A A M J Anveshana Ayurveda Medical Journal

A A M J Anveshana Ayurveda Medical Journal www.aamj.in ISSN: 2395-4159 Review Article Review on Postnatal depression and its Ayurvedic management w.s.r. to Sūtika Unmāda Manisha K. Dawre 1 Milind B. Nikumbh 2 Ashlesha A. Nagrale 3 Pranali U. Mangrule 4 A b s t r a c t In whole world not major but not too neglecting issue are growing up in today s era. What is it? It s mental health. What is cause? Not possible to say because its personal issue, but in which one such a leading problem related to mother, sometime neglected but much serious that is Postnatal Depression (PND) seen in postnatal mother. Ancient science already mentions such problem under a heading of Sūtika Unmāda. Postnatal depression is a depressive illness which affects 10 to 15 in every 100 women having baby and 10 million cases per year (India) [i]. Postnatal depression is defined as symptoms of major depression developing within the first month often delivery, risk can persist for much longer. Here I mention Ayurvedic management because in Kasyapa Smhita, author described 74 Sūtikavyādhi in which he said Sūtika unmāda [ii]. Its management according to Samhita, Kasyapa mentioned in Khilastana, all sūtikavyādhi to be treated or managed same as normal vyādhi its cause was difference but symptoms and treatment are same [iii]. Key words- Mental Health, Postnatal depression, Sūtikaunmāda. 1 Associate Professor, 2 Professor and HOD, 3& 4 PG Scholar, Department of RachanaSharir, Govt. Ayurved College, Osmanabad, Maharashtra, India. CORRESPONDING AUTHOR Dr. Manisha K. Dawre Associate Professor, Department of RachanaSharir, Govt. Ayurved College, Osmanabad, Osmanabad, Maharashtra,(India). Email: manisha.dawre218@gmail.com http://aamj.in/wpcontent/uploads/volume4/is sue1/aamj_1650_1654.pdf AAMJ / Vol. 4 / Issue 1 / Jan Feb 2018

INTRODUCTION W hy we study this topic? It s not about leading disease but it s life-threatening and not only patient suffer bit simultaneously her family and mainly her baby also suffers, so it s more important issue. Mainly this study will be helpful too- 1. A woman who have or think they might have postnatal depression. 2. A pregnant woman who are worried about getting postnatal depression. 3. And to partners, family and friends. In modern science, only sedative treatment mentioned for PND. Therefore it s harmful in lactating mother. So this topic study according to Ayurvedic science we give you best treatment and no harmful to the baby. Under the heading of Sūtikaparicharya we give preventive management of PND. But clearly, Kasyapa told Sūtikaunmādavyādhi so we all go through that. Depression The term depression is included in mental illness. Where there is a loss of contact with reality. Within time and careful management, most of the people recover fully and these episodes may never have another episode. Women are most at risk of developing a significant mental illness during pregnancy or in the first year after birth. Postnatal depression is the most common but most dramatic & severe requiring emergency, specialist treatment inpatient is required in a psychiatric unit. This is also usually necessary & may include antidepressants or antipsychotic medication. But sometimes it can be harmful to the child so not useful in breastfeeding mothers. Safety of the mother & her infant at risk, go through the Ayurvedic management on PND. There are three recognized mood disorders in the postnatal period. [iv] 1. Baby blues- affecting about 80% of a new mother. 2. Postnatal psychosis-is a serious condition. 3. Postnatal depression-between the blues & postnatal psychosis lays PND. Many women do not know that PND can occur after delivery & typically blame themselves, their partners or their baby for the way they feel. It s important for women & their partners to learn to recognize the signs & symptoms of PND. So, they can ask for help as early as possible. Sūtika Unmāda Postnatal Depression Kasyapa has described puerperal disorders at two places once in Dusprajata Cikitsitadhyaya without giving an exact number but numbering thirty-five and again sixty-four disorders in sūtikopkramaniyaadhyaya. Twenty-five disorders have been enumerated at both the places while other differs. Thus total puerperal disorders described at both the places taken together seventy-four. Under seventy-four disease, four disorders are related to psychological abnormality. Which are given hereunder- 1. Pralāpa 2. Unmāda 3. Moha 4. Prajagarana According to symptoms, we compared Unmāda to PND. General etiology of these puerperal disorders [v] - outing during night, terror of fight, sudden fall from height, jealousy, grief, fear, anger, suppression of various natural urges, day-sleeping, eating even in indigestion, eating before the digestion of previous meals and certain other factors are responsible for puerperal disorders. Cause of sūtikaroga - Sūtikaroga developing due to use of direct air, dietetic and mode of life likely to aggravate doṣas [vi], incompatible food and indigestion are very serious [vii,viii,ix]. AIMS & OBJECTIVES 1. To diagnose postnatal depression with the help of literature review. 2. Ayurvedic management on postnatal depression w.s.r. to Sūtikaunmāda. Causes of PND - Biological- Sudden hormones changes during pregnancy and delivery. Changes in HPA axis. Nutritional deficiencies sleep deprivation. A difficult pregnancy or childbirth experiences. History of pre-menstrual tension. Previous experience of postnatal depression or family/personal history of mental health conditions. Genetic predisposition to depression. Psychological- Infertility and use of IVF for conception. Difficult or traumatic birth (unexpected interventions e.g. emergency caesarean). Traumatic or abusive childhood (particularly sexual abuse). Unrealistic expectations of motherhood and of herself. Certain personality types (perfectionist or controlling). Limited social and emotional skills (difficulties in effectively communicating). Problematic or unresolved relationship issues with own mother. Past unresolved issues of grief and loss such as previous miscarriage. Social Lack of family and community support. Difficult relationship with a partner - removed emotionally, works long hours or travels. Intrusive or difficult family relationships. Social isolation and lack of transport. Financial hardship. Lack of close friends, particular families with children. Being of a younger or older age. Stressful life events such as a death in the family or job loss. AAMJ / Vol. 4 / Issue 1 / Jan Feb 2018 1651

Symptoms - Depressed - Feel low, unhappy and tearful for much or all of the time. May feel worse at certain times of the day, like morning or evenings. Irritable - May get irritable or angry with your partner, baby or other children. Tired All new mothers get pretty tired. Depression can make feel utterly exhausted and lack in energy. Sleeplessness Even though tired, can't fall asleep. May lie awake worrying about things. Wake during the night even when your baby is asleep. May wake very early before baby wakes up. Appetite changes May lose appetite and forget to eat.some women eat for comfort and then feel bad about gaining weight. Loss of interest in sex There are several reasons why lose interest in sex after having a baby. It may be painful or may be too tired. PND can take away any desire. A partner may not understand this and feel rejected. Negative and guilty thoughts. Anxious. When feeling anxious, you may have some of the following: Racing pulse. Thumping heart. Breathless. Sweating. Fear that may have a heart attack or collapse. Avoid other people. Hopeless. Thoughts of suicide. Psychotic symptoms. DISCUSSION According to modern science treatment on PND is, Psychotherapy- In which 1) Counseling - To patient as well as her partner and family members. 2) Medicine - 1) Antidepressant. 2) Selective serotonin reuptake inhibitors (SSRI S). Ayurvedic management- According to Kasyapasamhita khilstana adhyaya 10- All sūtika disorder treats same as normal vyādhi. Principles of treatment [x,xi] -Treatment capable of suppressing vāyu or else on the basis of aggravation of doṣas and strength of the women should be done. congenital diet considering the doṣa and diseases should be given. Sūtika Unmāda Sūtikacikitsa- According to above-mentioned principle treatment predominately vātadoṣa affected in sūtikas. Therefore here we consider a vāta doṣa Chikitsa important in sūtikaunmāda. Vātaja unmāda treatment [xiii] - firstly snehapan is important if due to kapha and pittadoṣavāta are obstructed it is removed by snehauktamruduvirechana. Counseling treatment [xiv] - Under the heading of Aashvasan treatment, charaka Saied patient love one gives a moral support. Or give extreme heart touching bad news related to her loved ones, because of that she thought about that and its mind are divert. Snehapan Kalyanaka ghruta, Mahakalyanak Ghruta, Purāṇa Ghruta. Mainly use it. Normally in sūtika paricharya due delivery vātadoṣa increases therefore ghrutapāna important treatment. Mruduvirechana- Erandasneha, Mrudvikaetc. Use. Diet- Diet is a most precious factor in our day to day life. In an ancient samhitas also, it has a wide range of description. Acharya Sushruta has mentioned the importance of diet as āhāra from the following verse- Rasajam Puruṣam Vidyat, Rasam Rakshet Prayatnataha Annapānashcha Matiman, Aacharacchaapyatandritaha (Sushruta, Sutrasthana14/12.) It states that the puruṣa i.e..whole human body is predominantly made up of rasa dhātus, which is eventually formed from the diet. Thus, a total constituent of a human body, it anatomically & functioning is dependent on the diet which an in visual consumes. Yoga (Prāṇāyāma) & Meditation- Technique-Focused and Mantra - both improve your mental capacity, decreases tensions and stabilizes the mind. Mūlabandha- It is Yoga features an exercise which can improve vaginal strength and strengthen to perineum area and related muscles. On a physical level, mūlabandha contracts muscles in the pelvic floor to give them strength and stability. This includes the anus, the perineum found between the genitals and the anus, and the genital muscles, so it will strengthen vaginal muscles for women. It is difficult to learn and do so not useful in most of the PND patients but if it learns properly and does regularly it gives tremendous results. Beneficial diet in Sūtikaroga [xii] - In sūtikarogas and other diseases due to vitiation of vāta with shlesma appropriate AAMJ / Vol. 4 / Issue 1 / Jan Feb 2018 1652

Panchakarma [xv-xx] - Basti (Nirūha, Snehbasti). Śirovirechana(Śirodhara & Śirobasti). Vamana. Anjana. Dhūmapāna. Siramokṣaṇa. Route of administration must also be considered in the treatment of mental illness so, in PND is one of the mental illness, therefore, most effective & obviously the easiest is often considered to be Dhūmapāna, The nose is considered the most direct route to the brain, especially when the medium which carries the herbs is a medicated oil preparation of ghee, sesame oil etc. The common routes of administration are Basti.Which can directly access the nervous system via the spinal cord. Then external oil treatment applied to the head including Śirovirechan. Vamana will remove doṣa from Hrudaya, Śiras, Indriya, Koṣṭa, therefore, Manas becomes prasanna. As a result, mental ability improved and psychological disorder minimizes its effect. Anjana If basti, vamana etc. cleansing mechanism done and then no more result that time tikshna Anjan and nasya will be used. It s step by step treatment. Anjan, nasya removes kapha from śiras and it helps to set mind. Siramokṣaṇa - Site of siramokṣaṇa is Shankhapradesha (keshantsandhi). In this process, restricted vāta easily is removed with the help of rakta doṣa. *Treatment- 1) Vātajdoṣa affected so treat firstly vātadoṣa. 2) Snehapan. 3) Shodhan Chikitsa. 4) Aashvasan Chikitsa. Above all discussion gives you such great knowledge about PND and sūtikaunmāda are treats with the same pattern by Ayurvedic management. CONCLUSION Postnatal depression is one of the fast growing mental illnesses. It s most dangerous because PND diagnosis is some difficulties. Acceptances are less. Mainly family and partner support is most important treatment in that cases. Antidepressant drugs are used but some are harmful to the child, so not safe in breastfeeding mother. Therefore go through Ayurvedic treatment. So, overall Ayurvedic management best in postnatal depression (PND). ΛΛΛΛ Above all study depend on ancient literature and modern literature. Here we mentioned sūtikaunmāda and PND relationship. It is proved by such classical references. Therefore this study gives you a new direction for a treatment of PND disorder. On comparison between modern treatment and ancient treatment we definitely say the ancient treatment was a more proper way treat the patient. More accurately and step by step treat patient in ancient science. Vātadoṣa is more affected in sūtikaunmāda. And vātajunmādalakshanas are same as a PND and as well as sūtikaunmāda. In postnatal period due to blood, loss vātadoṣa was increased. Vātadoṣatreat bysnehpan. Unmāda is under the heading of vātajdoṣavyādhi. Due to vātaprakopa, sūtika is more prone to affect vātaj disease. So prevention is better than cure sūtika paricharya are a more important factor in today s era. In short, we manage this patient in following steps- *Under the heading of prevention - 1) Preconceptional counseling is most effective things. 2) Sūtikaparicharya by Ayurveda is very well managed in it. 3) Massage therapy is relief anxiety and feels good. 4) Yoga prāṇāyāma improve mental health. AAMJ / Vol. 4 / Issue 1 / Jan Feb 2018 1653

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