Joshi KS. Docosahexaenoic acid content is significantly higher in ghrita prepared by traditional Ayurvedic method. J Ayurveda Integr Med 2014;5:85-8.
16Athavale A, Jirankalgikar N, Nariya P, Dev S. Evaluation of in- vitro antioxidant activity of Panchagavya: A traditional Ayurvedic preparation. Int J Pharm Sci Res 2012;3:2543-9.
17Thirthalli J, Naveen GH, Rao MG, Varambally S, Christopher R, Gangadhar BN. Cortisol and antidepressant effects of yoga. Indian J Psychiatry 2013;55:S405-8.
18Kim EJ, Pellman B, Kim JJ. Stress effects on the hippocampus: A critical review. Learn Mem 2015;22:411-6.
19Bellani M, Baiano M, Brambilla P. Brain anatomy of major depression II. Focus on amygdala. Epidemiol Psychiatr Sci 2011;20:33-6.
20Belaguli G, Savitha HP. An empirical understanding on the concept of Satvavajaya Chikitsa (Ayurveda Psychotherapy) and a mini-review of its research update. Indian J Health Sci Biomed Res 2019;12:15-20.