- A RETROSPECTIVE STUDY ON CASE OF BIPOLAR DEPRESSION - September 3, 2020
A 62 yr old, female, housewife consulted me in 2010 for frequent attacks of cough, coryza and depression. She was diagnosed as bipolar depression by a renowned psychiatrist. She had frequent attacks of cough since 35 yrs and had taken many treatments from various doctors. When none could provide relief, finally she surrendered to the steroids. She said “I want to do my routine work ,worship god, cook, and go on evening walks etc. I do all these things even with severe attacks of cough. I feel good doing my work. My son says I should not do work but I want to do it. Previously I was able to do all the work – cook, teach my kids, provide care for my in-laws and maintained all social relations too. I was a big helping hand for everybody!! Then how can I sit at one place without work?”
At every 4-5 months interval I get depressed, cannot move, cannot get up, and cannot perform my daily routine during depression. I just sit or lie at one place crying and nervous and don’t like to be talked to or forced to do anything.
Dr : How do you behave when not in depression phase?
Pt : I am such a busy, active and cheerful person, full of life! I enjoy food, talking, watching T.V. I enjoy everything.
Dr : How does it start?
Pt. : All of a sudden, I feel sleeplessness on one night and then, in the morning I feel myself very drowsy, cannot get up and gradually my sad phase starts up…
Dr. : Exactly what happens?
Pt. : I want, to move, eat, walk, talk, but cannot do. I cannot explain you how unbearable a feeling is this! It keeps me awake throughout the night. I have taken allopathics for this but not getting benefit so I stopped it.
Dr : What do you do during this phase?
Pt. : I just sit at one place or keep to my bed.
Dr : How does your family help you during this phase?
Pt : They cannot do anything for me. Nobody can help me to pull out from this situation. Will you help me?
Dr : Tell me your exact feeling, during depression?
Pt : I don’t want any noise around me, nobody should talk or ask anything. Her daughter in law said “If we disturb her, she shouts loudly, we avoid talking because of her irritating behaviour”
Pt : When this depression increases I do not understand what to do, what to talk. I fear that I may lose my temper and use wrong words as not able to think. I feel that I have no sense left and behave nonsense.
Dr : How do you feel When you come to know about your behaviour during attack?
Pt. : I do not remember anything about it. I wonder “Was that me who behaved like this?” Dr. I want relief. I don’t want to be mad. I want to do so many things but cannot. I want to move but my body is not listening to me. If it is not controlled I will be nowhere. I want to control myself and want to become what I was, that happy cheerful person! But my body is not following my wishes! You all are happy and normal, only I am not [with sad and dull expression].
Physical Generals : Appetite, thirst, stool, urine, sweating – NAD.
Thermally – Chilly
Family H/o – N.A.D.
Past H/o : No major illness, no suppressions, Nothing specific.
On observation – Patient keeping her hand on forehead while talking.
August 2010- Hyoscyamus Niger 30 BD for 20 days, prescribed by considering her anger, delirium, hand gestures, emotional blocking, abusive during attacks etc.
Sep. 2010 No specific change. Hyoscyamus 1M x 1 dose prescribed with placebo for 45 days.
Nov. 2010 Case is at standstill. Her daughter in-law said when she is well she is hyperactive, doing various activities with enthusiasm but when depression starts she become sad. I consider the rubric “Eccentricity alternating with sadness” – This time Stramonium 1M prescribed.
Feb. 2011 – Depression reduced. Patient feeling well. [But that was not due the Stramonium, as her depression, itself reduced after 4-5 months period.]
I decided to wait and watch. Only placebo prescribed.
May 2011 – The attack relapsed. Stramonium 1 M x 1dose prescribed.
June 2011 – No relief at all! Stramonium 10 M x 1 dose given.
July 2011 – Slight changes.
Aug. 2011 – Case stand still! Almost 1 yr passed and I couldn’t relieve her. I tried Cannabis Indica, Anacardium and one or two other remedies as per their indications.
Oct. 2011 – Condition the same.
I retook the case and paid importance only to the present complaint.
The following rubrics were taken.
- Light desire for (positive).
- Exhilaration, can recall things long forgotten.
- Embarrassed, ailments after.
- Will, muscles refuses to obey the will. (Lack of co-ordination between mind and body)
- Shrieking pain with the
- Quiet wants to be
- Disturbed averse to being
- Delirium wild
- Irritability spoken to when, confusion of mind
- Senses dull blunted
- Confusion identity duality sense of
- Fear, losing self control
- Coryza cough with
This totality indicated Gelsemium. While studying in college, I knew Gelsemium for exam funk with its famous 3D – Dullness, Dizziness and Drowsiness. During practise I prescribed Gelesemium mostly for muscular complaints with trembling headache, paralytic weakness etc.
Core of Gelesemium: Cowardly patient with torpor state. The Gelsemium remembers his successful past which gives him happiness, confidence and ability to face any challenge. Disturbance of any kind causes him to lose his concentration and consequently the position of comfort which he had achieved with so much effort. This embarrasses him and makes him irritable, sometimes even delirious. Because, it is difficult to regain this position, the patient does not want to be spoken to, avoids disturbances. Ultimately he does not want to lose control which he has gained for himself. Even a little effort scares him. His positive and strong past work are a light for his will which pulls him out from the state of torpor.