INTRODUCTION
Major Depressive Disorder is one of the most prevalent neuropsychiatric disorders, characterized by impairments in cognition, memory, motor skills, motivation, emotional regulation, and the presence of neurovegetative symptoms. It is diagnosed when an individual has a persistently low or depressed mood, anhedonia or decreased interest in pleasurable activities, feelings of guilt or worthlessness, lack of energy, poor concentration, appetite changes, psychomotor retardation or agitation, sleep disturbances, or suicidal thoughts. It was introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. It is estimated that 3.8% of the population experience depression, including 5% of adults (4% among men and 6% among women), and 5.7% of adults older than 60 years. The below case report helps to understand the usefulness of homeopathy medicine in the treatment of MDD.
A CASE REPORT
PRELIMINARY DATA
| Enrollment No. | 27 | Date | 03/02/23 |
| Registration no. | 78042 | Occupation | Pvt. School Teacher |
| Patient Name | Ms.I.J. | Socio-economicstatus | Middle class |
| Age/ Sex | 26/F | Marital Status | Engaged |
| Education | MA | Address | Jaipur |
| Religious/ | Islamic | Nationality | Indian |
| Mother Age/Occupation | 42yr old/Housewife | Sibling Age/Occupation | B-16 yr.(x)- blood cancerS-(i) 19 yr./ B.A.student 2nd year , (ii)5.5 yr./ (x) RTA |
CHIEF COMPLAINT(S)/PRESENT COMPLAINT(S):
| No. | Location | Sensation & Pathology | Modalities A.F., <, > | Concomitant |
| 1. | Head , temporal occiput region Since 5 yearsO- gradual D- sudden comes &sudden go P-slow | Pain – pricking type of+2, on above eye ball (supraorbital region) | A/f thinking from< outing/shopping,> mind divert by her own | Irritability, Anger, Restless |
| 2. | Mind Since childhood O- gradual D- morethan an hour P-slow | Anger suppressed+3, Sadness loneliness+2, Indifference+2, Decrease Socialization+3, Mood swings+2, Low Mood+3, Depressive Mood+3 ,Desire to be alone+3, Brooding+3, Lack of interest in day to day activity +3, Thoughts Negative+3, Thoughts Suicidal+3(did 2-3 attempt) | < Suppressed emtions+2,<forsaken feeling+3,< thinking on +2, < anger on+2,< family environment from+3, | Anger+2; violent+2, Restless |
ASSOCIATED COMPLAINTS:
| No. | Location | Sensation & Pathology | Modalities A.F., <, > | Concomitant |
| 1. | Chest Sincechildhood (7th std.)O- sudden D-fewminutes(sudden comes and go) P-Slow, constant | Pain +1, (pain- kind needle pricking) | < talk to finance/Mo/Fa> Drink water<Breathe intake | – |
PHYSICAL CHARACTERISTICS/PHYSICAL GENERALS:
| Appearance: Whitish complexion, average height, well eye to eye contact, wear burkha. | Digestion: – Appetite: 3 time /day Thirst: 2-3 liter day, room temp.Aversion: N.S. Cravings: Brownie chocolate+3;spicy+3; solid food+3;butter chicken+2;kadhai paneer+2;chicken biryani+3 | Eliminations: Stool-Unsatisfactory+3(after 2-3 days) Urine-5-6/day. |
| Menstrual Functions: Menarche – 12yrs of age, Irregular period; LLMP-15/01/23/LMP- 02/02/23;black in color, leucorrhea- thin; watery; scanty. | Sexual Functions: N.S. | Sleep/Dreams: Sleep- deep for 12 hours.Dream-about marriage, grandmother; givesmoney |
| Physical general modalities: Nausea-< in car;> open air | Thermal: Towards Hot | Perspiration:Scanty+1 |
PARENTS/MOTHER’S OBSTERICS HISTORY:
Uneventful
PAST HISTORY:
OCP- few months ago
FAMILY HISTORY:
| Paternal | Maternal |
| PGM- Heart attack(x) PGF-Blood Ca (x)Younger brother-Blood Ca (x)Younger sister- Road accident(x) | MGF-Heart Disease(x), Angioplasty, Pacemaker, |
LIFE SPACE:
Pt. is born & brought up in J, currently lives with her parents and 1 younger sibling. She is eldest among them. Pt. has not good IPR with family; she is introverted and has very less interaction with them. In childhood when she was
2.5 yrs. of age, her mother had 2nd pregnancy and unable to take care of her so that she gave pt. to her grandmother. As they had not enough money for their daily livelihood needs, they sent her to primary school where they also didn‘t have enough money to pay school fees and school teachers punish her for the same. When she came back to home to tell her PGM, she slapped and beat her with broom, slippers and sticks. Her Mo knew about all things but did not raise voice against it as PGM did all expenditure of them. She had jealousy from siblings, but never reveals this to anyone. Life became hell for me, one day 22 Feb. 2013 In school, a boy named Bharat proposed me , he took care of me, I fell in love with him and that news my parents got and mocking in front of relatives, scold me, even Bharat didn‘t support me, that day I felt alone myself in this whole world. I had depressive symptoms but I tried my hard joined part time job and paid fees of 12th class and got average marks. After a year, got admission in college, and again fell in love another guy, this time thought that God would not do any wrong with me; we had 4 year of relationship but after sometime I got pregnant and he left me alone. I took OCP, again I had trust issue with people, this time I went into depression, had thoughts of suicidal and did 2-3 attempt of suicides. After few months this person called me, blackmailed me that he told to my family members and when I begged him to not do this, he abused me physically and mentally. I told to my one of friend (at work place) to get rid of this situation, then after few months I got relief from this situation. At the same time, my PGM died due to Heart attack, and went back to home. After that, I found job at Jaipur and help my mother to stay with her. But these negative thoughts and suicidal thoughts are continues and now I am fed up of why God did this to me, why I fell in love with that person. My life is worthless, nobody love and care me. My father planned marriage of me with my finance but I am not happy, I have no emotions, wants to end my life just because my mother I did not take this step, otherwise this life has no means.
PHYSICAL EXAMINATIONS:
| General examination- | B.P.-110/70mmHg, PR-84/min, RR-14/min., Weight 56kg, Height 5‘6‖, Skin-eruption on face (mild)Conjunctiva- Pink, P0/C0/I0/O0/ |
| Systemic examination- | CNS- conscious, oriented, sensation and motor functions normal, reflexes normal, muscles strength normal |
INVESTIGATIONS:
CBC-(Hb-11g/dl) ESR-36
HbA1c- 5.1%
MENTAL STATE EXAMINATION (MSE):
| Appearance & Behavior | Average height, whitish complexion, weak eye to eye contact, wear Burkah |
| Motor activity | Appropriate |
| Speech | Clear, Monotonous |
| Mood | Congruent |
| Affect | Sad, Depressive |
| Thought content | Suicidal, Negative |
| Thought process | Depressive |
| Perceptual disturbances | No Hallucination, no Delusion |
| Cognition | Well oriented to Time/Place/Person |
| Abstract reasoning | Maintained |
| Insight | Good |
| Judgment | Good |
PROVISIONAL DIAGNOSIS:
Depressive Disorder
DIFFERENTIAL DIAGNOSIS:
Depressive Disorder Somatic Disorder Dysthymia
DIAGNOSIS:
Major Depressive Disorder (MDD)
SCORING OF HDRS (Hamilton Depression Rating Scale): 22
SCORING OF MSSI (Modified Scale for Suicide Ideation, Miller et.al): 26
EVALUATION OF SYMPTOMS:
| Mental Wants to be alone+3 Brooding+2 Negative thought+3 Suicidal thought+3Feeling of forsaken+3 Jealousy from siblings+3Lack of interest in day to day activity+2Mood Swings+2< thinking +3< contradiction+2 | Physicals Appetite- normal Thirst- 2-3 literDesire_ Non-Veg(Chicken Biryani+3, Butter Chicken+3), Brownie chocolate, cake+3, Spicy+3Aversion-milk+3, Cabbage+2 Thermal- Towards hot, Perspiration- ScantyStool-Unsatisfactory | Particulars Head- pain in temporal-occipital regionPain –pricking<talk, going outside, > Rest Chest pain> drinking water; Relax when |
TOTALITY OF SYMPTOMS:
< thinking +3 Wants to be alone+3 Brooding+2
Feeling for forsaken+3
Negative thoughts +3 Suicidal thoughts+3
Lack of interest in day-to-day activity+2 Mood Swings+2
Reproaching herself+3
Desire – chicken biryani, butter chicken, chocolate cake+3 Aversion- Milk+3
Perspiration-Scanty+3 Stool- Unsatisfactory
Headache< thinking; talk from Contradiction aggravation Chest pain > relax
REPERTORIAL TOTALITY:
Mind- brooding
Mind- company aversion to Mind- reproached
Mind-thinking ailments from Mind- thoughts suicidal Head-headache
Perspiration- scanty sweat Generals- Food & Drinks chicken
Generals- Food & Drinks-Milk Aversion Generals- Food & Drinks- Desire spices
REMEDY DIFFERENTIATION:
Nat Mur-6/10 Sulph – 5/9 Sepia5/8
Nux-V.-5/8 Nux-M.5/5
SELECTION OF FINAL REMEDY WITH POSOLOGY:
Natrum Muriaticum 1M
FOLLOW UPS:
| Date | Remedy response | Interpretation | Prescription | Reason | Expectations |
| 10/02/23 | Constipation – 10% | Registration of | Rx | Pt. got relief | Chest pain |
| relived, Headache-SQ, | medicine seen , | (i) Natrum Mur | in her chest | decreased, Anger | |
| Anger on finance | physical | 1M/1P/HS | pain, | level will be | |
| (because of some | complaints ↓ | (ii)Rii 6P/HS | decrease, Negative | ||
| argument), chest | (iii)Rii 30 | though will also | |||
| pain> by 30-40%, | 4pills/TDS/ | decrease. | |||
| Negative thought | 2weeks | ||||
| persist, Suicidal | |||||
| ideation- yet not a | |||||
| single episode | |||||
| 24/02/23 | Headache increased, < | Rx | |||
| on thinking (duration | (i) Natrum Mur | ||||
| 30mins. to 1 hour) | 1M/1P/HS | ||||
| Chest Pain- decreased | (ii) Rii 6P/HS | ||||
| but again occurred | (iii) Rii 30 | ||||
| due to arguments with | 4pills/TDS/ | ||||
| Fa, fiancé, | 2weeks | ||||
| Constipation- relieved | |||||
| 30-40%, negative | |||||
| thoughts ↓by 40%, | |||||
| Suicidal thought- mild | |||||
| but can control on | |||||
| this. |
| 10/03/23 | Menses-LMP- 03/02/23;cramps+2, severe pain during menses, irritation decrease by 50%, negative thought- not yet, suicidal thought- try to adjust withfamily and its environment, | RxNatrum Mur 1M/3P/HSRii 4P/HS/ 3 weeks | Planning to give Pulsatilla for complaints. | Periods regular , cramps↓↓ | |
| 01/04/23 | Menses- LMP- 31/03/23, No negative thought , suicidal thoughts- not a single episode yet, Anger level- ↓ 70%-80% | RxMag Phos 6x/SOS (ii)Pulsatilla 200c/3P/HSRii30 4Pills/TDS/ 4weeks (Advice to repeat USG on3rd day of menses) | ↓ size of cyst & menstrual discomfort | ||
| 28/04/23 | USG-not done because of some reason, but menstrual pain ↓↓, Anger level↓, Appetite- ↓, Brooding -40-50% present no suicidal ideation, not yet any episode of negative thoughts, try tobalance in life | RxNatrum Mur 1M/3P/HSRii 4Pills/TDS/3 weeks (iii)M.P. 6x/SOS | Brooding ↓↓, | ||
| 19/05/23 | Suicidal thought- not a single episode yet, feeling better, constipation sometimes on and off(due to non-veg) Headache-80%↓ LMP- 29/04/23-regular, not significant pain. | RxNatrum Mur 1M/1P/HS alternate weekRii 4Pills/TDS/4 weeks |
SCORING OF MSSI & HDRS (after 3rd Month):
HDRS score-3
MSSI score- 0
DISCUSSION:
Natrum Muriaticum is the indicated remedy that was prescribed upon different expressions of mental state along with physical generals, & it showed effective result on every aspect from Mental, Physical, to Particulars. To assess the patient’s depressive state, we have applied HDRS scale, as patient had suicidal thought, we also applied to assess it from MSSI Scale. Patient scored 22 in pre-HRDS score & 26 in pre-MSSI score, after 3 month of re-assessment patient scored 3 in post-HDRS score as well as 0 in Post MSSI Score.
