Ayurveda Treatment for Bipolar Disorder

Integrated Summary

Clinical Status

Allopathy

Ayurveda

Vital Parameters

BP:110/70
Pulse:68 beats/min
RR:17/ min
Weight:58 kgs
BMI: 22.1
WHR:0.91

Asta Sthana Pariksha

Nadi: vaata pitta
Malam: samyak
- Pravruthi:1-3 times
- Varna-Haridra
- Akriti:Samhat
Mutra:5-6 times
Jihwa:Raktha varna
Shabda:Sadharan
Sparsha:Anushnaa seetha
Drik:Sadharana
Akruti:Sama

Examinations

i. GC: fait
ii. CVS:Normal
iii. RS:Normal
iv. PA:soft, no organomegaly
Relevant systemic
examination:CNS
EXAMINATION:A. Higher mental function
i. Consciousness: normal
ii. Delirium: periods of agitation once in 4 days, increased wakefulness ( sleeps only for 4 hours a day) , tremors,
iii. Pupils size and reactivity: Normal.
iv. Appearance and behaviour: patient is less bothered about dressing and appearance.
v. Emotional status-depressed mood~dysthymic disorder, emotional instability, anxiety with somatic symptoms like tremors.
vi. Orientation- good.
vii. Handedness-right.
viii. General intelligence- good.
ix. Memory-good. Sleep-onset insomnia

No muscle wasting
Motor:
Reflexes both superficial and deep normal
Visceral reflexes – Normal.
Sensory:normal
Coordination- normal
Involuntary movements-Absent
Gait- normal

Dasa Vidha Pariksha

Prakriti:Vatha pitha
Vikriti:Vaata kapha
Sara:madhyama
Samhanana:madhyama
Pramana:Madhyama
Satmya:sarva rasa
Satva:avara
Aharashakti:pravara
Vyayam Shakti:pravara
Vaya:Madhyama
Desha:Deha deasa Vatha pitta
Kala:hemanta

Rogi Bala – avara

Roga Bala – madyama

DSQ findings	Rating
1. ADRS	low
2. LUPPN	Med

NidanaPanchaka

1. Nidana -chinta, bhaya, shoka, udwega, upahata manas, bheeru.
2. Purvaroopa – UNMATTA CHITTATA, SHIRASAHA SHHONATVAM.
3. Roopa -stanam ekadeshe, anannabhilasha,
4. Updrava: NIL
5. Arishta Lakshana: NIL
6. Samprapti: Due to the nidana buddhi gets prachalita –> udeerna dosha –> enter hrudaya –> avarana of manovaha strotas and there by manifestation of unmade lakshana.
7. Samprapti ghatakas:
i. Dosha- maanasika- raja, tama
ii. Shaaririka- vaata: prana vaata, udana vaata, vyana vaata
a. Pitta: saadhaka
b. Kapha: tarpaka
iii. Dooshya- rasaadi sarva dhatu
iv. Agni-Manda
v. Strotas- manovaha, sarvastrooto dusthi.
vi. Dusti- sanga, atipravrutti
vii. Udbhava sthana- hrudaya
viii. Saadhyasaadhyata- kruchrasaadhya
ix. Upadrava-unmaadadi manovikara or shareera vikara
x. Adhistaana-avayava
visesha- mano sanjovaha strotamsi

Lab Tests: 29/10/2013

Lab Findings	Last Recorded Value	Lab Findings	Last Recorded Value
FBS	89	TSH	1.41
HBA1C	—-	TGL	102
Total Chol.	173	HB	13.3
HDL	47	Liver	–
LDL	105	ESR	10

Thyroid function test: WNL

T3 – O.95
T4-7.5
TSH-3.25

Serum folic acid -8.58.
VitaminB-12 -182.0
Vitamin D- 13.6 (–> severely deficient)

Haemoglobin- 12.5 gm/dl
Total count- 4,900/cmm

Differential count:
Neutophils- 55%
Lymphocytes- 37%
Eosinophils- 06%
Monocytes-02%
Basophols-00%
RBS- 4.33million/cmm
PCV- 35.5%
MCV-82.0fl
MCH-28.9 pg
MCHC-35.2g/dl
Platelets-2,01,000
ESR-06mm/hr

Treatment given

First visit:

1. Tab Siledin- 1-0-1
2. Saraswatharishtam with gold- 15ml-0-15ml with half cup of warm water.
3. Pravala bhasma-1 pinch before food twice daily.
Counselling+ shavasana with imagery

Fear fullness- 10/10
Self worth-9/10
Slow motor activity-agitated, or very lethargic- 7/10
Change in eating, appetite- or weight- 4/10
Loss of interest 8/10
Anhedonia 8/10
Lack of concentration- 10/10
Recurrent thoughts of death/ suicide- 0/10
Insomnia : 8/10
BP- 110/70 mm Hg

Followup (14/11/2014)

1. Tab.siledin 1-0-0
2. saraswatharishta with gold 15ml-0-15ml with half cup of warm water twice daily before food.
3. Vaishwanara choorna ½ tsp-0-1/2 tsp before food.
4. Shatpala ghritam 5ml-0-5ml
Counselling + shavasana with imagery

Follow-up outcome:

Fear fullness- 8/10
Self worth-9/10
Slow motor activity-agitated, or very lethargic- 7/10
Change in eating, appetite-4/10
weight- 0/10( no changes observed)
Loss of interest 8/10
Anhedonia 8/10
Lack of concentration- 7/10
Recurrent thoughts of death/ suicide- 0/10.
Insomnia : 8/10
BP- 110/70 mm Hg

DASS42 :
Depression- 27( severe)
Anxiety- 3 (mild)
Stress-15( mild)

Follow-up date (17/11/2014)

1. Tab.siledin 1-0-0
2. Saraswatharishta with gold 15ml-0-15ml with half cup of warm water twice daily before food.
3. Vaishwanara choorna ½ tsp-0-1/2 tsp before food.
4. Shatpala ghritam 5ml-0-5ml
5. Tagara-0-0-2
Counselling + shavasana with imagery

Follow-up outcome:

Fearfullness-3/10
Self worth- 6/10
Slow motor activity-agitated, or very lethargic- 5/10
Change in eating, appetite(manda)- 2/10
Weight-0/10( no changes observed)
Loss of interest 7/10
Anhedonia 7/10
Lack of concentration- 6/10
Recurrent thoughts of death/ suicide- 0/10.
Insomnia : 8/10
BP- 110/70 mm Hg
Tab. Nexit 10 mg 0-0-1 was tapered to 5 mg 0-0-1 on alternate days along with the ayurvedic medications.

Follow-up date (27/11/2014)

Stop vaishwanara choorna
Replace shatpala grita with brahmi ghrita
1. Tab.siledin 1-0-0
2. Saraswatharishta with gold 15ml-0-15ml with half cup of warm water twice daily before food.
3. Brahmi ghritam 5ml-0-5ml before food
4. Tagara-0-0-2
Counselling + shavasana with imagery

Follow-up outcome:

Fearfullness-3/10
Self worth- 5/10
Slow motor activity-agitated, or very lethargic- 3/10
Change in eating, appetite( manda)- 0/10
Weight-0/10( no changes observed)
Loss of interest 5/10
Anhedonia 5/10
Lack of concentration- 5/10
Recurrent thoughts of death/ suicide- 0/10.
Insomnia : 5/10
BP- 110/70 mm Hg
Tab. Nexit 5 mg 0-0-1 was tapered from alternate days to once in 3 days along with the ayurvedic medications.

DASS42 :
Depression- 15( moderate)
Anxiety- 4 (normal)
Stress- 14 (normal)

Follow-up date( 3/1/2015)

Stop siledin
1. Saraswatharishta with gold 15ml-0-15ml with half cup of warm water twice daily before food.
2. Brahmi ghritam 5ml-0-5ml before food
3. Tagara-0-0-2
4. Kalyanaka kashayam-15ml twice daily with half cup of warm water before food.
Counselling + shavasana with imagery

Followup outcome:

Bp-100/60 Tearfullness-0/10
Self worth- 3/10
Slow motor activity-agitated, or very lethargic- 2/10
Change in eating, appetite( manda)- 0/10
Weight-61kgs↑
Loss of interest 5/10
Anhedonia 5/10
Lack of concentration- 5/10
Recurrent thoughts of death/ suicide- 0/10.
Insomnia : 5/10
BP- 100/60 mm Hg sitting
BP- 80/60 mm Hg standing , no giddiness – so selidin was stopped

DASS42 :
Depression- 10 (mild)
Anxiety- 4 (normal)
Stress-10 (normal)

Differential Diagnosis with reasoning

Ayurveda differential diagnosis

Saapeksha nidhana

1. Mano vishada and utseda
2. Kaphaja unmade
3. Manodhukhaja unmade
4. Smaronmada

Diagnosis :

Mano vishada and utseda leading to Kaphaja unmade

Differential Diagnosis as per modern with reasoning

As per DASS 42 at the time of presentation patient had severe depression which scored 27 in DASS42 and mild anxiety with scoring 3 and mild stress score of 15. Thus, it can be said that patient had major symptoms of depression so from the below table it can be said patient presented with mild hypomania symptoms associated with major depressive symptoms. Thus, diagnosis can be made under bipolar disorder.

Evidence Based Diagnosis with References Common symptoms of bipolar depression include:

Feeling hopeless, sad, or empty-
Irritability-
Inability to experience pleasure (anhedonia)-
Fatigue or loss of energy-
Physical and mental sluggishness-
Appetite –
weight changes-
Sleep problems-
Concentration and memory problems-
Feelings of worthlessness or guilt-
Thoughts of suicide-

Evidence Based Diagnosis with References

Other manic and more pitta type symptoms include: -over-confidence-
-irritability-
-aggression or anger directed outwardly against other people-
– under-sleeping-
-hyperactivity-
Other side of the coin are the depressive (more kaphaja) symptoms of bipolar disorder, include:

-feelings of sadness-
– lethargy-
-lack of enthusiasm-
-apathy-
-lack of appetite-
-lack of sexual interest-
-over-sleeping-
– hypoactivity-

Thus, we can say that there is increased pitta and kapha, thereby increased rajo and tamo guna.

ChikitsaVivechana: Ahara-Vihara-Aushadh

Samanya unmade chikitsa:

There are three methods of healing:

Stawaava jaaya

Counselling techniques such as Cognitive behavioural therapy, family-focused therapy, and psycho education.

Daiva vyapashra- Chanting the name of the deity.
Yukti vyapashraya-

Ahara – Foods should favour the sweet, sour, and salty taste and nourish majja dhatu.
Agni deepana and vatanulomana – Vaishawanarchurnam

Aushadh- Brahmi ghritam (As Hr Ut 6/44-45)

Referral Opinion Sought if any—nil

Integrated View: The principles of ashwaasana, harshana, and other treatment resorts are very apt in managing the disease Bipolar disorder. The same is explained in detail in the other psychiatric principles like cognitive behavioural therapy. The utilization of the technique along the Ayurveda medication has resulted in the better outcome. Shodhan Chikitsa is recommended for the complete and sustained relief.

Outcome

• DASS 42 – assessment scale
Standardised Outcome Scales Used (Summary Table to be Attached)

DASS 42 Score:

Before Treatment	After treatment
DASS42 : Depression- 27( severe) Anxiety- 3(mild) Stress-15( mild)	DASS42 : Depression- 10(mild) Anxiety- 4(normal) Stress-10(normal)

Conclusion

The overall improvement in improvement of symptoms was very good, the parallel medication with ayurveda and gradual tapering ease the management as patient is not put into overwrought situation. The improvement in DASS 42 is the evidence to prove the same.

Bipolar Disorder

Brief Medical History

Integrated Summary

Clinical Status

Outcome

Conclusion