Homeopathy for many faces of Depression
by Dr. Kanjaksha Ghosh, MD FRCPath
Key words : Depression, Gastric Disturbances, headache, Ignatia, Natrum Mur, Complimentary medicine
Running Head : Homeopathy for depression.
Abstract :
Objective : To study Ignatia as treatment for severe depression where drug picture fits the clinical picture of the patient.
Design: Case series treated with Ignatia.
Setting/ location: General practice in urban and rural India .
Outcome Measures: Freedom from signs and symptoms of depression and ability to come out of the medicine without recurrence of symptoms and signs of depression.
Results : All three patients while on therapy recovered totally from depression . Two of these three patients were given adequate modern antidepressive therapy for adequate time without any response .However one patient even after 2 years needs to continue Ignatia infrequently to control her symptoms.
Conclusion: Ignatia works as an effective antidepressive medication where clinical and drug picture fits. This could be a suitable alternative even for the patients who does not respond or develop intolerable side effects to modern anti-depressive medication
Introduction
Depression is a common condition in modern stressful world. The depression could be reactive due to loss of near or dear ones, bad news, misfortune, loss of friends, misplaced love etc. or depression could be the primary event without any apparent precipitating cause. In modern medicine depression can be treated by several drugs like tricyclic anti-depressants, serotonin reuptake blockers, atypical anti-depressants. When the depression is associated with anxiety, tranquillizers are also combined with some of the anti depressants. First generation anti-depressants like MAO inhibitors, tricyclic anti depressants have substantial side effects and 2-3 weeks time on medicine is required before some relief from depression is seen. Modern tetracyclic anti-depressants, atypical anti-depressants and serotonin reuptake inhibitors act quickly but they are also not without side effects. Many depressed patients stops anti-depressant drugs because of side effects (40%) or not infrequently they become dependent on it. Moreover many of the modern antidepressants are costly. Combined drugs and psychotherapeutic approaches increase the compliance with those drugs. In this paper three different patients with severe depression are described. All of them recovered smoothly on homeopathic medicine.
Case – 1
A fair complexioned, thin built 14 year old girl having dark hair developed intimate relationship with a boy in her neighborhood in a small district town in West Bengal, India. The patient was very bright in her studies and her parents did not approve this relationship at all. Additionally they took measures to isolate the girl from the boy. This led to severe depression and frequent crying spells. Her performance in school deteriorated to the extent that she failed her class examination and started playing truant. The girl also developed extreme erotic and suicidal tendencies. Parents took her to a psychiatrist where she had several sessions and fluoxetine was started at 20 mg/day. This medicine was continued without any relief for 8 weeks with increase in dosage to 40mg/ day. The medicine was changed to citalopram, an ideal drug for this kind of problem around puberty at a dose of 20 mg/day.
She was taken away from home for two months with the idea that she might forget the episode with the change of her environment . However her depression, crying, suicidal tendencies and erotic overtures continued along with loss of appetite, abdominal pain, and headache .
At this point she was prescribed few does of Aurum metallicum 200 without much relief. However her suicidal tendencies were controlled on Aurum but this drug had very little effect on her overt depression and scholastic performance.
She was then prescribed Ignatia 200 on similia principles. Four globules daily dissolved in half cup of water for 10 days which brought significant relief to her condition. This was followed by Ignatia 1M 6 drops in ½ cup of water once every fortnight. Three such doses completely cured her affliction. She was seen three years later to be well without any signs of depression. Her parents were also satisfied by the results of the therapy. She passed her XII standard examination (A level) with more than 80% marks in aggregate.
Case – 2
The lady was a 28 year old mother of 2 children. She studied up to 10th standard (O level) then married to a policeman in a remote village in Maharashtra state of India. She was plump with wheatish complexion and dark hair. Due to some unknown reason she developed extreme sadness with frequent bouts of crying for over two months before she was evaluated. She would not talk to anybody. She would stare outside the window for hours. She started neglecting her children (youngest one was 3 years of age). Apparently there were no bereavement in the family and no altercation with her husband.
The husband could not throw any light on her recent change in behaviour but he observed that she even does not sleep at night but only cries. She complained of severe bi-temporal headaches which is likened to driving nails into her head. There was no loss of memory but as a part of general neglect she herself was also not groomed properly, neither was she eating properly and was vomiting once or twice daily. On examination no neurological deficit was found. Considering the recent changes in behaviour, headache and vomiting possibility of a tumor in the temporal lobe was suspected and it was advised that the patient should get a CT scan done and should seek a neurologist’s and a psychiatrist ‘s opinion.
However the parents of this lady were not able to bring her to the city quickly for imaging studies and further evaluation hence requested some intervention till they could arrange her to come to Mumbai in 2-3 months time. She was prescribed Ignatia 200C, 4 globules daily for 15 days to be followed by 4 globules in 30 ml of water shaken 30 times and 2 spoonfuls from this taken early in the morning once daily for another 15 days. She came to the city for further investigations and consultations after two months with her husband, father and children. She was no longer depressed and her relatives felt there is little use for further consultations with a neurologist and a psychiatrist as all her imaging studies ( MRI & CT scan of Head ) were normal.
Case – 3
The last patient was a 43 year old psychiatrist who has a daughter of 14 years. She is tall and thin, has dark complexion with dark hair. She was operated for renal carcinoma 8 years back and since then there was no relapse but she has an underlying fear that the disease may come back at any time. In the intervening period she occasionally felt severe back ache and the back ache was controlled by non-steriodal anti-inflammatory drugs. However, for six months before consulting she felt extreme sadness, grief and a feeling of helplessness for no apparent reason. She had regular periods and she was not on any oral contraceptive. She had no suicidal tendency but had a fear of dying. Occasional headache, loss of appetite and sleeplessness were associated with severe depression. She could not control bouts of crying. She has a very understanding husband and being in a nuclear family there was no extraneous pressure, or financial hardship to explain as exacerbating causes for her depression.
She could not tolerate most of the modern antidepressant medicines which she tried for 16 months (Fluoxetin, Dothiepine, Venlafaxin and Citalopram) in adequate doses. Hence her quest was for an alternative medicine to manage her depression. She was started on Aurum Met.200C but after 3 or 4 doses she felt severe warmth inside her body, with sleeplessness and restlessness. As she could not tolerate Aurum she received placebo (Sac lac) and within 7 days she started feeling extremely sad. At this point of time she received Ignatia 200C, 4 globules twice daily for 10 days and subsequently once daily and then requested her to increase the interval of medications. However, she was not able to come out of Ignatia. medication totally. As per her observation as a trained psychiatrist she felt Ignatia was working like a mild serotonin uptake inhibitor and Aurum acted like a tricyclic anti-depressant. Ignatia completely controlled all her symptoms but she was not able to come out of Ignatia even after 6 months of therapy. Considering the fact that she had a cancer diathesis she received a dose of Thuja 1M as a constitutional remedy. She immediately reacted to this medicine with palpitation and tachycardia (120beats/min) which lasted for 6-7 days before subsiding. She was given also Natrum Mur for some time as a chronic for Ignatia but it did no good . Hence she is back on Ignatia which has controlled her depression completely.
Discussion
In this brief report three women with severe depression are described. They belonged to three different age groups, to different strata of society and had different education and value systems. One grew up and got married in a village, the other a student in a school in a small district town and the third one was an accomplished psychiatrist in a metropolis. The student was depressed because of the broken infatuations which she considered as love but for other two there were no apparent extraneous causes for such depression though for the third patient past history of renal cancer can be a justifiable reason for continued apprehension about the disease and depression.
In two patients Ignatia initiated and completed the cure and as Kent (1) wrote ‘the medicine is frequently required and is specially suited to sensitive and delicate women and children.’ Margarette Tyler (2) observed that “The medicine is associated with changeable mood and complete absence of sexual desire alternating with the reverse.” Nash (3) also repeatedly pointed that this drug has a pre eminent place with changeable mood. Our patient No.1 did present with extreme changes in mood associated with erotic overtures. Silent grief which is one of the main presenting feature of Ignatia was present in both case 1 and case 2. Silent grief has been emphasized by authorities like Blackwood (4) too. Harimohan Choudhary (5) in his book on “Millesimal potency in theory and practice” described a case ‘Homeopathy cures a patient summoned by death and left by all other schools of therapeutics’ where Ignatia helped a male patient to recover completely from deep depression which arose because of broken love and a combination of vomiting, headache and change in mood that lead the best doctor of that time to suspect a brain tumour. It may be noted that patient No.2 presented similarly and we had a clinical suspicion of brain tumour for that case.
Finally case #3 is very instructive. She herself being a psychiatrist had an insight about her problem. She also treated innumerable patients with depression and finally she herself fell into the abyss of the same depression. Most of the anti depressants she was not able to tolerate. Being an extremely sensitive lady she had aggravation on Aurum and had severe tachycardia on a constitutional remedy, Thuja. Ignatia initiated a perfect recovery but as Kent predicted Ignatia often cannot finish such cases and we need to give Natrum Mur. Natrum Mur has been described as a complimentary medicine to Ignatia by Boericke6. All of our three patients had headache and gastric disturbances, loss of appetite as physical accompaniments of depression which is a strong similia for Ignatia.
In Pubmed when ‘Homeopathy in depression’ is keyed, 54 references are seen. Several of the references deal with or review homeopathic treatment of depression.
Several (7) used Aurum muriaticum natronatum successfully in two of his patients with suicidal ideation , depression and eczema. Davidson et al (8) showed efficacy of homeopathic medicine in this condition. Adler et al (9) in a well-controlled blinded randomised trial involving more than 90 patients conclusively proved non-inferiority of homeopathic medicine to fluoxetine over 8 weeks period in cases of acute depression. The group used the method of homeopathic individualization with more than 20 drugs using Q potency medicine. However systematic review by Pilkington et al (10) on the subject showed methodological weakness of many of the trials. Pinto et al (11) used Chamomilla for depression in animal studies and showed this model can also be adopted for homeopathic medicine.
However, a physician is involved with individual patients and striking improvement in depression after failure of modern anti-depressive drug is a reason persuasive enough to give homeopathy a chance for management of depression .
References:
Kent JT. “Lectures on material medica”Ignatia B Jain publishers N.Delhi 2000:592.
Tyler ML ”Ignatia in Homeopathic drug pictures” PP424-431 CW Daniel Co. Ltd. England. 3rd Ed 1952 :424.
Nash EB. Ignatia in “Leaders in Homeopathic Therapeutics” 4th Ed 1913. reprinted by B Jain Publishers Ltd. N.Delhi , India 1985:163.
Blackwood A. Ignatia Amara in “A manual of Materia Medica therapeutics and pharamacology” 2nd Edition 1922 reprinted by B.Jain Publishers N.Delhi , India. 1990:378.
Choudhury H. ‘50 Millseimal potency in theory and practice’ pp 80-85 3rd edition by B.Jain Publishers N.Delhi, India.1990:80.
Boericke W. Ignatia in “Pocket manual of Homeopathic mateia medica” pp 9th edition 1927. published in Indiaby Sett Dey and Co. Kolkata , India. 1976:342.
Sevar R. Aurum muriaticum natronatum--four case reports. Homeopathy. 2007;96:258-69.
Davidson JR, Morrison RM, Shore J et al. Homeopathic treatment of depression and anxiety. Altern Ther Health Med; 1997;3:46-9.
Adler UC, Paiva NM, Cesar AT, et al. Homeopathic Individualized Q-potencies versus Fluoxetine for Moderate to Severe Depression: Double-blind, Randomized Non-inferiority Trial. Evidence Based Complement Alternat Med. 2009 Aug 17. [Epub ahead of print]
Pilkington K, Kirkwood G, Rampes H,et al. Homeopathy for depression: a systematic review of the research evidence.Homeopathy. 2005 ;94:153-63.
Pinto SA, Bohland E, Coelho P,et al..An animal model for the study of Chamomilla in stress and depression: pilot study. Homeopathy. 2008 ;97:141-4.