Comprehensive Ayurvedic Management of Treatment Resistant Major Depressive Disorder: A Case Report

Abstract

Background: Major Depressive Disorder (MDD), a frequently found severe psychiatric condition which leads to significant impairment in mood, cognition, daily functioning as well as overall quality-of-life. Features include depressed mood, loss-of-interest, feelings of worthlessness, guilt and reduced sleep. In Ayurveda, such conditions parallel with Kaphaja unmada involving vata and tama dosha. Clinical Findings: A 21-year-old-male presented with chief complaints of low mood, loss-of-interest, feeling of worthlessness, hopelessness, suicidal thoughts, feeling guilty and reduced sleep. His general appearance was poorly groomed, sad with reduced motor-activity. On examination reveals slow speech with low-pitch-voice, depressed mood with abnormal thought content. The severity was checked by assessment scales : Hamilton Depression Rating Scale (HAM-D) 32 and The Montgomery–Asberg Depression Rating Scale (MADRS) 30, reveals severe depression. Hamilton Anxiety Rating Scale (HAM-A) score 25 suggesting severe anxiety and Beck’s Hopelessness (BHS) 23 indicating moderate hopelessness. As per DSM-V-TR, diagnosed as MDD, characterized by depressed mood, loss-of-interest, feeling of worthlessness and insomnia. Intervention:Intervention encompassed comprehensive protocol spanning over 375 days with 2-in-patient admissions comprising Shodhana, External procedures, nasya along with oral medications, Satwawajayachikitsa (psychotherapy) and yoga. Outcome: Gradual improvement was observed in assessment parameters across multiple domains. HAM-D reduced to 13 from 32, MADRS reduced to 12 from 30, HAM-A reduced to 10 from 25 and BHS reduced to 8 from 13, at baseline, indicating clinical improvement in mood disturbances and anxiety. Conclusion: A chronic case of treatment-resistant severe depression with recurrent episodes, on combined therapy, showed marked improvement after comprehensive management, as assessed through HAM-D, MADRS, HAM-A and BHS domains without any adverse events. Long-term follow-up of 12 months shows sustained relief and improved daily functioning in MDD. This case explains the role of comprehensive Ayurveda protocol in the management of treatment-resistant severe depression.