CASE9: BIPOLAR DISORDER – AYURVEDIC HELP 

BACKGROUND

Client Presentation: Follow up visit for 31 year old VP female who is a single parent (2 year old boy), and has been previously diagnosed with bipolar disorder, and recently been presenting with effects of ongoing depression (hypomania). Client reports currently that she has been on Sertraline for 6 weeks. Her energy has improved somewhat, her days are busy being more social and looking for work, which she is excited about. Her memory is OK, her bowels are OK, although she does get constipated if she eats bad/unhealthy food. Her urination is fine, appetite is good, and she is sleeping well. She reports has no current suicidal or self-harm thoughts, does not hear things, has no hallucinations. Her negative thought patterns occur in the mornings, but she now reports that she is better able to shift them quicker.

 

HISTORY OF PRESENTING COMPLAINTS

  • Low, flat moods.
  • Client is struggling financially, is in the mix of a relationship breakup with the father of her child, who is also not in contact with her/their son. She has trouble looking for work as it needs to fit in with day care. Her appetite is up and down. Client reports no hyper manic states – and only feels good when she goes for a run. She has noticed behavioural changes of feeling frustrated, but reports has no current suicidal thoughts, does not hear things, has no hallucinations. Her negative thought patterns occur in the mornings and when she is really exhausted.

 

 

PAST MEDICAL HISTORY

  • Previously on Lithium. Does not want to go back on it.

 

 

SURGICAL HISTORY

  • N/A

 

MEDICATIONS

  • Sertraline 50mg for 6 weeks
  • Ayuna Ashwagunda tablets. 1 capsule at bedtime.
  • Ayuna Joint-S. 1—1 with meals daily.
  • Saswatharishtam 15ml——15ml with warm water.

 

  • Keep using Vid D, Iron and Fish oil supplements.

 

FAMILY HISTORY

 

SOCIAL HISTORY

 

PHYSICAL EXAMINATION

Nadi Pariksha (Pulse Examination)

  • Phone consultation

 

Mutra Pariksha (Examination of Urine)

  • Normal

Mala Pariksha (Stool Examination)

  • Normal

Jihwa Pariksha (Tongue Examination)

  • Not assessed video consultation

Shabda Pariksha (Voice Examination)

  • Normal

Sparsha Pariksha (Touch Examination)

  • Not assessed video consultation

Drik Pariksha (Eye Examination)

  • NAD

 

Akrti Pariksha (Physical Appearance Examination)

  • Looking more lively than 1 month ago. Laughed.

 

Akruti (volume and tension of pulse)

  • Not assessed phone consultation

 

INVESTIGATION (BASED ON CURRENT CONSULTATION AFTER PANCHKARMA)

 

Prakruthi:            VP

Vikruthi:              VP

Agni:                     Currently stable

 

Sub dosha Vata (Prana, Udana, Samana, Vyana, Apana):

Vyana Vyana Vayu(bipolar/despression), Prana Vayu (bipolar/depression), Samana Vaya (bipolar/depression)

 

Sub dosha Pitta (Sadhaka, Alochaka, Pachaka, Bhrajaka, Ranjaka):

Sadhaka pitta (depression)

 

Sub dosha Kapha (Tarpaka, Bodhaka, Kledaka, Sleshaka, Avalambaka):

 

Dhatus (Rasa, Rakta, Mamsa, Meda, Asti, Majja, Shukra):

Rasa dhatu dushti (low energy), Rasa Kshaya (malaise, fatigue) Rakta Kshaya (lack of lustre, lack of enthusiasm), mamsa vruddhi (low energy/fatigue), Majja diushti (depression),

Ojas kshaya, (lack of zeal), chronic vata disorders), Prana visramsa (prana moving in wrong direction, fatigue, negative thoughts)

 

  • Whilst client has not reported all of these symptoms today (from 1 months ago), her condition will be up and down quite often – and the tendency for these will still be present. The medication will also be masking some of these symptoms that are present with her condition.

 

Srotas (Annavaha {Digestive}, Pranavaha {Respiratory}, Udakavaha {Fluid}, Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Majjavaha, Sukravaha, Swedavaha, Purishsvaha, Mutravaha, Manovavaha, Arthavavaha {Menstruation}, Stanyavaha {Lactation}: 

Manovaha sroto dushti (negative thinking)

 

Prana, Tejas, Ojas:

Ojas kshaya, (lack of zeal), chronic vata disorders), Prana visramsa (prana moving on wrong direction, fatigue, negative thoughts)

 

Pathway (Internal, external, middle): Middle

 

Kriyakala (Accumulation (Sanchaya); Aggravation (Prakopa); Overflow (Prasara); Relocation (Sthyana Samsraya); Manifestation (Vyakti);  Complications (Bheda): Manifestation

 

Dosha gati (Direction): Urdhava vata, tiryag vata

 

Purvaroopa (Prodormal Signs and symptoms): Negative thinking, tendency for flat mood, tendency for low energy

 

Roopa (Disease Manifest Signs and symptoms): Hypomania/bipolar disorder

 

Ayurvedic Pathogenesis:  

UNMADA – Closest description to Bipolar in the Ayurveda texts.

Vata aggravating diet and lifestyle factors aggravate Vata’s movement through the purishavaha srota (colon). Here it then overflows into the rasa dhatu (plasma tissue), and rakta dhatu (blood tissue). If there are pre-existing tissue and pathway weaknesses due to genetics or in the case of the brain and mind, emotional trauma, then repeated doshic disturbances will relocate to those sites. In bipolar disorder, Vata moves from plasma and blood to mano vaha srota resulting in loss of awareness of one’s situation and fluctuations in emotional states. It also then relocates into majja dhatu and majja vaha srota resulting in biochemical changes to the.  From here, numerous signs and symptoms of bipolar disorder arise.

 

Conventional Perspective:

Bipolar disorder consists of episodes of both mania and depression, with many patients having a predominance of one. Idiopathic, but heredity, changes in the level of brain neurotransmitters, and psychosocial factors are thought to be involved. BP begins with an acute phase of symptoms, followed by a repeating course of remission and relapse. Remissions can be full, but many will have residual symptoms, and some people cannot fully  function at work or at home. Relapses are discrete episodes of more intense symptoms that are manic, depressive, hypomanic, or a mixture of depressive and manic features.

 

Ayurvedic herbs:

 

PRESCRIBED HERBS FOR THIS CLIENT:

  • Ayuna Ashwagunda tablets. 1 capsule at bedtime.
  • Ayuna Joint-S. 1—1 with meals daily.
  • Saswatharishtam 15ml——15ml with warm water.

 

Keep using Vid D, Iron and Fish oil supplements.

 

Keep on the same medications from your GP.

 

IN ADDTION, BENEFICIAL AYURVEDIC HERBS FOR HYPOMANIA/DEPRESSION:

 

Vata Pitta Balancing: Shatavari, Turmeric, Licorice, Brahmi, Haritaki, Licorice, Jatamamsi, Mandukaparni, Ginseng, Shatavari

Vata Kapha Balancing: Turmeric, Ashwaganda, Brahmi,  Jatamamsi, Guduchi, Ashwaganda, Shankapushpi, Bhringaraja, Tulsi,

Pitta Vata Balancing: Turmeric – not in excess , Guduchi, Licorice, Brahmi, Licorice, Jatamamsi, Mandukaparni, Ginseng, Shatavari

Pitta Kapha Balancing: Turmeric – not in excess, Brahmi, Haritaki, St John’s Wort, Jatamamsi,

Kapha Vata Balancing: Turmeric, Brahmi, Ashwaganda, Bhringaraja, Guduchi, Tulsi, Jatamamsi, Jyostismathi,

Kapha Pitta Balancing: Turmeric, Brahmi, Shankapushpi, St John’s Wort, Jatamamsi,

 

Traditional Ayurvedic Treatment(s) for these conditions:

  • The recommended follow-up treatment for this client is diet and herbs as prescribed, keeping up a social life, continuing on with what she is currently doing to help balance and improve her moods (see lifestyle advice below).

 

Ayurvedic treatment approach for hypomania/depression:

– Increase Ojas and decrease the stressors.

– Balance Vata first before the other doshic imbalances.

– Diet and herbs for the physical body, prana and senses balances on a subtle level and meditation and mantra on a mind level.

– Abhyanga, shirodara, shirobasti, basto, Navara khizi, nasya.

– Yoga, exercise, mantra, counselling, pranayama

– If client strong enough, Panchakarma is a preferred treatment.

 

Ayurvedic Diet for this client:

–              Client needs to be on a Vata Pitta balancing/pacifying diet.

–              See the general diet chart at the end of this advice form – taking into consideration any contraindicated food that are listed here.

–              In general, you need to eat on time, keep eating healthy food, eat warm food, wholefoods, cooked food, steamed veggies, boiled eggs or whites, soaked almonds, soaked walnuts. Keep aggravating spices to a minimum and do not over-spice meals. Keep food combinations and preparation methods simple and nutritious.

–              Pomegranate – 1 per day (or pomegranate juice)

–              Coconut water 200-300ml per day

–              Eat a healthy and balanced meal for breakfast and lunch and a lighter dinner.

–              Few times per week it is recommended that you eat meat (chicken, lamb).

–              Use ghee in cooking.

–              Upon waking: Drink a glass of warm water with 1 tsp powdered fenugreek, ginger and lemon lemon juice.

–              (Allow 6 hours between meals and snack 3 hours after a meal, and only if hungry).

–              Aim to work towards more of a Sattvic diet (See Food Mood information at the end of this advice form.

 

–              AVOID: Cold foods, raw foods, leftover foods (24 hours), frozen foods, cold water, processed and packaged foods, soft drinks, alcohol, coffee, wine, high fat foods, greasy foods, potatoes.

 

–              WATER INTAKE: Drink 2-3 litres warm water during the day. This will also help to keep system clear of toxins and help avoid constipation.

–              Use all of the five senses at mealtimes. Create a ritual of eating to bring back the sacredness of eating. Stop eating when ¾ full.

–              Eat in a pleasant environment. Eat seated. No TV, no electronic devices.

–              Eat slowly, eat with respect/reverence for what you are eating, chew thoroughly. Savour the food. This helps prevent overeating and helps to retrain the brains wrings in relationship to food.

–              Avoid excess eating (emotional eating), eating during indigestion and eating while previous meal is being digested.

 

Ayurvedic Lifestyle advice for this client:

–              Do what makes you happy.

–              Continue on with working out solutions to the issues with your partner and the financial issues. These will be feeding the hypomanic state for you.

–              Continue with looking for work either paid or unpaid.

–              Continue setting up your support network and spending time with family.

–              Regular daily routines are essential – and stick to them.

–              Daily exercise is important (yoga, gym, swimming, walking, tai chi etc.). Referral letter to a yoga therapist is included with this case study.

–              Spend time in nature and listen to uplifting music.

–              Add in sun salutations to your daily routine. Start on 24 and can increase slowly to 48.

–              Avoid stress.

–              Look at introducing meditation and more yoga into your lifestyle to help combat stress and help balance hormones.

–              Make sure to be in bed by 10pm and get sufficient sleep.

–              Continue working to keep positive thoughts – you may want to visit a holistic counsellor if you need to.

 

REFERRAL: To yoga therapist to help with learning how to better rebalancing the mind.

 

REVIEW: 8 weeks

 

Note: It is always advised to continue all prescribed conventional medicine as advised by one’s healthcare practitioner. Should one use Ayurvedic herbs alongside conventional medicines, be sure to consult with your GP and/or medical specialist and your qualified Ayurvedic practitioner about any possible drug interactions and potential side effects.

 

CASE PRESENTED BY: FIRE SANDARES

CASE SEEN BY: DR KUMAR AT JEEVA HEALTH MELBOURNE