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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 31-38

Depressive disorders treated with homeopathic medicine Nux vomica - A case series


1 Former President Homoeopathy University, Jaipur, Rajasthan, India
2 Department of Organon of Medicine, Dr. M. P. K. H. M.C, Hospital and Research Centre, Jaipur, Rajasthan, India
3 Department of Homoeopathic Pharmacy, Dr. M. P. K. H. M.C, Hospital and Research Centre, Jaipur, Rajasthan, India

Date of Submission20-Jan-2021
Date of Acceptance08-Feb-2021
Date of Web Publication09-Jul-2021

Correspondence Address:
Dr. Astha Mathur
77/142, Sapteshwar Marg, Aravali Marg, Mansarovar, Jaipur - 302 020, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AYUHOM.AYUHOM_5_21

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  Abstract 


Depression is a common and often underdiagnosed mental disorder. Homeopathy has a major role in the treatment of depressive disorders. Homeopathic treatment takes personality and temperament of the patient into consideration for selection of medicine. As such it believes in the concept of individualization, thereby each patient suffering from depression may require a similimum, different from other patient. Three cases of depressive disorders treated by Nux vomica are presented. All the cases were improved; analysis was done by Hamilton depression rating scale.

Keywords: Depressive disorders, Hamilton depression rating scale, Homeopathy, Nux vomica


How to cite this article:
Nayak C, Singh AK, Singh R, Mathur A. Depressive disorders treated with homeopathic medicine Nux vomica - A case series. AYUHOM 2020;7:31-8

How to cite this URL:
Nayak C, Singh AK, Singh R, Mathur A. Depressive disorders treated with homeopathic medicine Nux vomica - A case series. AYUHOM [serial online] 2020 [cited 2021 Jul 31];7:31-8. Available from: http://www.ayuhom.com/text.asp?2020/7/1/31/321042




  Introduction Top


Depressive disorders are characterized by persistent low mood, loss of interest and enjoyment, and reduced energy. They often impair day-to-day functioning of the patient.[1]

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification of mental disorders with associated criteria designed to facilitate more reliable diagnoses of these disorders.[2]

DSM is intended to serve as a practical, functional, and flexible guide for organizing information that can aid in the accurate diagnosis and treatment of mental disorders. It is a tool for clinicians, an essential educational resource for students and practitioners, and a reference for researchers in the field.[2]

The classification of disorders is harmonized with the World Health Organization's (WHO) International Classification of Diseases (ICD), the official coding system used in the United States, so that the DSM criteria define disorders identified by ICD diagnostic names and code numbers. In DSM-V, both ICD-9-CM and ICD-10-CM codes (the latter scheduled for adoption in October 2014) are attached to the relevant disorder in the classification.[2]

DSM-V classifies depressive disorders as:[2] disruptive mood dysregulation disorder; major depressive disorder, single and recurrent episodes; persistent depressive disorder (dysthymia); premenstrual dysphoric disorder; substance/medication-induced depressive disorder; depressive disorder due to another medical condition; other specified depressive disorder; and unspecified depressive disorder.

The common feature of all of these disorders is the presence of persistent sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual's capacity to function. However, they differ according to duration, timing, or presumed etiology.[1]

In 1978, the WHO entered into a long-term collaborative project with the Alcohol, Drug Abuse and Mental Health Administration in the USA, aiming to facilitate further improvements in the classification and diagnosis of mental disorders and alcohol- and drug-related problems. A mutually beneficial relationship evolved between these projects and the work on definitions of mental and behavioral disorders in the Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10).[3]

Master Hahnemann in his Organon of Medicine has described about mental diseases in §210–§230, classifying them into four types: somatopsychic, psychosomatic, acute mental disease presentation, and from doubtful origin. In each and every type of mental diseases, an antipsoric medicine has been recommended along with the treatment on the basis of totality of symptoms and auxiliary management (§228–§229). Ascertaining the etiology and progress are of chief importance in homeopathic management of these disorders. In addition, Hahnemann stressed on constitutional treatment of patients presenting with acute episodes of mental disorders.[4]


  Materials and Methodology Top


These cases were treated at the outpatient department (OPD) of Dr. Madan Pratap Khunteta Homoeopathic Medical College and Hospital, Sindhi Camp, Jaipur, between June 2016 and December 2017. These cases were screened following DSM-V criteria of depressive disorder in a structured pro forma. Patients presenting with major depressive disorder as per the DSM-V classification and mild and moderate depression according to HDRS were included.

The signs and symptoms of each patient were recorded in detail in a standardized case record format, including his/her clinical history, current symptoms, mental/emotional states and medication, past/family history; performing analysis and evaluation of symptoms; and constructing totality of symptoms, repertorization, and due consultation of Homoeopathic Materia Medica. Repertorization was done using Schryons F. RADAR [Computer Program]. Ver. 10.0. Belgium: Archibel; 2009.[5]

Similimum for each case was selected out of the medicine obtained after considering higher number of symptoms and securing higher values on repertorization, however, in consultation with Homeopathic Materia Medica.[6],[7] During follow-up, changes in the signs and symptoms of each case were noted. Subsequent prescriptions were done according to homoeopathic principles.[4]

Patients were advised to report at 15-day interval or early, if needed. Each time, their symptoms were recorded in detail. Individualized homeopathic medicines were given in pills. Assessment and reassessment were done by HDRS – pre- and post-test scores.

Inclusion criteria

Patients from above the age of 18 years and both sexes were included. Patients presenting with major depressive disorder as per DSM-V and mild and moderate depression according to HDRS were included.

Exclusion criteria

Patients presenting with disruptive mood dysregulation disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, depression due to substance abuse, mood disturbances when associated with schizophrenia, schizophrenia form disorder, schizoaffective disorder or psychotic disorder not otherwise specified, bipolar affective disorders, currently receiving treatment with an effective antidepressant (patient may be considered for inclusion in the study after 2 weeks wash-out period), cases diagnosed with life-threatening diseases or currently active physical disease, for which medicine is being adjusted, any other condition requiring emergency or surgical intervention, a lifetime or current diagnosis of schizophrenia, schizoaffective disorder, or manic depressive psychosis, pregnancy and lactation (pregnancy test was done in initial screening, if required), patient with Vitamin B12 deficiency, hypothyroidism, and actively suicidal tendency.


  Case Profile Top


Case 1

A 32-year-old married Hindu male patient, teacher, came to our OPD (OPD Reg. No. 2855/63809, dated July 18, 2016) with complaints of heaviness of head and tendency to use wrong words when speaking for the past 1 year. The patient was apparently well 1 year back and then gradually developed heaviness of the head and tendency to use wrong words when speaking, after death of his child. The patient was a literary and studious person with marked irritability and tendency to be quarrelsome. Stammering speech develops during the last part of a sentence while talking.

  1. Mental symptoms


    • Oversensitive to external impressions, to noise, odors, light, and music
    • Suppressed anger
    • Fear of disease and death
    • Desire for solitude.


  2. Physical generals: Chilly patient. Thin built, appetite decreased
  3. Stool: Constipation, incomplete and unsatisfactory; feeling as if part remained unexpelled
  4. Perspiration profuse on face
  5. Personal history: Male patient, married, teacher
  6. Past history: Nothing specific
  7. Family history


    • Father: Died, history of paralysis
    • Mother: Died, history of heart attack


  8. On general examination: No abnormality detected (NAD)
  9. Provisional diagnosis: Moderate depression; based on Hamilton depression rating scale (HDRS) Score = 14.


  10. Evaluation and totality of symptoms


    • Oversensitive to external impressions, to noise, odors, light, and music
    • Anger suppressed
    • Fear of disease
    • Fear of death
    • Desire for solitude
    • Appetite: Decreased
    • Speech: Stammering, toward last words of the sentence
    • Constipation: Incomplete and unsatisfactory stool; feeling as if part remained unexpelled
    • Perspiration: Profuse on face
    • Heaviness of head
    • Tendency to use wrong words when speaking.


Repertorial totality: Rubrics

  1. MIND-SENSITIVE - Oversensitive
  2. MIND-SENSITIVE - External impressions to all
  3. MIND-SENSITIVE - Noise, to
  4. MIND-SENSITIVE - Light
  5. MIND-SENSITIVE - Music, to
  6. MIND-ANGER - Irascibility-suppressed, from
  7. MIND-FEAR - Disease, of impending
  8. MIND-FEAR - Death of
  9. MIND-COMPANY - Aversion to - desire solitude - to indulge her fancy
  10. STOMACH-APPETITE - Diminished
  11. RECTUM-CONSTIPATION - Insufficient, incomplete, unsatisfactory stools
  12. FACE-PERSPIRATION
  13. HEAD-HEAVINESS
  14. MOUTH-SPEECH - Stammering last words of the sentence.


Repertorization [Figure 1]
Figure 1: Repertorial sheet - Schryons F..RADAR [Computer Program]. Ver. 10.0. Belgium: Archibel; 2009.

Click here to view


Repertorial analysis

  • Nux vomica: 28/11; marks secured - 28; number of rubrics covered - 11
  • Phosphorus: 23/10; marks secured - 23; number of rubrics covered - 10
  • Lycopodium: 19/9; marks secured - 19; number of rubrics covered - 9
  • Natrum muriaticum: 18/9; marks secured - 18; number of rubrics covered - 9
  • Ignatia 17/9: Marks secured - 17; number of rubrics covered – 9.


First prescription

After repertorization and consulting Materia Medica, Nux vomica 200, single dose, was given to the patient on July 18, 2016 [Table 1].
Table 1: Follow-up of patient

Click here to view


Case 2

A 48-year-old married Hindu female patient, homemaker, came to our OPD (OPD Reg. No. 3406/79938, dated July 22, 2016) with pain in head, constriction feeling in stomach, pain in both legs for the past 3 years. The patient was apparently well 3 years back; then, gradually, she started developing pain in the head vertex region, pain in the legs, and constriction feeling in the stomach (especially after death of her daughter-in-law 3 years back).

  1. Mental symptoms


    • Ailments after death of her daughter-in-law
    • Dominating
    • Laziness
    • Angered easily
    • Desire for company
    • Does not wish to do work


  2. Physical generals


    • Chilly patient


  3. Craving: Spices
  4. Stool: Hard
  5. Personal history: Female, married, homemaker
  6. Past history: Malaria 20 years back
  7. Menstrual history: Normal, regular, flow 3–4 days/30 days
  8. Obstetric history: Gravid3, Para2, Abortus1, Living2 (Full term normal Delivery) G3P2A1L2. FTND
  9. Family history


    • Father: Died, history of depression
    • Mother: Died, history of bronchial asthma


  10. General examination: NAD
  11. Provisional diagnosis: Mild depression; based on HDRS score = 12
  12. Evaluation and totality of symptoms


    • Ailments after death of her daughter-in-law
    • Dominating
    • Laziness
    • Anger easily
    • Desire for company
    • Does not wish to do work
    • Chilly patient
    • Craving: Spices
    • Stool: Hard
    • Pain in head-vertex
    • Pain in legs
    • Constriction feeling in stomach


Repertorial totality

  1. MIND-ANGER - Easily
  2. MIND-AILMENT FROM - Death of loved ones
  3. MIND-COMPANY - Desire for
  4. MIND-LAZINESS
  5. GENERALS-FOOD and DRINKS - Spices–desire
  6. STOOL-HARD
  7. HEAD-PAIN - Vertex
  8. EXTREMITIES-PAIN - Leg
  9. STOMACH-CONSTRICTION.


Repertorization [Figure 2]
Figure 2: Repertorial sheet - Schryons F..RADAR [Computer Program]. Ver. 10.0. Belgium: Archibel; 2009.

Click here to view


Repertorial analysis

  • Nux vomica: 19/9; marks secured - 19; number of rubrics covered - 9
  • Arsenic album: 16/9; marks secured - 16; number of rubrics covered - 9
  • Phosphorus: 20/8; marks secured - 20; number of rubrics covered - 8
  • Sulfur: 17/8; marks secured - 17; number of rubrics covered - 8.


First prescription

After repertorization, considering totality of symptoms and consulting Materia Medica, Nux vomica 200, single dose, was given to the patient on July 22, 2016. [Table 2]
Table 2: Follow-up of patient

Click here to view


Case 3

A 55-year-old married Hindu male patient, government school teacher by profession, came to our hospital OPD (OPD Reg. No. 6178, dated February 17, 2017) with complaints of anger; heaviness of head; burning sensation in eyes, throat, and abdomen for the past 1 year. The patient was apparently well 1 year back then gradually he started developing complaint of heaviness of head, burning sensation in eyes, throat, and abdomen. The apparent cause was a feeling of loneliness after the death of his brother, 1 year back. His all symptoms got aggravated after fit of anger.

  1. Mental symptoms


    • Anger
    • Ailments from anger; after death of his brother
    • Likes solitude
    • Aversion to music.


  2. Physical general


    • Chilly patient
    • Desire alcoholic drinks.


  3. Personal history: Male patient, married, teacher
  4. Past history: Nothing specific
  5. Family history:


    • Father: Died from heart attack
    • Mother: Died from heart attack


  6. General examination: NAD
  7. Provisional diagnosis: Mild depression; based on HDRS score = 12
  8. Evaluation and totality of symptoms


    • Ailments after anger and death of his brother
    • Like solitude
    • Aversion to music
    • Heaviness of head
    • Burning sensation in throat, eyes and abdomen
    • Alcoholic drink desire.


Repertorial totality

MIND-AILMENTS FROM - Anger

MIND-BAD - News, ailments from

MIND-COMPANY - Aversion to

MIND-SENSITIVE - Music, to

HEAD-HEAVINESS

THROAT INTERNAL-PAIN - Burning

EYE-PAIN - Burning

ABDOMEN-PAIN - Burning

GENERALS FOOD AND DRINKS - Alcoholic drinks–desire.

Repertorization [Figure 3]
Figure 3: Repertorial sheet - Schryons F..RADAR [Computer Program]. Ver. 10.0. Belgium: Archibel; 2009

Click here to view


Repertorial analysis

  • Nux vomica: 23/9; marks secured - 23; number of rubrics covered - 9
  • Natrum muriaticum: 22/9; marks secured - 22; number of rubrics covered - 9
  • Aconite: 19/9; marks secured - 19; number of rubrics covered - 9
  • Sepia: 19/9; marks secured - 19; number of rubrics covered - 9
  • Sulfur: 19/9; marks secured - 19; number of rubrics covered – 9.


First prescription

After repertorization, considering totality of symptoms and consulting Materia Medica, Nux vomica 200, single dose, was given to the patient on February 17, 2017 [Table 3].
Table 3: Follow-up of patient

Click here to view



  Discussion Top


In this case series, three case studies are presented. In each of these cases, Nux vomica was selected on the basis of individualization, which was successful in the treatment of patients suffering from depressive disorders along with relief of associated symptoms of the patients. All the patients continued follow-ups for the next 3 months to 1 year with no recurrence. No patient complained of any side effects or any negative consequences. Nux vomica covered mental symptoms such as oversensitive to external impressions, to noise, odors, light, and music, anger suppressed, fear of disease, and death; desire for solitude; and ailments after death of loved ones, aversion to musicc.

In three cases, the age group was 32–55 years. A higher prevalence of depression in working adults (aged 20–69 years) has been consistently reported by Indian studies.[8]

Various studies show women to be more frequent sufferers of depression.[8] However, the baseline data of this study do not corroborate with these findings.

In one previous study, the homeopathic medicines that gave favorable result to the patients suffering from depression were Natrum muriaticum, Arsenicum album, Pulsatilla nigricans, Lycopodium clavatum, Phosphorus, Sulfur, Lachesis, Aurum metallicum, Sepia, Calcarea carbonica, and Nux vomica.[8] Thus, Nux vomica, which was successful in the treatment of depressive disorders in this case, corroborates with the fact that it was also one of the effective medicines, in the previous study.

Limitations of the study

Since this case series is a retrospective study of treatment of depressive disorders treated with Nux vomica only in three cases, it cannot be generalized for the holistic treatment of depressive disorders following classical method of homeopathy treatment.


  Conclusion Top


The depressive disorders are usually considered difficult to cure, but many physicians only target to treat such cases and suppress the manifestations in conventional system of treatment. However, the constitutional medicines prescribed after repertorization and in consultation with Homoeopathic Materia Medica not only improved the patients' symptomatology of depressive disorders, but also the score of depression in each case was also reduced as per HDRS. Thus, homeopathy system offers holistic treatment in these kinds of difficult cases. Hence, it is recommended to undertake prospective interventional randomized controlled trials with greater sample size to vindicate the scientific basis of Homeopathy. Moreover, it is suggested that further studies should be undertaken to ascertain comparative role of centesimal and 50 Millesimal potencies in the treatment of depressive disorders with long duration.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
George MK, Praveen A. Medicine Prep Manual for Undergraduate. 5th ed. Manipal Technologies Ltd., Manipal: Elsevier; 2015. p. 793-79.  Back to cited text no. 1
    
2.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.  Back to cited text no. 2
    
3.
WHO. ICD 10, Classification of Mental and Behavioural Disorder, Clinical Descriptions and Diagnostic Guidelines. 5th edition. Geneva: World Health Organization; 1992. p. 119-25.  Back to cited text no. 3
    
4.
Hahnemann S. Organon of Medicine. 5th and 6th ed. New Delhi, India: B. Jain Publishers (P) Ltd.; 2010. p. 111-7.  Back to cited text no. 4
    
5.
Schryons F. RADAR [Computer Program]. Ver. 10.0. Belgium: Archibel; 2009.  Back to cited text no. 5
    
6.
Boericke W. Pocket Manual of Homoeopathic Materia Medica. 9th ed. New Delhi: B. Jain Publishers; 1985. p. 422-5.  Back to cited text no. 6
    
7.
Allen HC. Keynotes and Characteristics with Comparisons of Some of the Leading Remedies of Materia Medica. 1st ed. Calcutta: Sett Dey & Co.; 1959. p. 209-12.  Back to cited text no. 7
    
8.
Oberai P, Balachandran I, Janardhanan Nair KR, Sharma A, Singh VP, Singh V, et al. Homoeopathic management in depressive episodes: A prospective, unicentric, non-comparative, open-label observational study. Indian J Res Homoeopathy 2013;7:116-25.  Back to cited text no. 8
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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