Ayurvedic Management of Persistent Depressive Disorder: A Clinical Correlation with Kaphaja Unmada with Vatanubandha

Abstract

Persistent Depressive Disorder (PDD), formerly termed dysthymia, is a chronic mood disorder characterized by persistent depressive symptoms and gradual impairment in affective state, motivation, interpersonal functioning and quality of life. A 56-year old woman presented with a history of depressive symptoms for more than 15 years, including persistent low mood, loss of interest, reduced energy, crying spells, disturbed sleep and reduced functioning. The symptoms had an insidious onset following psychosocial stressors and were subsequently aggravated by recurrent adverse life events. The case was diagnosed as Persistent Depressive Disorder with late onset according to DSM 5 TR, and as Dysthymic Disorder according to ICD11. From an Ayurvedic perspective, the presentation was correlated with Kaphaja Unmada with Vatanubandha. Management was planned based on the Ayurvedic assessment, with emphasis on Doṣa śamana, Agni correction, Srotośodhana and management of mental functions. The treatment including Virecana, Nasya, Śirodhara, Snehapana, Abhyaṅga, Uṣmasveda and Yogavasti along with internal medication. Following treatment, improvement was observed in low mood, anhedonia, sleep disturbance, fatigue, crying spells and social interaction. The Hamilton Depression Rating Scale score decreased from 27 at baseline to 13 after treatment and 2 at six-month follow-up. This case highlights the chronic and relapsing nature of Persistent Depressive Disorder and illustrates an Ayurvedic approach based on the assessment of Doṣa, Agni, Srotas and Manas. The observed clinical improvement suggests the potential role of an individualized Ayurvedic protocol in the management of persistent depressive disorders.