Manovasada(Depression)

Introduction

Depression is a common mental disorder, characterized by sadness, loss of interest, pleasure,feeling of guilt or low self worth, disturb sleep, poor appetite, low energy and poor concentration. It is a common mood disorder in elderly and contributes to significant psychological and physical distress, physical disability and higher mortality. Depression is not a normal part of ageing.Many of our senior citizens face difficult changes such as - the death of a spouse or chronic

medical problems that can lead to depression. Depression not only prevents from enjoying life like it could be, it also takes a heavy toll on death. Untreated depression poses serious risks for older people including illness, alcohol, drug abuse and even suicide.International studies, including those in India suggest uniform prevalence of mood disorders across the world. Life time risk for major depression ranges from 2-25% with most authorities agreeing to a range of 10-15%. It is about 10% in men and 20% in women. By2020, the World Health Organization (WHO) expects Depression to be the second frequent cause of morbidity world over.

Aetiology

1. Family history of depression/ hereditary

2. Trauma and stress caused by things like financial problems, breakup of a relationship or death of a loved one can cause depression

3. Pessimistic personality with low self-esteem and a negative outlook are at higher risk of becoming depressed

4. Medical illnesses such as stroke, heart attack, cancer, parkinson's disease, and

hormonal disorders can cause depressive illness

5. Many medications such as steroids, pain killers, anti-hypertensive drugs, tranquilizers,cancer drugs, hormones etc. can trigger or exacerbate depression

6. Psychological disorders like Anxiety disorders, eating disorders, schizophrenia,

substance abuse etc.

7. Living alone can result in depression

Risk factors

1. Family history

2. Female gender

3. Death of dear ones

4. Functional disability due to chronic illness

5. Substance abuse of alcohol and drugs

6. Cognitive impairment

7. Sleep disorders

Pathogenesis

By advancing age, Acetylcholine, dopamine and norepinephrine decrease in the CNS; elevated levels of mono amine oxidase (MAO) and decrease in number of neuro-receptors with increased resistance to diffusion of drugs contribute to the vulnerability to depression in older adults.

Clinical features

1. Mood variations; often worse in the morning, improving later in the day

2. Change in sleeping, eating habits or appetite

3. Weight gain or weight loss

4. Feeling of guilt and/ or hopelessness

5. Slowed thoughts, speech and movement

6. Negative thoughts, blaming self and low self-esteem, thoughts of death / suicide.

7. Complaints that have no physical cause (somatic complaints) such as unexplained aches and pains.

8. Short temper, feeling of anxiety

9. Tearfulness for no reason, unrealistic sense of failure

10. Lack of concentration and difficulty in making decisions

11. Feeling of loneliness

12. Reduced desire for sex

Diagnosis

Before coming on the conclusion for the  diagnosis of  depression, patients are required to be screened for the following common health issues that can affect mood-

1. Anxiety disorders

2. Personality disorders

3. Vit B deficiency

4. Hypothyroidism

5. Systemic malignancies

6. Nutritional deficiencies

7. Metabolic disorders including diabetes and hepatic dysfunction

Investigations

1.      Neurological examination

2.       Mini mental status test

3.       Geriatric depression scale (GDS) (Yesavage)

4.       Haemogram

                 5.        Blood sugar

                 6.        Blood urea and nitrogen

                 7.        Serum creatinine

                 8.        Liver Function Test

                 9.        Serum Vitamin B12

                 10.      Serum T3,T4, TSH

Management approaches

a. Prevention

1. Use of fiber rich food like whole grams, whole fruits, fresh vegetables, Amla

(Phyllanthus emblica Gartn.) is beneficial.

2. keep active physically and mentally and conduct exercise regularly.

3 Avoidance of loneliness by engaging in social activities.

4. Continuance of  medications as per instructions of vaidya.

5. Practice of yogasnas and meditation

6. Avoidance of non-vegetarian diet, frequent eating and very high calory food

7. Avoidance of uncalled far excessive thinking

b. Medical management

Line of treatment

1. Nidana parivarjana (avoidance of aetiological factors) -  In order to treat depression,factors like trauma, use of steroids, pain killers, etc. need to be avoided.If there is any Chronic illness It  should be tackled  first and living alone should be avoided.

2. Shodhana chikitsa (Bio-cleansing therapies) followed by Samana chikitsa (Palliative therapy) may be done.Following shodhana processes are specially recomended

A, Snehapana (Internal oleation) - Kalyanaka ghrita 50 ml with 2 gm Saindhava

Lavana(Rock salt) for 3 - 7 days (for early oleation) is recommended.

B, Virechana (Purgation) with Eranda taila 10 - 20 ml or Trivrita churna 5-10gm in half glass of warm milk at  bed time in night is recommended.

C, Nasya karma  Brihana nasya with Purana ghrita (old cow ghee) or Anu taila or

Mahakalyanaka ghrita in the dose of 8 drops in both nostrils for 7 days is recomended

D,Shiro vasti with Narayana taila  for 45 minutes daily up to  7 days is helpful.

E,Shirodhara with medicated oils (Narayana taila / Chandanadi taila/ Himasagara taila) (or) Ksheera dhara / Jala dhara / Takradhara daily 30-90 minutes for 1-2 weeks

F, shiro abhyanga (head Massage) with medicated oils (Brahmi taila) etc.

C  Common medicinal Plants

Medicinal Plants

Dosage (per dose)

Vehicle

Duration

Asvagandha(Withaniasomnifera (Dunal)

Powder

3 gm

Water

15 days

Jatamansi(Nardostachys jatamamasi(DC.)

Powder

1-2gm

Milk

15 days

Kapikacchu (Mucuna pruriens (Hook)

Powder

2-4 gm

Water

15 days

Brahmi (Bacopa monnieri(Linn.)

Svarasa(Juice)

5-10 ml

Water

15 days

Mandukkaparni(Centella asiatica (Linn.) Urban.) svarasa(Juice)

5-10 ml

Water

15 days

Guduchi(Tinosporacordifolia (Willd.) Miers) svarasa(Juice

5-10 ml

Water

15 days

Kapikachhu(Benincasa hispida)

Svarasa(Juice)

5-10 ml

Sugar

15 days

Shakhapushpi(Convolvulus pleuricaulis Choisy) kalka (Paste)

2-4 gm

Water

15 days

Tagara (Valeriana wallichii DC)

Churna(Powder)

1-2gm

Water

15 days

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D Shastriya(Ethical) Formulations

Drug

Dosage (per dose)

Vehicle

Duration

Brahmi vati

250-500 mg

Honey

15 days

Manasa mitra vataka

125 mg

Milk

Milk

Mahakalyanaka ghrita

6 gm

Luke warm water

15 days

Br!hmi ghrita

6-12 gm

Luke warm water

15 days

Kalyana ghrita

6 gm

Luke warm water

15 days

Sarasvatarishta

10-20ml

Water

15 days

Ashvagandharishta

10-20ml

Water

15 days

Brahma rasayana

10 gm

Milk

15 days

Candan!di taila

for Shirodhara/ Shirovasti

 

15days

Himasagara taila

for Shirodhara/ Shirovasti

 

15days

Narayana taila

for Shirodhara/ Shirovasti

 

15 days

Brahmi taila

for head massage

 

15 days

NOTE: Out of the drugs mentioned above any one of the drug or in the combination may be prescribed by the physician.The duration of the treatment may vary from patient to patient. Physician should decide the dosage (per dose) and duration of the therapy based on the clinical findings and response to therapy.

E. Yogic Practices

 The following yogic practices are beneficial in Depression; however,these should be performed only under the guidance of qualified Yoga therapist. Duration also should be decided by the Yoga therapist.

1. Padmasana, Savasana, Suryanamask!ra, Bhujangasana, Paschimottanasana,Sarvangasana

2. Pranayama (Kapalabhati, Bhastrika, Surya anuloma viloma

3. Meditation..

Following sequence of yoga is to be followed

1. Sukshma vyayama (loosening exercise)

2. Asana

3. Pranayama

4. Deep relaxation technique

5. Meditation -Nada anusandhana

Counselling  for -

1. Spending time with loved once

2. Take diet rich in antioxidants

3. Take green vegetables and yellow fruit (Vitamin B1, B2, B12 and Biotin) in  sufficient quantity

4. Take low fat diet

5. Practice yoga, meditation and exercise regularly

6. Be active and happy always

7. Participation in satsanga (association with virtuous people)

8. Visit of religious places 

9. Avoidance of driving lonely

Indications for referral

1. Suicidal tendency

2. Complicated cases

3. Non-responsive to medication

Reference

AYURVEDIC MANAGEMENT OF SELECT GERIATRIC DISEASE CONDITIONS

CENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHA Department of AYUSH, Ministry of Health & Family Welfare Government of India, New Delhi - 110 058

  • PUBLISHED DATE : Feb 12, 2016
  • PUBLISHED BY : Zahid
  • CREATED / VALIDATED BY : Janardan Panday
  • LAST UPDATED ON : Feb 12, 2016

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