“A Clinical Study to evaluate the efficacy of Saraswatarishta in the management of depression in Menopausal women”

Presented by:Dr.Khyati.Santwani.SudAssistant professor Dept. of KayachikitsaS.G.A.M Jamnagar

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• Women hold a very special place in the

family, society, nation and world.

• Any disturbances - Physical or Psychological

associated with the health status of Women

causes a great deal of impairment at social

and occupational level.

“Menopause is one such condition

that may cause untoward physical

and mental agony”

It is a common myth that as women enter the menopausal years, it is “normal” to feel depressed.

Serious depression, however, should never be viewed as a “normal” event, and women who suffer from it at any time in life should receive the same attention as for any other medical illness.

Extensive research on Menopause is done in the West, but in India only a few research institutes have recognized the potential of research on this subject.

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Beware It May Be Serious Depression !!!

Hormone Replacement Therapy(H.R.T).-

The treatment of Choice

High risk - serious side effects like

Breast Cancer, Uterine Cancer, Venous

thromboembolism,Stroke,etc.

In such cases Ayurveda can extensively

contribute to manage this condition by

using Rasayana treatment

This will not only help to manage

Depression but also improve quality of

life of Menopausal women

To study the prevalence of women's depression and discuss the importance and rationale for screening it during menopausal transition

To clinically evaluate the efficacy of Saraswatarishta in the management of Depression in Menopause

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Inclusion Criteria

• Age between 40-55 years

• Women not having menses since at least last 6 months

• Patients having symptoms of Depression during this phase

Exclusion Criteria

• Patients having Surgical Menopause

• Patients suffering from any major illnesses like T.B., Carcinoma, D.M., etc.

Selection of the patient-

Total 30 patients having classical symptoms of

Menopause and having symptoms of

Depression were selected from the o.p.d

and i.p.d. of I.P.G.T&RA hospital Jamnagar

irrespective of occupation, caste, religion, etc.

Dose & Duration-

Saraswatarishta 20 ml b.d. mixed with water for 45 days

Criteria for assessment:

• Detailed history, physical and mental examination was done on the basis of

a specialized proforma designed for this purpose

• Relief in the subjective sign & symptoms of Menopause

• Gradation was done on the basis of Hamilton’s Depression Rating Scale[1]

and Manasa Pariksha Bhavas from Charak Samhita [2]

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1) Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23:56–62

2) Agnivesha, Charaka Samhita of Agnivesha revised by Charaka and Dridhbala with elaborated Vidyotini Hindi Commentary by

Pt.Kasinatha Shashtri and Dr.Gorakhanatha Chaturvedi, Chaukhambha Bharati Academy, Varanasi , Vimanasthana 4/8, pg.707, 2001

Effect of Therapy: Effect on Manasa Bhavas

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Manas

Bhavas

Mean Score Relief % S.D. S.E. t P

B.T. A.T

Moha 2.73 1.66 39.02% 0.25 0.06 16 <0.001

Krodha 2.2 1.06 51.51% 0.35 0.09 12.47 <0.001

Shoka 2.46 1.33 45.94% 0.35 0.90 12.47 <0.001

Bhaya 2.06 1.06 48.38% 0.37 0.09 10.24 <0.001

Medha 2 1.06 46.66% 0.25 0.06 14 <0.001

Smriti 2 1.06 46.66% 0.25 0.06 14 <0.001

* Highly significant improvement (p=<0.001) in all the Manas Bhavas.

Source: Thesis work Santwani, et al: An assessment of Manasika Bhavas in Menopausal syndrome and its management,2009,I.P.G.T.&RA,Jamnagar

Symptoms Mean Score Relief % S.D. S.E. t P

B.T. A.T.

Depressed mood 2.33 0.93 60% 0.50 0.13 10.69 <0.001

Guilt 2.13 1.06 46.87% 0.53 0.13 7.24 <0.001

Suicide 0.6 0.06 68.88% 0.74 0.19 2.77 <0.02

Insomnia 2.6 1 62.5% 0.61 0.15 10.4 <0.001

Work interest 1.53 0.33 78.26% 0.77 0.2 6 <0.001

Retardation 1.33 0.4 70% 0.70 0.18 5.13 <0.001

Agitation 3.4 1.5 54.90% 0.51 0.13 14 <0.001

Anxiety(Psyche) 1.66 0.66 60% 0.53 0.13 7.2 <0.001

Anxiety(Somatic) 2.26 0.66 70.58% 0.73 0.19 8.4 <0.001

GIT complain 3.26 1.66 48.97% 0.50 0.13 12.22 <0.001

Genital complain 2 0.6 70% 0.50 0.13 10.69 <0.001

Hypochondriasis 2.26 0.93 58.82% 0.48 0.13 10.58 <0.001

Insight 1.66 0.6 64% 0.70 0.18 5.8 <0.001

Weight loss 0 0.4 0% 0.73 0.19 2.10 <0.10

Effect on Hamilton’s Depression Rating Scale

*Highly significant result (p=<0.001) in Hamilton’s Depression Rating scale except for

Suicidal tendencies which showed significant result (p=<0.02) and Weight loss which showed

insignificant result (p=<0.10)

Effect on hematological and biochemical parameters:

Values Mean Score % Relief S.D. S.E. t P

B.T. A.T.

Hb% 11.30 11.46 1.35 0.37 0.09 1.56 >0.10

TLC 7420 7120 4.04 1499.52 387.17 0.77 >0.10

ESR 35.86 26.53 26.02 17.69 4.56 2.04 <0.10

PCV 35.82 36.16 0.97 1.07 0 0 >0.10

FBS 93.93 94.13 0.21 16.95 4.37 0.04 >0.10

S.Cholesterol 180.73 188.4 4.24 29.08 7.51 1.02 >0.10

S.Triglyceride 133.27 123.07 7.65 38.34 9.89 1.03 >0.10

HDL 43 41.2 4.18 9.54 2.46 0.73 >0.10

Total protein 7.34 7.47 1.81 0.34 0.09 1.47 >0.10

Alkaline

Phosphatase

62.53 59.40 5.01 10.64 2.74 1.1 >0.10

Source: Thesis work Santwani, et al: An assessment of Manasika Bhavas in Menopausal

syndrome and its management,2009,I.P.G.T.&RA,Jamnagar

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• During the perimenopause and menopause, emotions can bubble to the surface in a way similar to that seen in the premenstrual syndrome or during the postpartum period.

• Minor mood problems, insomnia, and hot flashes are common during Menopause. In some women, these symptoms progress to a more severe mood disorder known as MAJOR DEPRESSION.

• Several theories have been proposed to explain the increase in depression during Menopause. A traditional psychological view is that the “EMPTY NEST SYNDROME” or other aspects of middle age lead to feelings of loss and sadness. 13

• More recently, scientists have focused on the biological effects of hormonal fluctuations on mood, since this is a time when the ovaries begin to make less estrogen and interacts with chemicals in the brain that can affect mood leading to depression.

• Many treatments for depression during Menopause have been suggested, but most have not yet been evaluated in scientific studies.

• Considering all these facts , the rasayana formulation Saraswatarishta was evaluated for its antidepressive effect in Menopausal women and was found to be highly effective not only to manage depression symptoms but also to improve the quality of life of menopausal women.

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Probable Mode of Action of Saraswatarishta Brahmi, which is a major ingredient of Saraswatarishta, is

reported to be an effective tranquilizer; it has intellect promoting and antidepressive properties [4] which may be useful in managing depression during the menopause.

Drugs like Usheera, Haritaki, Mishreya, Vidarikanda, and Brahmi possess diuretic properties and this helps in the management of urinary tract infections during the menopause.[5]

Drugs like Brahmi, Vidari, Haritaki, etc.act as a cardiotonicand helps in the prevention of cardiac problems.[6]

Drugs like Vidarikanda, Mishreya, and Shatavari are reportedto have estrogenic properties. [7]

4. Data Base on medicinal plants used in Ayurveda Vol.1 P.N.-935. Data Base on medicinal plants used in Ayurveda - Vol.1 P.N.-93,418/ Vol.5 P.N.-445/ Vol.6 P.N.44/ Vol.7 P.N.2836. Data Base on medicinal plants used in Ayurveda Vol.1 P.N.-93/ Vol.6 P.N.44/ Vol.3 P.N.2827. Data Base on medicinal plants used in Ayurveda Vol.6 P.N.44/ Vol.7 P.N.283, Shrestha et. al. 2003

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The ingredients of Saraswatarishta also possess digestive properties (e.g., carminative, laxative, antispasmodic, etc. actions), which are attributed to the Deepan-Pachana Karma, and helps to control gastrointestinal complaints such as constipation, loss of appetite, etc.

Suvarna may act as a driving force by enhancing the activities of other Rasayana drugs in Saraswatarishta.

Modern research shows that gold is beneficial for rejuvenating sluggish organs, especially the brain and digestive system.*

It has been used in cases of glandular and nervous congestionand lack of coordination.*

Colloidal gold is used to improve mental attitude and emotional states.*

* http://www.purestcolloids.com/history-gold.php

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• In a nutshell, Saraswatarishta is believed to comprise antioxidant, nootropic, adaptogenic, immunomodulatory, antidepressant and intellect-promoting drugs, all of which enhance the Rasayana property.

• Hence, Saraswatarishta can be used as an effective drug to manage Depression well as improve the qualityof life of Menopausal women

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