Integrating Unani medicine in managing major depressive disorder: a series of case reports

Meraj Meraj; Noushiba Khan; Abdul Rehman Ishaquddin; Naseem A. Khan; Sadique Husain; Prachi Virpara; Shaikh A. N. Kamal; Mohammad Sameer

doi:10.18203/2394-6040.ijcmph20250940

Authors

Meraj Meraj Department of Ilāj bi’l Tadbīr (Regimenal Therapy), Hakim Syed Ziaul Hasan, Government (Autonomous) Unani Medical College and Hospital, Bhopal, Madhya Pradesh, India
Noushiba Khan Department of Tahaffuzi Wa Samaji Tibb, (Preventive and Social Medicine), Hakim Syed Ziaul Hasan Government (Autonomous) Unani Medical College and Hospital, Bhopal, Madhya Pradesh, India https://orcid.org/0009-0008-1487-7432
Abdul Rehman Ishaquddin Department of Ilāj bi’l Tadbīr (Regimenal Therapy), Hakim Syed Ziaul Hasan, Government (Autonomous) Unani Medical College and Hospital, Bhopal, Madhya Pradesh, India https://orcid.org/0009-0008-3625-3655
Naseem A. Khan Department of Munafeul Aza (Physiology), Hakim Syed Ziaul Hasan, Government (Autonomous) Unani Medical College and Hospital, Bhopal, Madhya Pradesh, India https://orcid.org/0009-0001-0373-2173
Sadique Husain Department of Ilmul Advia (Unani Pharmacology), Hakim Syed Ziaul Hasan, Government (Autonomous) Unani Medical, College and Hospital, Bhopal, Madhya Pradesh, India https://orcid.org/0009-0006-3611-7763
Prachi Virpara Department of Moalajat, National Institute of Unani Medicine, Kottigapalya Main Magadi Road Bangalore, Karnataka, India
Shaikh A. N. Kamal Department of Ilmul Advia (Unani Pharmacology), Government Nizamia Tibbi College, Charminar, Hyderabad, Telangana, India https://orcid.org/0009-0001-1787-3284
Mohammad Sameer Department of Ilāj bi’l Tadbīr (Regimenal Therapy), Hakim Syed Ziaul Hasan, Government (Autonomous) Unani Medical College and Hospital, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20250940

Keywords:

Depression, Ilāj bi’l Tadbīr, Major depressive disorder, Mālankhūliyā, Unani system of medicine

Abstract

Major depressive disorder (MDD) is a chronic condition affecting mood, cognition, and physical well-being. In Unani medicine, MDD is similar to Mālankhūliyā. This case series aimed to integrate Unani medicine into an outpatient model for holistic MDD treatment. Seven participants (four females, three males) with moderate to severe MDD were diagnosed using the DSM-V and Unani criteria for Mālankhūliyā Sawdāwī. They underwent a 19-week treatment protocol, consisting of 17 weeks of active treatment and 2 weeks of observation. The Unani-based approach combined Ilāj bi’l Tadbīr (regimenal therapy) like Naṭūl (forehead irrigation with medicated oil), Sa‘ūṭ (nasal drops), and Tadhīn (oiling). Pharmacotherapy included Majoon Njah, Jawarish Shahi (5 g twice daily), and Dawa-ul-Misk Sada with Arq Gawzaban (5 g and 60 ml twice daily). Conventional antidepressants were tapered and discontinued. Outcomes were assessed using primary self-reported questionnaires and secondary measures including quality of life (QoL) and routine blood tests. The intervention showed significant reductions in the Hamilton depression rating scale (HDRS-21) (p<0.001), Beck depression inventory (BDI) (p<0.002), and insomnia, measured by the insomnia severity index (ISI) (p<0.004). QoL improved significantly (p<0.007). Thus, the integrative Unani medicine approach demonstrated efficacy in managing MDD. The combination of pharmacotherapy and regimenal therapy significantly alleviated depressive symptoms and improved QoL. However, further rigorous studies are needed to confirm its broader applicability in MDD treatment.

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References

Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJL, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013;10(11):e1001547. DOI: https://doi.org/10.1371/journal.pmed.1001547

Baxter AJ, Charlson FJ, Cheng HG, Shidhaye R, Ferrari AJ, Whiteford HA. Prevalence of mental, neurological and substance use disorders in China and India: a systemic analysis. Lancet Psychiatr. 2016;3:832e41. DOI: https://doi.org/10.1016/S2215-0366(16)30139-0

Indu PS, Anilkumar TV, Pisharody R, Russell PSS, Raju D, Sarma PS, et al. Prevalence of depression and past suicide attempt in primary care. Asian J Psychiatr. 2017;27:48-52. DOI: https://doi.org/10.1016/j.ajp.2017.02.008

Patten SB, Williams JA, Lavorato DH, Wang JL, McDonald K, Bulloch AG. Descriptive epidemiology of major depressive disorder in Canada in 2012. Can J Psychiatr. 2015;60(1):23-30.

Isometsea E. Suicidal behaviour in mood disordersdwho, when, and why? Can J Psychiatr. 2014;59(3):120-30. DOI: https://doi.org/10.1177/070674371405900303

Patten SB, Williams JA, Lavorato DH, Wang JL, McDonald K, Bulloch AG. Descriptive epidemiology of major depressive disorder in Canada in 2012. Can J Psychiatr. 2015;60(1):23-30. DOI: https://doi.org/10.1177/070674371506000106

Whooley MA, Wong JM. Depression and cardiovascular disorders. Annu Rev Clin Psychol. 2013;9:327-54. DOI: https://doi.org/10.1146/annurev-clinpsy-050212-185526

Patten SB, Kennedy SH, Lam RW, O'Donovan C, FilteauMJ, Parikh SV, et al. Canadian network for mood and anxiety treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. I. Classification, burden and principles of management. J Affect Disord. 2009;117:S5-14. DOI: https://doi.org/10.1016/j.jad.2009.06.044

Health quality Ontario. Psychotherapy for major depressive disorder and generalized anxiety disorder: a health technology assessment. Ont Health Technol Assess Ser. 2017;17(15):1-167.

Bhargava J, Khan ZY. Comparative Evaluation of the efficacy and side effects of imipramine, sertraline and an ayurvedic formulation in patients of depression. J Clin Diagn Res. 2012;6(2):220-5.

Khan MA. Iksir-i-Azam. 2nd edition. Matba Nami Munshi Naval Kishor. Lucknow. 1906;186-213.

Tabri A. Mualajat al- Buqratiyya (Urdu translation). CCRUM. New Delhi. 1995;374-90.

Bhat MD, Nazir A, Ahmad H, Wani S, Najar F. Melancholia a Psychiatric Disorder Described in Unani System of Medicine: Its Similarities and Differences with Depression. J Res History Med. 2023;12(1):27-34.

Ahmad A. Ibn Sina. Al-Qanun fi’l Ṭibb Book 3, Part-I. Jamia Hamdard. New Delhi 1411. 2024;93-103.

Rizwan K. Sharah Asbab Wa Alamaat (Urdu Translation). Central Council for Research in Unani Medicine. New Delhi. 2010;186-219.

Meraj M, Rehman A, Khan NA, Husain S, Khan N. Utilization of unani regimenal therapy for the management of insomnia: a rapid scoping review. World J Curr Med Pharm Res. 2024;6(2):18-3. DOI: https://doi.org/10.37022/wjcmpr.v6i2.325

Jahan M, Shervani AMK, Ahmed U, Firdose FK, Ansari AN, Jahan N. An international trial to evaluate the efficacy of Nutool therapy in the control of primary insomnia among the elderly using structured insomnia schedule. Int Res J Med Sci. 2014;2(2):1-6.

Nayab M, Khan F, Ansari AN, Khan TN, Itrat M. Nutūl as an effective and time tested regimenal modality in Unani system of medicine: An Overview. J Drug Delivery Ther. 2021;11(3):132-7. DOI: https://doi.org/10.22270/jddt.v11i3.4716

Tortora GJ, Grabowski SR. Principles of Anatomy and Physiology. 9th edition. New York: Wiley. 2000.

Uebaba K, Xu FH, Ogawa H, Tatsuse T, Wang BH, Hisajima T, et al. Psychoneuroimmunologic effects of Ayurvedic oil-dripping treatment. J Altern Complement Med. 2008;14(10):1189-98. DOI: https://doi.org/10.1089/acm.2008.0273

Meraj M, Rehman MI, Khan NA, Husain S, Khan N. A Comprehensive Review of Insomnia and Its Regimenal Management in The Unani System of Medicine. J Drug Delivery Ther. 2024;14(5):158-62. DOI: https://doi.org/10.22270/jddt.v14i5.6562

Khan P, Verma R, Khan A, Akhtar J. The efficacy and safety of a Unani pharmacopoeal formulations-raughan kahu in Sahar (Insomnia): A preliminary study. Int J Unani Integr Med. 2023;7(1):46-51. DOI: https://doi.org/10.33545/2616454X.2023.v7.i1a.230

Pathirana W, Abhayawardhana P, Kariyawasam PH, Ratnasooriya WD. Transcranial route of brain targeted delivery of methadone in oil. Indian J Pharm Sci. 2009;71(3):264-9. DOI: https://doi.org/10.4103/0250-474X.56024

Dhingra D, Joshi P, Gupta A, Chhillar R. Possible involvement of monoami nergic neurotransmission in antidepressant-like activity of Emblica officinalis fruits in mice. CNS Neurosci Ther. 2012;18(5):419-25. DOI: https://doi.org/10.1111/j.1755-5949.2011.00256.x

Pawar DB, Marathe PA, Rege NN. Antidepressant activity of aqueous extracts of fruits of Terminalia chebula and Phyllanthus emblica in behavioural models of depression: involvement of monoaminergic system. Int J Pharm Pharm Sci. 2014;6(8):615-20.

Adnan M, Chy MNU, Kamal ATMM, Chowdhury MR, Islam MS, Hossain MA, et al. Unveiling Pharmacological Responses and Potential Targets Insights of Identified Bioactive Constituents of Cuscutare flexa Roxb. Leaves through in vivo and in silico Approaches. Pharmaceuticals. 2020;13(3):50. DOI: https://doi.org/10.3390/ph13030050

Rahmati B, Kiasalari Z, Roghani M, Khalili M, Ansari F. Antidepressant and anxiolytic activity of Lavandulam officinalis aerial parts hydroalcoholic extract in scopolamine-treated rats. Pharm Biol. 2017;55(1):958-65. DOI: https://doi.org/10.1080/13880209.2017.1285320

Arzani HMA. Qarabadeen Quadri. Munshi Nawal Kishore. Kanpur India. 2018;453.

Moazzam SW, Mobeen A, Siddiqui MA. Efficacy of Jawarish Shahi a herbal formulation in irritable bowel syndrome: An open-labeled single-arm clinical trial. J Tradit Complement Med. 2022;12(6):529-35. DOI: https://doi.org/10.1016/j.jtcme.2022.04.004

Mani V, Sajid S, Rabbani SI, Alqasir AS, Alharbi HA, Alshumaym A. Anxiolyticlike and antidepressant-like effects of ethanol extract of Terminalia chebula in mice. J Trad Complementary Med. 2021;11(6):493-502. DOI: https://doi.org/10.1016/j.jtcme.2021.04.003

Pemminati S, Gopalakrishna HN, Swati B, Shreyasi C, Pai MR, Nair V. Antianxiety effect of aqueous extract of fruits of Emblica officinalis (EO) on acute and chronic administration in rats. J Pharm Res. 2010;3(2):219-33.

Mahendra P, Bisht S. Anti-anxiety activity of Coriandrum sativum assessed using different experimental anxiety models. Indian J Pharmacol. 2011;43(5):574-7. DOI: https://doi.org/10.4103/0253-7613.84975

Masoumi-Ardakani Y, Mahmoudvand H, Mirzaei A, Esmaeilpour K, Ghazvini H, Khalifeh S, et al. The effect of Elettaria cardamomum extract on anxiety-like behavior in a rat model of post-traumatic stress disorder. Biomed Pharmacother. 2017;87:489-95. DOI: https://doi.org/10.1016/j.biopha.2016.12.116

Tawfeek N, Mahmoud MF, Hamdan DI, Sobeh M, Farrag N, Wink M, et al. Phytochemistry, Pharmacology and Medicinal Uses of Plants of the Genus Salix: An Updated Review. Front Pharmacol. 2021;12:593856. DOI: https://doi.org/10.3389/fphar.2021.593856