Adjunctive Ayurvedic Management in Patient with Bipolar Disorder Receiving Conventional Psychiatric Treatment: A Case Report

Abstract

Bipolar disorder is a chronic and recurrent psychiatric disorder characterized by fluctuations between depressive, manic, hypomanic, and euthymic episodes. Management includes psychosocial interventions, psychoeducation, lifestyle modification, and other complementary approaches may be incorporated into individualized care. Ayurveda describes severe disturbances of cognition, behaviour and conduct under the broader concept of Unmada. A 39-year-old female patient presented with chief complaints of excessive and increased speech, which was occasionally incoherent, along with elevated mood, increased wandering, excessive social interaction, frequent smiling and laughing, accelerated flow of thoughts, irritability, episodes of anger. The patient had a documented history of bipolar disorder for 1 year and had experienced previous mixed episode of mania-depression. Baseline assessment using Young Mania Rating Scale and Hamilton Depression Rating Scale demonstrated 30 and 21. The patient was managed through an integrated approach comprising conventional psychiatric treatment and individualized Ayurvedic intervention including shamana chikitsa with gokshuradi guggulu, trinpanchmoola kwatha, brahm rasayana, arjunarishta etc, along with panchkarma, based on Ayurvedic clinical assessment. During 4-months follow-up, the patient demonstrated significant reduction in symptoms, improvement in sleep and psychosocial functioning, and reduction in YMMRS and HAM-D scores. As well, observed systematic de-escalation of patient's existing allopathic pharmacotherapy up to 75%. No any significant adverse events were observed and treatment adherence was good. This case demonstrates the potential feasibility of an individualized integrative approach in the longitudinal management of bipolar disorder. Further studies with standardized interventions and validated outcome measures are required to determine the efficacy and safety of integrative approaches in bipolar disorder.