Ayurveda and depression

Depression affects over 18 million Americans a year and that number is growing according to the National Institute of Mental Health (Lewis, 1997). One in five Americans can anticipate suffering from a depressive illness that includes high levels of stress, anxiety, and sadness {NIMH). With such an epidemic of depression, complementary and alternative approaches are becoming more available. Utilizing the Ayurvedic concepts, we will explore how these approaches can be of benefit. In order to understand depression, we must first understand how it affects the body and mind. First we will explore what modern science currently knows about the mind.

​Nervous System

The nervous system (NS)  is considered the control center of the body as it processes information in milliseconds with electrical and chemical pulses that travel along the length of an interconnected web of nerve cells. The tree of nervous system is comprised of two primary parts. The trunk is the brain and spinal cord which makes up the central nervous system (CNS) The primary branches that come off of the trunk are the peripheral nerves and ganglia that comprise the peripheral nervous system (PNS). The large branches of the PNS are divided into two additional functions: autonomic and somatic. The autonomic system controls involuntary bodily functions, including glands, smooth muscle, and the heart while the somatic nervous system controls voluntary bodily functions. Within the autonomic system are two subsystems known as the sympathetic and parasympathetic systems. These are buzzwords these days as many mind body approaches are aimed at getting us out of fight or flight (Sympathetic) and into parasympathetic (calming). As each organ receives stimulus from both subsystems it is not as black and white as it may appear in popular literature. 

Brain Chemistry

Within the various nerves that make up the branches of the nervous system there are many ways of signaling necessary for coordination and control. Structures throughout the body secrete chemical messengers that act on receptor molecules to change the functions of various tissues within the body. The two primary pathways for these messengers are the bloodstream and the nerve cells. When the glands release chemical messengers called hormones into the blood these can stimulate a cell to do many things, including manufacture chemicals like estrogen or even cause changes in the operation of genetic material. The other form of communication called neuronal signaling differs from hormonal signaling in that the messages travel over nerve cells. The brain and nerve cells talk with each other via neurotransmitters, chemical messaging molecules that send information from one nerve cell to the next like an advanced game of telephone. There are more than 300 neurotransmitters and a class of neurotransmitters called neuropeptides that all deliver complex messages to other parts of the body. As Alan Tillotson describes them “Neurotransmitters are like fingers on a hand and the receptor sites as keys on a piano. Each finger has its place on a particular key and the resulting pressure produces an expected note or reaction.” The regulatory activities of the body are performed in this way. 

What is depression?

The Diagnostic and Statistical Manual (DSM-IV) definition is: “Clinical depression is a mental disorder characterized by an all encompassing low mood accompanied by low self esteem and a loss of interest in normally enjoyable activities.” Clinical depression is diagnosed by determining the patient’s unique symptom cluster. Possible symptoms and their Ayurvedic correlations will be described later. Now back to the physiology.  

Mood Managing neurochemicals: Serotonin, Noradrenaline, Dopamine

The complexity of mood management is facilitated by a group of neurotransmitters called monoamines, which include serotonin, melatonin, dopamine, epinephrine, and norepinephrine. The dominant theory used to diagnosis and treat depression, relies on managing the concentrations of these chemicals, and yet their relationship to mood is not fully understood (Coupland, 1996). These mood managing neurotransmitters are manufactured from dietary amino acids. The mood is determined by an increase in the production, the inhibition, or the breakdown of these chemicals within the body. Neurotransmitters do not work in isolation, but here is a brief description of the primary monoamines:

• Glutamate is the primary stimulatory neurotransmitter within the nervous system
• GABA (gamma-aminobutyric acid) is the primary inhibitory neurotransmitter and is enhanced by the presence of Serotonin. When excitatory neurotransmitters  are elevated GABA increased through a negative feedback mechanism. Low serotonin levels are frequently an underlying component of many clinical conditions that are also related to GABA function, e.g. insomnia, depression, & anxiety. (strahlendorf, 1989)
• Serotonin is a neuromodulator and its concentration seems to modulate every other neurotransmitter indirectly. (stralendorf, 1989)  Serotonin is produced in the digestive system, skin, blood, and brain and it relates to more than a dozen different receptors found in different areas of the body. Serotonin can influence over 500,000 target neurons so it is no wonder that it is linked to many kinds of behavior including depression.  .More is not necessarily better as Serotonin syndrome can occur. This is one of the dangers of over-supplementation. As levels of serotonin are increased through trypophan and 5 htp supplementation the body stops producing serotonin because the levels have increased.(Coupland, 1996) It has been theorized that it is the availability of serotonin receptors not the concentration of serotonin that is implicated in depression. 
• Noradrenalin binds to opiate receptors and acts as natural painkilleras well as regulating alertness and energy.  In conjunction with serotonin it is responsible for cognitive function, mood, emotion, anxiety, and irritability. (Stahl) This can be further refined by the correlation between motivation and  nor epinephrine and serotonins strong effect on impulsivity, sex, appetite, and aggression.
• Dopamine has the most symbiotic relationship with Serotonin as its metabolism, synthesis, and uptake pathways are intimately intertwined.  When dopamine is acting independently it preferentially regulates pleasure and reward. Motivating us to receive more of both.  

Fulfillment of desire (Dayan)

Depression is more than a mood disorder that affects the body and mind and is often related to our soul. Depression All of us have intentions for our life. Hopes and dreams that we want to see come to fruition in our lifetimes. When the natural obstacles of life arise then we are unable to fulfill these desires and this can lead to depression. Developing a perspective that is inclusive of the totality of life and does not look at the world from an human centric view but recognizes that mass is energy and what we experience in our life is a complex web of effects that we cannot begin to understand. That is why we cannot take anything personally, but simultaneously we must take responsibility for our behaviors. By living a life that is humble and generous we cannot expect great success. We must live this way for the joy it brings us to love all those around us, not because we wish to receive some boon from the heavens. When we take that perspective our unfilled desires no longer leave us feeling like a victim and we can find the silver lining in challenging experiences. 

A General Diagnosis can be determined by following these three steps:

1. Rule out all others and determine duration, severity, and characteristics, symptoms, diet, stress, medications, sleep.
2. Rule out bipolar, schizophrenia, adhd, personality disorder
3. Determine levels of serotonin, dopamine, nor epinephrine, salt and sugar levels, hormone function. Use CT scans to check for blood clots, tumors or consider a spinal tap. 

DSM-IV symptoms and the four types of depression in Ayurveda

In Ayurveda how the inherent intelligence in the body responds to unfulfilled desire varies and can be associated with the symptoms described in the DSM-IV. Below we will look at individual symptom profiles and their relationship to Ayurvedic concepts. This next section requires a deeper understanding of Ayurvedic concepts. This is how an Ayurvedic practitioner would differentially diagnosis depression in order to administer the correct treatment. Determining the underlying cause is usually determined by pulse diagnosis or by an extensive health history. 

1. The most common manifestation of the symptom profile of depression is caused by and underlying imbalance within the Vata Dosha. This affects the motion of Prana Vayu (sensory input) and resides within the Manovahasrota (mind). This will manifest as the following symptoms:
   • Insomnia
   • Indecisiveness
   • If the Ayurvedic diagnostics include low Ojas the patient may also experience a depressed mood.
   • If they include ama or the outlook on life includes tamas than suicide ideation is a possible outcome of this imbalance as well.
   • Factors that may predispose a patient to the imbalance of Vata, Prana and Manovahasrota’s are:
     • Grief 
     • Anxiety
     • Eating disorders
   Treatment of a Vata imbalance that is affected Prana vayu and the manovahasrota
   • Thymoleptics otherwise known as adaptogens help the organism mobilize an appropriate response to stress
   • Nervine trophorestoratives calm and nourish the nerves.
   • Warm oil massage to stimulate the skins pharmacy
2. Another possible imbalance that can lead to the symptoms of depression listed below is low Ojas in combination with weak Agni. This leads to Fatigue.
   The cause low Ojas and weak Agni leading to fatigue associated depression is:
   • Age – as we age our Agni and Ojas may become depleted leading to age associated depression.
   • Dopamine levels become unstable without the support of Ojas
   • Nutrient deficiencies arise when Agni is not strong enough to digest the food we consume.
   Herbal treatment of low Ojas
   • Use cerebrovascular stimulants that improve nourishment to the brain and enhance emotional nourishment by stimulating feelings of joy and love.
3. When there is an imbalance within Sadhak Pitta (fire of the heart/passion). Then the following symptoms may be present.
   • Diminished interest
   • Feeling of worthlessness
   • Suicidal tendencies may be present with the addition of ama in the pulse or as determined by the health history.
   The lifestyle causes that can lead to a disruption in Sadhak Pitta are:
   • Prolonged grief or the inability to grieve
   • Endocrine disorders that affect brain chemistry
   Treatment of Sadhak Pitta
   • Antimanic herbs used to control mood swings
   • Entheogen are psychoactive substances used as part of a shamanic ritual to get a new perspective on reality.
   These must be used with extreme caution.
   • Stop consumption of alcohol and  mehtylxanthines such as chocolate
4. Vyana Vayu is responsible for motor impulses and is an indication of a deep seated vata imbalance that often affects the cardiovascular sysasfasdtem as well as the the emotional heart. In terms of depression it can also lead to:
   • Psychotic agitation or retardation
   Vata naturally increases with age and a lifestyle that deranges our biological age can lead to this symptom of depression.
   
5. When there is unmanaged toxicity in the body that begins to adversely affect the nervous system then this is Ama (undigested/toxins) leading to a depressive mood
   Toxicity in the body can be caused by or accompany the following conditions:
   • Severed medical diagnosis such as cancer or MS
   • Chronic pain or disability
   • Side effects from drugs
   • Substance use or abuse
   Treatment of toxicity can be accomplished with the following strategies
   • Cholegogues- herbs that increase the flow of bile and break down fat soluble toxins
   • Digestive stimulants
   • Udvartana- herbal exfoliation treatment
   • Garshana – ayurvedic bodytherapy using silk gloves
   • Removing food allergens from the diet
   In treating depression with Ayurveda diagnosis is very important. By determining the underlying imbalances through pulse diagnosis or a comprehensive health history form we can admister a treatment that addresses the cause of the condition.

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