AYUHOM

RESEARCH ARTICLE
Year
: 2020  |  Volume : 7  |  Issue : 2  |  Page : 80--85

A study on the scope of homoeopathy in the management of suicidal ideation in depressive episodes


Thounaojam Nanao1, UK Girish Navada2,  
1 Department of Obstetrics and Gynecology, North Eastern Institute of Ayurveda and Homoeopathy, Shillong, Meghalaya, India
2 Department of Psychiatry, Father Muller Homoeopathic Medical College and Hospital, Mangaluru, Karnataka, India

Correspondence Address:
Dr. Thounaojam Nanao
Department of Obstetrics and Gynecology, North Eastern Institute of Ayurveda and Homoeopathy, Shillong - 793 018, Meghalaya
India

Abstract

Background: Suicidal ideation in depressive patient is one of the risk factors for premature death due to their hopelessness, worthlessness, to escape or solve the problem, or to take revenge. Objective: The objective of the study is to study the effectiveness of homeopathic medicine in the management of suicidal ideation in depressive episodes. Materials and Methods: Thirty patients were selected for this study based on purposive sampling. The diagnosis was made on international classification of diseases-10 and DSM-V criteria, and grading of severity of depressive episodes and suicidal ideations were assessed before and after treatment by Hamilton depression rating scale and scale of suicidal ideation. This study was carried out for a period of 24 months. The remedy selection was based on the individualization of each case. Potencies ranging 30-10 M were used on the demand of the cases. Patients were reviewed on weekly basis initially and fortnightly on considerable improvement or on demand of the case. Each case was followed up for a minimum period of 6 months. The descriptive statistics such as mean, standard deviation, and percentage were used, and statistical inference was obtained by paired t-test with the scores of before and after treatment P < 0.05 was taken as significant. Results: Scores before and after treatment were compared and statistically significant was observed as P = 0.00001 which is significant. No report of suicidal behavior or attempt or no increased suicidal ideation was reported during the course of study. Conclusion: Homeopathic medicine is found effective in the management of suicidal ideation in depressive episodes.



How to cite this article:
Nanao T, Girish Navada U K. A study on the scope of homoeopathy in the management of suicidal ideation in depressive episodes.AYUHOM 2020;7:80-85


How to cite this URL:
Nanao T, Girish Navada U K. A study on the scope of homoeopathy in the management of suicidal ideation in depressive episodes. AYUHOM [serial online] 2020 [cited 2021 Dec 9 ];7:80-85
Available from: http://www.ayuhom.com/text.asp?2020/7/2/80/324631


Full Text



 Introduction



Suicidal ideation in depression should always be taken seriously and should be treated before it goes to the worst, as suicide is becoming a leading cause of premature death. According to the WHO, 8 lakh people globally die by suicide every year which amounts to a suicide death every 40 s and accounted for 1.4% of all deaths worldwide, making it the 18th leading cause of death in 2016. Suicide attempts are thought to be at least 25 times the suicide death rates. Suicide is an emerging and serious public health issue in India; the suicide mortality rate per 100,000 population in 2016 was 16.5.[1] Suicide is also an important mental health issue, and as such, identification of relevant factors associated with suicide risk is a critical research endeavor.[2] Suicidal ideation is the occurrence of passive thoughts about wanting to be dead or active thoughts about killing oneself.[3] The thoughts range from a belief that others would be better off if the person was dead, to transient but recurrent thoughts of committing suicide, to actual specific plans of how to commit suicide. The frequency, intensity, and lethality of these thoughts can be quite variable like transient (1–2 min) or recurrent thoughts (once or twice a week).[4] Suicidal ideation may vary in seriousness depending on the specificity of suicide plans and the degree of suicidal intent.[5] The desire or ideation about suicide is really a desire to escape the situation or problems of the patients or desperate attempt to exercise some control in their troubled lives or is an expression of their anger toward others whom they want to make guilty, manipulate, or gain revenge.[6]. Attempted suicide (parasuicide, pseudosuicide, nonfatal deliberate self-harm) is defined as any act of self-damage carried out with the apparent intention of self-destruction, however, vague, halfhearted, and ineffective.[7] Suicide is commonly associated with various psychiatric disorders such as mood and affective disorders, posttraumatic stress disorder, psychoactive drugs abuser, personality disorder, and schizophrenia. Personality, mental and physical illness, and social factors contribute in varying proportion; and suicide arises from their interaction.[8] Suicide is a distinct danger particularly in severe depression.[9] Hopelessness, loss of interest, guilt, worthlessness, and low self-esteem in depressed individuals contribute to an increased likelihood of suicidal ideation and suicide attempts. Patients with high levels of hopelessness have an increased risk for future suicide.[10] Suicidal ideation coexists in all the types of depression. Treatment in proper time can save from converting their ideation to an act. The homeopathic system of medicine recommends a variety of medicines that have symptoms of suicide and depression. Therefore, it was postulated that homeopathic medicine and management can be effective in the treatment of suicidal thoughts in depressive episodes for which, the hypothesis is tested in this study.

Management of suicidal patients

Establishing a therapeutic relationship with empathic listening of the patient's concerns, validation of their feelings to ensure that the patient's feelings are heard and understood and taking a collaborative approach to the session with the patient is the foremost step.[3],[10] The clinician should elicit even the smallest of suicidal intentions, because such ideation may suggest important implications for disposition and treatment. The clinician can ethically breech the confidentiality under certain emergency conditions involving danger, risk of suicide, etc., without patient's consent.[11] It even requires asking of direct questions about the thoughts and behavior in a sensitive manner. Passive thoughts are also important risk factor for completed suicide. A suicidal ideation should be determined including the following information: duration and frequency of thoughts, ability to cope with the thoughts, plan for suicide, adaptive and maladaptive coping strategies, and deterrents to complete suicide. Previous self-injurious behavior or present intention of self-harming should be assessed. Consulting other informants might provide important information about the patient's behavior. Family history of psychiatric illness and suicide should be elicited. The clinician is not expected to be able to predict the future but will develop a judgment about the patient's current level of risk and respond accordingly in the interest of patient's safety.[12] In high-risk patients, emergency referral and hospitalization are important. Markers of risk include degree planning to attempt suicide, including selection of time and place to minimize rescue or interruption; the individual's mental state at the time of the behavior, with acute agitation being especially concerning; recent discharged from inpatient care; or recent discontinuation of mood stabilizer such as lithium or an antipsychotic drug such as clozapine in the case of schizophrenia.[13]

Psychotherapies

Psychotherapies and other psychosocial interventions play an important role in the treatment of individuals with suicidal thoughts and behaviors. Psychotherapies such as interpersonal psychotherapy and cognitive behavior therapy may be considered appropriate treatments for suicidal behavior, particularly when it occurs in the context of depression.[13],[14],[15] Mindfulness meditation, a modern movement, appropriated from ancient Buddhist roots, and clinically innovated by Jon Kabat-Zin is a novel strategy which is gaining popularity for helping people who are experiencing a variety of psychological and psychiatric conditions.[16]

Homeopathic concept regarding suicide and depression

The cause of catastrophes for suicidal behavior with emphasis of patient management had been well explained in Lesser Writings by Master Hahnemann under the heading “The un-charitableness toward suicides.”[17] Suicide and depression can be classified according to the guidelines of Dr. Hahnemann, mentioned in Organon of Medicine, in aphorisms 210–230 and can fall under any of the four categories such as mental diseases arising from corporeal origin (aphorism 216), mental diseases appearing suddenly (aphorism. 221), mental diseases of doubtful origin (aphorism 224), and mental diseases arising from prolonged emotional causes (aphorism 225).[18] Suicide and depression can be expressed under all four miasms, namely Psora, Syphilis, Sycosis, and Tubercular with unique presentations corresponding to each miasm.[19],[20] Suicidal disposition and other modalities are mostly given in various homeopathic repertories in “mind” chapter, and for this study, mostly rubrics and inputs were taken from Kent's repertory where suicidal disposition, time modalities, means or tools for suicide are well explained with medicines.[21] The remedy selection of the individual cases was based on the analysis of symptomatology such as causative factors, qualified mental, physical generals, concomitants, characteristic particulars, repertorial references, and adequate references from various Homoeopathic Materia Medicas from diverse authors such as Dr. William Boerike, Dr. J. T. Kent, and Dr. T. F. Allen.

 Materials and Methods



Source of data

This study was conducted during April 2014 to March 2016 in patients who reported to outpatient department and in-patient department of Father Muller Homoeopathic Medical College and Hospital, Kankanady and Deralakatte, Mangaluru.

Informed consents were obtained from the participants. Case recording and physical examination were performed accordingly and recorded according to the standardized case record format. Ethical clearance was obtained from the Institutional Ethical Committee of the Father Muller Medical College on 25/04/2014 with the reference no. FMHMC/572/2014.

Study design

Nonrandomized, nonplacebo controlled interventional study.

Study setting

Inpatient and outpatient departments of Father Muller Homoeopathic Medical College and Hospital, Mangalore.

Sample size

Twenty seven.

Study duration

April 2014 to March 2016.

Sampling method

Purposive sampling.

Blinding

Nonblinded study.

Intervention

Individualized homeopathic medicine was given in suitable potencies ranging from 30, 200, 1M, 10M according to the need of each case.

Duration of intervention

Six months.

Follow-up period

The patients were followed up on weekly basis initially and fortnightly or on demand of the case.

Diagnosis

The diagnosis was made according to the diagnostic criteria of international classification of diseases (ICD) 10 and DSM5.

Inclusion criteria

Male and female patients from 15 to 65 yearsCases diagnosed from the diagnostic criteria of ICD10 and DSM5Para suicide.

Exclusion criteria

Psychotic patients with or without suicidal ideationsPatients on medication from other system of medicine.

Collection of data

Data were collected from patients and patient's attendants as well as through clinical examination. The severity was recorded through the Hamilton depression rating scale (HDRS)[22] and scale of suicidal ideation (SIS),[23] before and after treatment. Totality of symptoms was erected in each case, taking in consideration of personality assessments as per the principles of Homeopathy and accordingly, therapeutic plan was evolved. The remedy was selected for each case after referring Homoeopathic Materia Medica and various Repertories, mainly Kent's Repertory. The cases were followed up to 6 months. After following up cases, the interferences were drawn by analysis of the outcomes. The remedy selection in the individual cases was based on the analysis of symptomatology such as causative factors, qualified mental, physical generals, concomitants, characteristic particulars, repertorial references, and Materia Medica. Various potencies ranging from 30 to 10 M have been used in this study. Potency selection and repetition of doses were done according to the demand of the cases with the consideration of homeopathic posology.

Statistical analysis

For an effective evaluation and assessment, disease intensity was graded according to the scores HDRS and SIS. After completion of the study, the posttreatment disease scores were compared with the pretreatment disease intensity scores.

Collected data were entered into MS Excel and data cleansing was performed. Data were then transferred into 9. IBM SPSS Statistics Base 22.0 SPSS South Asia Pvt. Ltd. Bangalore 560043, India software and analyzed. Descriptive statistics such as mean, standard deviation (SD), and percentage were used. Analytical statistics such as paired t-test were applied. P < 0.05 was taken as statistically significant.

 Observation and Results



A total number of 27 cases were included in the study after screening as per the inclusion criteria. All the 27 cases were followed up for a period of minimum 6 months. These cases were subjected to statistical study and the statistical analysis is given below [Table 1].{Table 1}

From the [Table 1], it was observed that 59.26% were female and 40.74% were male patients. Predominantly, depression with suicidal ideation was seen in the age group of 31–46, i.e. 55.56% of cases. Suicidal ideation was observed more in moderate depressive episodes and seen in all the severities. Depression was seen in 51.86% of cases who were divorce or having marital discord. Hopelessness was seen in 48.15% of depressive patients which were their reasons for suicidal ideation.

From the [Table 2], it is observed that constitutional remedies were used in 92.6% (25) of cases and 7.40% (2) of cases were on acute remedies.{Table 2}

From the [Table 3], it is observed that the maximum and minimum score of HDRS after the treatment reduces to 14 and 3 respectively.

From the above [Table 4] and [Table 5], we have found that mean ± SD before and after treatment of suicidal ideation was 6.407 ± 2.080 and the standard error of mean was 0.400. Hence, the critical ratio “t” =16.004 and P < 0.05 which is significant. Hence, we rejected the null hypothesis of this study, i.e. there is no difference between the scores before and the after the homeopathic treatment.{Table 3}{Table 4}{Table 5}

 Discussion



In this study, suicidal ideation was found in all the types of depression and suicidal ideations in those patients were due to hopelessness, guilt, worthlessness and desire to escape from the problems as a result of marital discord, divorce, financial problems or joblessness, sickness of loved ones, and disappointment in love. It is also found that suicidal ideation reduces with the improvement of depression and vice versa as SIS scores of all the 27 cases reduce to zero along with the reduction of HRDS scores in those patients. Although there were a few randomized controlled trials related to depression and its management through homeopathy, which provides preliminary support for both the acceptability and the effectiveness of treatment for patients with self-reported depression[24],[25] yet the research evidence for effectiveness of homeopathic treatment in suicidal patients is meager. There have been debates regarding the effects of antidepressants, particularly SSRIs on suicidal behavior, with many studies, and there is some evidence that suicidal feeling and attempts may be increased in the early week after starting SSRIs, with the development of tension and agitation in children and adolescents.[26]

In this study, suicidal ideations were observed even in mild cases of depression which should be further implicated through extensive researches. It is highly recommended to conduct more research in the area of depressive episodes separately based on the severity, by correlating with association of suicidal ideations, and its homeopathic management could be studied in detail through individualization and miasmatic evaluation.

 Conclusion



In this study, it is observed that with improvement in suicidal ideation, there was an improvement in depression by using certain homeopathic medicines. No aggravation of suicidal ideation and suicide attempt was found during the study period. Thus, it can be concluded that homeopathic treatment is effective in the management of suicidal ideation in depressive episodes. However, the role of homeopathy should be explored through randomized controlled trials, with a larger sample size to develop effective management protocol for suicidal patients.

Acknowledgment

I sincerely acknowledge the support of Dr. N. Minita Devi, Assistant Professor, Dept. of Community Medicine, Jawaharlal Nehru Institute of Medical Science, Imphal, Manipur for helping in statistical analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Suicide Data; 2021. Available from: https://www.who.int/teams/mental-health-and-substance-use/suicide-data. [Last accessed on 2021 May 10].
2Campos R, Holden R. Testing models relating rejection, depression, interpersonal needs, and psychache to suicide risk in nonclinical individuals. J Clin Psychol 2015;71:994-1003.
3Tasman A, Jerald K, Lieberman AJ, First BM, Maj M. Psychiatry. 2nd ed. Philadelphia: W.B Saunders Company; 2008. p. 879, 1288, 2145-46.
4American Psychiatric Association. DSM-4®-TR. 4th ed. India: Jaypee Brothers Medical Publishers (P) Ltd.,; 2000. p. 350-1.
5Suicide Ideation. Available from: http://https/www.medicinalnewstoday.com/articles/193026.php. 5. [Last accessed on 2015 Jan 03].
6Trzepacz TP, Baker R. The Psychiatric Mental Status Examination. New York: Oxford University Press; 1993. p. 104.
7Bhatia M. Essentials of Psychiatry. 7th ed. New Delhi: CBS Publishers and Distributors Pvt Ltd.,; 2013. p. 544.
8Gross M, Slater E, Roth M. Clinical Psychiatry. 3rd ed. India: Cassel and Company; 1960. p. 792.
9World Health Organisation. The ICD-10 Classification of Mental and Behavioural Disorders. Indian ed. New Delhi :AITBS Publishers and Distributors; 2007. p119-21.
10Vyas J, Ahuja N. Textbook of Postgraduate Psychiatry. 2nd ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.,; 2003. p. 526-8.
11Shea C. Psychiatric Interviewing: The art of understanding. 2nd ed. USA: Saunders; 1988.
12Gutheil T, Appelbaum P, Weisz SR. Clinical Handbook of Psychiatry and the Law. 3rd ed. USA: Lippincott Williams and Wilkins; 2000. p. 22.
13Bhatia M. The Textbook of Clinical Psychology. India: New Age International private Ltd.,; 2008. p. 30-33.
14Gabbard G, Beck J, Holmes J. Oxford Textbook of Psychotherapy. New York: Oxford University Press; 2005. p. 111-28.
15Sandock B, Sandock V, Ruiz P. Kalpan'snd Sandock's Comprehensive Textbook of Psychiatry. 9th ed. USA: Wolters Klumer; 2012. p. 2717-31.
16The Mindfullness. Available from: https://www.psychologytoday.com/basics/mindfulness. [Last accessed on 2015 Dec 12].
17Dudgeon R. The Lesser Writing of Samuel Hahnemann. New Delhi: B. Jain Large Print; 2007. p. 695.
18Hahnemann S. Organon of Medicine. 6th ed. New Delhi: B. Jain Publishers (P) Ltd.,; 2013. p. 203-7.
19Allen JH. The Chronic Miasm with Repertory. 1st ed. New Delhi: B Jain Publishers (P) Ltd.,; 2007.
20Hahnemann S. The Chronic Diseases their Peculiar Nature and the Homeopathic Cure. India: B. Jain Publishers (P) Ltd.,; 2007.
21Kent JT. Repertory of the Homoeopathic Materia Medica. Mind, Suicidal Disposition. 4th ed. New Delhi: B. Jain Publishers (P); 2007. p. 85.
22Halminton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.
23Beck A, Kovacs M, Weissman A. Assesment of suicidal intention: The scale for suicidal ideation. J Consult Clin Psychol 1979;47:343-52.
24Katz T, Fisher P, Katz A, Davidson J, Feder G. The feasibility of a randomised, placebo-controlled clinical trial of homeopathic treatment of depression in general practice. Homeopathy 2005;94:145-52.
25Viksveen P, Relton C, Nicholl J. Depressed patients treated by homeopaths: A randomised controlled trial using the “cohort multiple randomised controlled trial” (cmRCT) design. Trials 2017;18:299.
26Gelder M, Andreasen N, Ibor Jr., Geddes J. New Textbook of Oxford Psychiatry. 2nd ed. New York: Oxford University Press; 2009. p. 951-60.