Managing Depression in the Situation of Brahmi Allergy: A Case History
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When it comes to depression and anxiety, typical Ayurvedic therapies involve use of Brahmi—as a tea or kwath, as a medicated ghee, in medicated shirodhara oil or in medicated oil for abhyanga. There is however a significant segment of the population who have an aberrant pathway of serotonin metabolism. This population, at high risk for depression and affective mood disorder, is unable to take either SSRI medications (selective serotonin re-uptake inhibitors) or Brahmi. Both varieties of Brahmi, centella asiatica and bacopa monniera, are equally dangerous for these individuals. The following case history illustrates treatment strategies that can be employed in this instance.
A forty-seven year old psychotherapist presented with arthritis and depression. She had typical vata-type depression, accompanied by worry, agitation and compulsivity. All medications she had tried for her depression induced unwanted symptoms. Prozac, which she tried for only nine days, led to a sudden onset of arthritis, a known, though rare, side effect of this drug. After these experiences she gave up on antidepressant medications and tried Saint John’s Wort. After about six months, she began to develop arthritis in response to this herb. In desperation, she tried Celexa, an SSRI medication, which immediately led to a severe exacerbation of allergy symptoms such as runny nose and asthma.
Her vata-type depression appeared to be hereditary, for she described her mother as “a worry-wort.” She was addicted to caffeine, claiming that black tea calmed her. Her digestion was” ‘churny’ with typical symptoms of Irritable Bowel Syndrome (IBS). The high vata situation in the mind, with so much worry, can lead to IBS, since the impulses from the vagus nerve to the digestive system are constantly implying a state of high alert.
On examination, she had strong worry lines across the forehead. Her tongue had tooth marks, indicative of malabsorption. Her prakruti was V3P2K1 with a vikruti of V4P3K1.5. Her prana was extremely low—so low that she did not respond to stimulants such as caffeine. There was a vata spike in the majja dhatu, indicative of vata-type depression. Among the upadoshas, sleshak kapha was weak, as suggested by her tendency to arthritis. Samana vayu was pushing apana vayu, a fairly typical finding in irritable bowel syndrome. Prana vayu and sadhak pitta in the brain and heart were weak, typical findings for a vata-type depression that also had significant pitta involvement. This was to be expected given her childhood experiences. She had grown up in a home with a rageaholic father who hit her with a belt when he flew into a temper. Beneath her pervasive anxiety lay deep-seated anger related to the abuse she had suffered as a child.
In selecting herbs for her formula, the need was to find remedies that would address the vata and pitta components of her depression and calm her digestion without producing the unwanted side-effects she had seen after using St John’s Wort. Bala was selected for her low prana and high vata, while Gulvel Sattva and Shankhabhasma were chosen to calm samana vayu. (NOTE: This case history dates from before Bala usage was affected by the Ephedra ban) Ashwagandha was the herb of choice for vata in the majja dhatu, and Shankapushpi for pitta components of depression. Sarasvati Churna was selected as a nervine and Guggulu for her arthritis.
Bala 8
Kaishore Guggulu 2
Ashwagandha 4
Shankhapushpi 4
Gulvel Sattva 3
Shankhabhasma 1
Sarasvati 2
1⁄2 tsp. three times daily after meals with warm water as anupan.
Regular shirodhara treatments were recommended to calm vata and rejuvenate majja dhatu. Because the usual shirodhara oil, which contains Brahmi, could not be used, Bala tailam— sesame oil medicated with Bala—was used as an alternative. She was given a vata-soothing diet. She was also gently encouraged to eliminate unnecessary stress and was slowly taught to be gentle and kind to herself.
At her one-month follow-up she reported that her digestion was considerably better. She was taking more care to eat warm, well-cooked foods, so this, as well as the herbs, may have contributed to an improvement. Her arthritis was better. The depression, however, was unchanged. A month later, she began to notice slight improvement regarding the depression. This improvement gradually continued. At one point, we tried a different formula, with no Ashwagandha and less Bala. She immediately noticed how much, by comparison, the original formula helped with her depression, and went back to the first formula.
She presented again two years later, having been taking the herbal formula for the entire time, even though she had not been seeing a practitioner. Although she was still troubled by depression and anxiety, she felt that, with the help of Ayurvedic herbs, her life was more livable. Because of her aberrant metabolic pathways, complete cure of her depression seemed an unattainable goal. However, Ayurvedic therapies had provided her with a source of help that did not carry unwanted side effects. Rather than seeking to cure her depression at risk of exacerbating other physical problems, Ayurveda offered help for the whole person. Her arthritis and digestion—as well as her moods— had improved. Today, Bala would not be used in her internal formula; however, one could still employ the strategy of substituting Bala Tailam for Brahmi-containing shirodhara oil.
With Brahmi ruled out, Ashwagandha was a key herb in leading this patient to a life worth living. However, it was not herbal therapies alone that helped her in her pursuit of greater happiness. Shirodhara treatments, diet counseling and a gradual creation of change both in her outer circumstances and in the way she related to herself were also important in empowering her to experience greater svasthi—wellbeing. It was not only Ayurveda’s herbal repertoire but also its whole person approach that rendered it the most effective modality for this individual.
Alakananda Ma M.B., B.S. (Lond.) is an Ayurvedic Doctor (NAMA) and graduate of a top London medical school. She is co-founder of Alandi Ayurveda Clinic and Alandi Ayurveda Gurukula in Boulder Colorado, as well as a spiritual mother, teacher, flower essence maker and storyteller. Alakananda is a well known and highly respected practitioner in the Ayurveda community both nationally and internationally.
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