Effective Ayurvedic Treatment Protocol For Depression

Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, B.A.M.S
Depression, the name itself is so ‘letting down’. It is a medical condition which not only affects the mind but also the body in due course of time. In Ayurveda we can call it as Avasada or Unmada or Bhutonmada or Kapha Avrita Pitta or Kapha Avrita Vayu Vikara. 

It is a high kapha disorder in which the activities of pitta and vayu have decreased. It is a disturbing condition not only to the patient but also to the family, friends and caretakers. The incidence and prevalence of depression is increasing with decades.

Ayurveda provides highly effective remedies for depression in the form of time-tested formulations and body cleansing and detoxification methods including Panchakarma methods.

Ayurvedic treatment schedule for Depression

Stage 1 treatment

Avoidance of causative factors

Nidana Parivarjana (Avoidance of causative factors) –
There may be many causes for the causation of depression. Enlisting the causes or probable ones (most causes might not be known to the patient or the guardians, many might not have been expressed by the patient) is the key. Later we try to help the patient or guardians to keep away from the causative or triggering factors. One should try to provide or satisfy the hidden wishes or unfulfilled wishes of the patients. This is possible only with the cooperation of the patient. For this counseling is a must.

Effective counselling

Motivating Dhee, Dhairya and Atma gnana (effective counseling) –
The first and foremost task is to get the patient into the confidence. They have come to you in a hopeless or little-hope condition after having tried all types of treatments and medicines. No one wants to be called or labeled as ‘mentally disturbed’ person and no one wants to carry the tag of ‘depression’ or any other scary name depicting a mental disorder with their name.

Effective counseling of the patient and attendants is an important strategy. The intelligence and confidence, presence and orientation of the patient (dhee), courage (dhairya) and self-realization, feeling of worthlessness should be dealt with. They should be motivated and put in a place where they can realize the importance of self and well being.

This is the toughest job and doesn’t essentially finish in one sitting. I have been successful to accomplish a few in single and many in more than one session. But effective speaking will get the patient in your confidence. Patient showing interest in taking medicines or treatment is ‘half-job-done’. I have seen most patients come to the ‘obliging ways’ after a schedule of medicines or treatments, when they themselves start feeling well, as and when the treatment gets effective, as and when the symptoms come down. In this stage it is easy for doctors to counsel the patient in the ‘hit the hot iron’ type of effective approach.

I have included one more strategy in treating these patients. I have personally conducted the treatment over them. They feel better after knowing that there are people to care and address their issues. Patients reveal a lot during these sessions which are helpful to combat the condition.

Since depression is a cloud or mask like condition enveloping the ‘thoughts, judgment memory and higher skills’ it is important to shed that envelope. Here the envelope of Kapha is masking the sadhaka pitta, Prana Vayu and Udana Vayu. Sadhaka Pitta is located in Hridaya (term used for both heart and mind). Therefore we need to remove the covering of kapha and release the sadhaka pitta.
‘Winning heart is winning mind’ I believe this and have seen it happen time and again!!
Read related: When to seek medical advice during depression

Digestives, carminatives

Deepana Pachana (kindling the digestive fire, expelling toxins) –
‘Sarve api rogaaha mande agnau’

Most diseases are caused by the depletion (disturbance) of the digestive fire (agni), including the physical and mental disorders. So correction of Agni is a must in the treatment of Depression. Sluggish fire will cause weak digestion and accumulation of ama (toxins) in the gut, circulation and cells. Ama further depletes the tissue metabolism and impairs (blocks) supply of oxygen and nutrients. Presence of toxins in the cells due to the presence of ama will slow down all the activities and cause many psycho-somatic disorders including depression. Therefore the medicines to kindle the fire and correct it (deepana) and to destroy and expel ama (pachana) medicines should be given. This forms the essential strategy in preliminary treatment line-up.
Read related: When you can manage yourself, without seeking medical advice 

Agni or fire is present in the body in the form of pitta. Therefore sluggish agni is directly proportional to sluggish pitta, sadhaka pitta in this instance.

Chitrakadi Vati, Trikatu Churna, Triphala Churna, Varanadi Kashayam, Kalyanaka Kashayam, Panchakola Churna, Shanka Vati etc are some of the medicines given to accomplish this job. The medicines should be chosen depending on the condition of the disease and diseased and is left to the wisdom and judgment of the physician.

Krimihara chikitsa

Krimihara Chikitsa (de-worming) –
Though not conventional or logical or theoretical, I have always used the Krimihara medicines before starting the actual medicines or treatment strategies for depression. Destroying and expelling the worms or parasites from the body is a neglected aspect in most diseases.

Stage 2 treatment

Stage 2 treatment includes Bhir-Parimarjana (external treatments) and Antah-Parimarjana or Shodhana or Panchakarma chikitsa (body cleansing and detoxification treatments).

External treatments

Bahir Parimarjana Chikitsa (External treatments)
In my clinical practice and 20 years experience in handling cases of depression, the below mentioned strategies have helped a lot (depending on the condition of the disease and diseased). They are:

Shiro Vasti – medicated oil and or ghee pooling over the head is the most effective treatment for depression in my clinical experience. The below said strategies are equally useful.

Taila-Ghrita Shiro Dhara – Stream pouring of medicated oil or ghee or both mixed together over the head
Takra-Shiro Dhara – stream pouring of medicated buttermilk over the head
Sarvanga taila dhara (Pizhichil) – stream pouring of medicate oils over the entire body

Sarvanga dhanyamla dhara – stream pouring of medicated fermented fluids all over the body (takes care of ama and excess kapha)

Abhyanga admixed with Udwarthana, Swedana and Nitya Virechana – body massage with medicated oils in combination with Udwarthana or herbal powder massage done in reverse direction (below upwards) over the body. This is the best strategy I have framed and followed in cases of depression. This has given good result. This treatment package is multi-dimensional especially when combined with Shiro Vasti or Shiro Dhara. Nitya Virechana (daily purgation with medicated oils or decoctions) should be administered during night times of the treatment days. This combination removes the blocks caused by kapha and ama, makes the body feel light and fresh, ignites agni, flushes toxins and reestablishes the body and mind health.

Internal treatments

Antah Parimarjana Chikitsa (Internal treatments)
Vamana – therapeutic emesis (in high kapha conditions) should be done. If the patient is intolerant to vamana, sadhyo vamana (instant vamana) should be administered. Generally Vamana precedes with Snehana (administration of medicated ghee or oil or both in increasing doses over a period of 3-7 days depending on the morbidity and strength of the disease and Swedana or fomentation).

Virechana – therapeutic purgation to expel excess pitta and to bring it under control should be done. Virechana is good for both pitta and vayu. This is generally preferred after Vamana, to expel the toxins if not pitta, the toxins which have exposed themselves after morbid kapha has been handled through Vamana. Virechana can either be sadhyo virechana (instant purgation) or krama Virechana (snehana, swedana and virechana).

Vasti – therapeutic enemas to control vitiated Vayu and hence balance all the physical and mental activities in the body.

Nasya – Nasya means nasal medication. This is worth praising treatment strategy in the treatment of depression. I have included this treatment in all the patients of depression. Ayurveda tells that ‘Nasa hi shiraso dwaaram’ i.e. Nose is the door / gateway of head (and brain). Nasya is the best treatment as far as mental disorders are concerned.

Other Strategies –

Nitya Sneha Pana – daily intake (in fixed doses) of medicated ghee or oile (Example, Kalyanaka Ghrita, Saraswatha Ghrita, Brahmi Ghrita etc)

Nitya Virechana – daily purgation by administering medicines like Gandharvahastadi eranda tailam, Nimbamritadi eranda tailam, Sukumara Ghritam, Gandharvahastadi kashayam etc

Stage 3 treatments

This stage comprises of administration of –

Vyahdihara aushadhas – disease modifying and palliative medicines should be given to address the root of the problem. Examples – Kalyanaka Kashayam, Manasamitra Vatakam, Kalyanaka Ghritam, Brahmi Ghritam, Saraswatha Ghritam, Kushmanda Rasayanam, Mahanarayana Tailam, Mahavatavidhwamsini Ras, Vatakulantak ras, Swarna Bhasma, Siddha Makaradhwaj, Shiva Gulika, Shilajatu, Prabhakara Vati, Saraswatharishtam, Arjunarishtam, Gorochanadi Vati, etc

Rasayana – rejuvenators, anti-ageing medicines, immune-modulators
Vihara and Vyayama – lifestyle changes and physical exercises
Pathya – wholesome diet
Yoga and Meditation etc

All these strategies come as follow-up measures. These strategies are needed for recovery, for re-establishment of health, fortification of health, mind and physical strengthening and for avoiding recurrences. They are maintenance of the servicing which have been effectively done and successively accomplished in stage 1 and 2.

FAQ

What is the percentage of recovery from depression with above said Ayurvedic approach?
Most of the cases of depression being considered as hopeless, the modern medicines being habit-forming and symptomatic, Ayurveda provides a natural way of body-mind healing and that too in a most effective, wholesome and comprehensive way. Results are good most of the times. It is difficult to give numbers so as to how many days or months or years it takes for the patient to be nil-depression or no-depression. In my experience I have seen cases which respond in few months and some to have taken a year or two to get substantial results. It depends on many factors like strength of the disease and diseased, the willingness and positive approach of the patient towards getting better, seriousness and continuation of treatment in order and with religious approach, age of the patient, acute or chronic nature of the problem, associated disorders, supporting factors and antagonistic factors playing on the treatment scale and lot more.
Read related: Depression Causes, Ayurvedic Treatment, Tips And Remedies

Is the treatment protocol universal, applicable as such to everyone?
No. No treatment or medicine is universal. The protocol of treatment and medication (blueprint) should be made differently for different patients. All patients do not respond to similar line of treatment. I have given a set of treatments in stages in the above described passage. They need to be mixed and matched according to the condition and depends on the wisdom and judgment of the wise physician.

How many schedules are needed?
In my experience there are few cases of depression which have effectively responded to treatments and medicines in 1 or 2 sittings, at least the symptoms started to reduce and the patient started feeling better. Shodhana which comes in the 2^nd stage of treatment has a good and serious impact on the disease. But the diseases should be seriously followed and the treatment protocols should be periodically planned for better and sustained results. At least 3-4 Shodhana therapies are needed in a year, even after the patient starts feeling better or even after most symptoms have gone away. This avoids recurrences. The consecutive treatment plan-ups may be short and simple. This also helps the physician to keep a track on the patient. But nothing is a rule. Strategies change from patient to patient, so do the effect of treatment.

Does Depression recur?
Yes, the episodes of depression can recur depending on the trigger and antagonistic factors, unfavorable conditions and availability (exposure) of causative factors.

Clinical experience

As I said earlier, I have a good long experience of handling the cases of depression. The results varied from good to moderately good to negligible to none. Most of the cases were between good and moderate relief. Some patients were not serious and some did not respond to many conversations and counseling sessions. Some did not have supportive family and some were not sure to continue. But those who continued treatment showed good recovery.

All the above said protocols are written out of my experience and on the basis of my practice. I still feel that this area of understanding mind and healing it is the toughest job and it needs to be bettered and mastered over a period of time and still there will be a quest for better and better remedies!!

Just Before Conclusion –
Ayurveda has best medicines and treatments for patients who are suffering from depression. Results are also good when the treatment is approached in a comprehensive way with equal and serious contributions from Chikitsa Chatushpada i.e. the physician, patient, medicines and caretakers. This article is to highlight the various options and blueprint for treating and curing depression in a natural way, in an Ayurvedic way!!

Is balancing digestive fire best and ultimate remedy in treatment of depression through Ayurveda?

According to Ayurveda concepts almost all diseases are believed to be caused due to weak digestive fire. Therefore, obviously treatment of any disease starts from correcting digestive fire and bringing it back to a state of balance. Balance of digestive fire is one of mandatory factors which fulfils criteria of being healthy person. This rule is applicable for both physical and mental disorders.

Depression is one of surging ailments which are haunting mankind of modern world. Though it is more about mind, depression cannot be strictly considered as mental disorder due to physical component being involved in a wider range.

Wide arrays of physical disorders are involved within spectrum of depression. Among them, digestive disorders are also included. While treating depression through Ayurvedic remedies should we balance digestive fire? Is balancing digestive fire best remedy for depression? We will figure out answers for these questions in this article.

Depression versus Agni

Like in any other disease, correction of digestive power should be focused upon in treatment of depression also. But is it only and best remedy for depression or is it a part and parcel of treatment protocol of depression need to be understood.

There is no doubt that entire treatment of Ayurveda depends on effective correction of digestive fire, strategy followed in both physical and mental ailments as already specified.

We cannot deny involvement of imbalance of digestive mechanism in depression. This can be accepted by seeing many digestive disorders being a part of depression syndrome.

One important point we need to note here is interrelationship between physical and mental disorders. As we all know, physical ailments impact on mind in case of somatic disorders. Similarly we can find that mental disorders make their impact on body in psychological disorders. In both these cases, mutual impact of physical disorders on mind and mental disorders on mind would occur at some stage of manifestation of diseases.

I would like to explain this with below mentioned examples in case of depression –

1. Body over Mind condition – A person suffers from chronic physical disorder like arthritis or neurological disorder which will impair activities of daily living and will prove a hindrance for him to work and earn for his family. He might get confined to home, lose his job and earning, become dependent and then go on to suffer from depression over a period of time. Here, just correction of digestive fire will not help. Patient will need counseling and a proper and comprehensive approach to cure his physical ailments and enable him to go back to work and feel confident.

2. Mind over body condition – A person may suffer from mental trauma following failures in life, loss of money, business or death of beloved ones, love failure, struggles, rejections or bullying resulting in depression. As a result he may develop many conditions like loss or gain of weight due to rejection of food or binge eating, obesity, hypertension, diabetes and many other systemic disorders. Even here, treatment of digestive fire will not help in totality.

Patient needs to be addressed with dhee (enhancing mental capabilities) dhairya (encouragement and effective counselling), Atmadi Vijgnanam (spiritual guidance) strategies along with effective medications and counselling sessions to overcome depression. He needs to be educated about self worth and usefulness of moving on in life. Along with that, disease modifying strategies may be considered.

 Moral of story in both above mentioned cases is –

Correction of agni is an essential part which may fall in plan-up of treatment protocol or accidentally introduced wherein certain medicines and treatment strategies, dravya or adravya, help in kindling digestive fire, correct it and balance it while main disease (mental or physical) is being addressed with comprehensive approaches including treatments, medicines, counselling, diet corrections and lifestyle modifications. But correcting of digestive fire is not be only and go for approach in treatment of depression.

As Being depressed is more of a tamasika bhava, enhancing digestive fire functioning might make sense but I feel correction of metabolism is a part and parcel of treatment protocol of depression, an inclusion, rather than a sole option.

On other hand, in my clinical practice, I have even see people with depression show early signs of recovery and open up in a different way, respond to things and get into patient hearing and behave differently, positively, when we start treatment with medicines and therapies which kindle digestive fire. treatments may be of likes of appetite and digestion enhancing medicines and intense acting medicines which are fiery in nature. Udwarthana or herbal powder massage and dhanyamla dhara i.e. sour fluid sudation will also work on similar lines. Thus treatment of depression need to be cause based. There is no harm in starting treatment of depression with digestive fire correcting strategies while planning for disease modifying protocol.

We also would have experienced feeling low and depressed, after an immediate meal. We also feel same in cold seasons. This is due to variability of heat or agni in us, which may be temporary but also acts as a trigger for depression. This shows that metabolic fire is related to mind, no doubt. And when we are depressed there are variations in fire. When fire is low, we may feel depressed. It is biphasic impact.

Strategies to tackle depression

Thus, in combating depression we need to follow below mentioned strategies, mix and match according to situational skills and condition of disease and diseased –

• Identifying and isolating cause of depression
• Counseling and diversion of patient in a positive way, motivation, give friendly environment,
• Correction of agni, digestive fire and tissue fires (gut level and tissue level metabolism)
• Proper planning and implementation of ideal mind friendly foods and life activities
• Tracking down individual and relative imbalances of prana vayu, sadhaka pitta, tarpaka kapha and udana vayu and addressing them accordingly
• Treatments and disease modifying medicines to address primary or secondary manifestations (mind may be primarily involved or secondary to physical ailments)
• Panchakarma and Rasayana therapies,
• External treatments like abhyanga, udwarthana, dhara, etc
• Regular indulgence in exercise, Yoga, concentration enhancing exercises and meditation
• Periodic checkups and making patient feel worthy

Click to Consult Dr Raghuram Y.S. MD (Ayu) – Email / Skype