Ayurvedic Approaches to the Treatment of Depression: By Laura Perlin

Depression is a major health epidemic, affecting 10-15% of the population of the western world.1  While almost everyone has experienced depression to some degree as a feeling of extreme sadness and melancholy, more and more people are being diagnosed and treated for clinical depression, a mood disorder characterized by ongoing sadness, anger, loss or frustration that lasts for weeks, months, or years and interferes with one’s abilities to work, go to school, and perform the functions of normal daily life.
 
Western medicine does not attribute a precise cause to depression, and medical researchers are currently exploring theories linking clinical depression to genetics, as well as to abnormalities in brain biochemistry. Depression can be triggered by disruption to normal brain chemistry caused by factors such as long-term sleep disturbance, long-term use of drugs affecting the endocrine system, patterns of drug and alcohol abuse, and diseases of the thyroid.2  Depression can also be triggered by stressful or traumatic events.
 
Depression is diagnosed by the ongoing presence of some or all of the following symptoms, present continuously over time and of such severity that they interfere with the functions of everyday life34:
  • negative distortion of worldview/negative attitude/hopelessness/pessismism
  • helplessness/low self esteem
  • sadness
  • agitation/restlessness/irritability/anxiety
  • changes in appetite/weight gain/weight loss
  • difficulty concentrating
  • fatigue/low energy
  • feelings of worthlessness/self-hate/guilt
  • withdrawal/isolation
  • headache/stomachache/digestive disturbance
1 “Incidence of Depression and Anxiety: the Stirling County Study.” http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC1349333/
2 “Major Depression.” Causes, Incidences, and Risk Factors. http://www.ncbi.nlm.nih.gov/pubmedhealth/ PMH0001941/
3 “Major Depression.” Symptoms. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/
4 “Understanding Depression.” Symptoms. http://www.webmd.com/depression/default.htm
  • loss of interest/pleasure in activities that were once enjoyed
  • suicidal tendencies/preoccupation with death
  • insomnia/excessive sleep
  • worsening of co-existing chronic disease
 
In its more severe forms, symptoms of depression can become psychotic, and patients may suffer from delusions and hallucinations. In the United States, approximately 3.4% of people with depression commit suicide, and approximately 60% of people who commit suicide suffer from depression or another mood disorder.5
 
The main methods that allopathic medicine uses to treat depression are pharmaceutical anti-depressants, the most common of which work by affecting the uptake of seratonin in the brain, and psychotherapy, which can help the patient increase awareness of thought patterns, develop skills to fight off negative thoughts, and explore unresolved personal issues.6  Additionally, western medicine recognizes the therapeutic benefits of having contact with others suffering from similar symptoms in the form of support groups. Electroconvulsive therapy (shock therapy) is used in extreme cases of depression, and light therapy is used in seasonal affective disorder, a seasonal form of depression.7
 
Ayurveda has a very different approach to depression, stemming from a radically different understanding of mind. In Western medicine, the understanding of mind is often limited to the function of the biochemical processes of the brain, an organ which is in itself little understood. Although consciousness, thought, emotion, and feeling are all recognized as universal realities of the human experience, Western medicine lacks a functional cohesive framework for working with these aspects of the human being.
Ayurveda has a lot to offer in this respect. By providing a complex theory of the human being and of health, as well as a holistic methodology of healing and transforming consciousness, Ayurvedic psychology offers many approaches to the understanding and treatment of depression.
 
5 “Major Depressive Disorder.” http://en.wikipedia.org/wiki/Major_depressive_disorder
6 “Major Depression.” Treatment. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/ 7 “Light Therapy.” http://www.mayoclinic.com/print/light-therapy/MY00195/ METHOD=print&DSECTION=all
 
In Ayurvedic thought, consciousness, or ‘chitta,’ describes the totality of the contents of the mind, including conscious, unconscious, and superconscious thought, ideas, emotions, sensations, energy, will, memory, intuition, instinct, love and faith.8  Chitta contains all memories and attachments, all mental conditioning which distorts our perception and disturbs our emotions.9  The term ‘chitta’ encompasses the totality of our inner world, and Ayurveda and its sister science Yoga teach us that by learning to look within and observe the contents of chitta with clarity, we can grow mentally and spiritually. As human beings, we have the ability to perceive through the aspect of consciousness known as ‘buddhi,’ or intelligence.
  • Buddhi is the aspect of consciousness that is filled with light and reveals the truth. When one’s Buddhi becomes fully developed, one becomes a Buddha or enlightened one. The main action of intelligence is to discern the true and real from the false and unreal.10

So what is the nature of the truth that is revealed when one’s intelligence is fully developed? In Ayurveda, truth is understood as the awareness, beyond time and space, beyond thought forms and forms of all types, of the unity of all existence, of all of creation pulsating together as a variegated but singular expression of the unfolding of divine consciousness. The journey to this thought-free awareness of one’s true identity as spirit is the journey towards moksha, liberation. This is the spiritual goal of existence.

 
Classical Ayurveda has the goal of alleviating all disease and suffering, including that related to chitta, which includes mental, psychological and emotional suffering. Ultimately the key to health on all levels is remembering one’s true nature as spirit.11  When one remembers this truth and abides in this knowledge, one chooses actions that are congruent with health and wholeness. Rather than identifying with the chitta, the personal consciousness, as the self, one recognizes one’s broader identity (or lack thereof) as a drop of water in the ocean of consciousness, a part of the greater whole and not differentiated from it.
 
8 Ayurveda and the Mind. Ch 6 - Conditioned Consciousness: The Greater Mental Field.
9 Ibid. p.75.
10 Ayurveda and the Mind. p. 93-94.
11 Principles of Ayurvedic Medicine. p.5.
 
Ayurveda looks at the world through an elemental model in which all aspects of manifest reality are created from the building blocks of the five elements - earth, water, fire, air, and ether.12  The earth element creates all solidity and stability. Earth is heavy, gross, dense, and static. The earth element provides material form and structure. In the mind, earth creates dependability, reliability, consistency, and stubbornness.
 
The water element embodies flow and liquidity. Water flows along the path of least resistance. It is moist, heavy, gross, and soft. The water element creates liquid matter, which has cohesion like earth but more movement and less density. In the mind, water creates love, gentleness, compassion, and attachment.
 
The fire element represents light, heat, and transformation. It allows us to see, perceive, and change.
 
Fire is hot, dry, mobile and sharp. Fire creates the potential for growth and evolution by allowing us to digest knowledge and experience. In the mind, fire is linked to perception, anger, judgement and criticism.
 
Air is the source of all motion, the force that pushes. Neither fire, water, nor earth will move without the force of air behind it. Air allows us to do, to move, to breathe and to be active. Air is light, subtle, flowing, and mobile. In the mind, air is the force that moves our thoughts.
 
Ether is the subtlest of the five elements. It is the empty space that exists all around. Ether represents the field of existence on which all that happens plays out. Ether is present between all things and thus connects all things. As the backdrop to all existence, ether is extremely light,subtle, and clear and difficult to perceive compared to the other elements. However, it is omnipresent. Without ether, there would be no consciousness because there would be no space to contain it.13
 
12 Ibid. p. 51.
13 Ibid. p. 50-51.
 
In Ayurvedic philosophy, the elements group together to form doshas, the three basic energies or principles that are present, in varying degrees, in all people and things.14  We each have a unique genetic blueprint, a unique constitution that accounts for the many differences in the way we look, feel, and behave.  When the doshas are in balance in our bodies and minds, our health is optimal and we are peaceful and at ease. It is easier for the light of truth to shine and for perception to be clear and
unmarred by negative thought patterns. However, the doshic balance can easily be disturbed by stress, environmental factors, and improper diet, which gives rise to negative emotions and physical and mental disease.15
 
Vata dosha is the energy of movement, comprised of the elements of air and ether. When vata is in balance, we are creative, flexible, happy, and joyous. When out of balance, vata creates fear, anxiety, and ungroundedness. Vata is related to prana, the pure life force that animates us without which we could not survive for one second.16  Prana provides us with a sense of excitement about life, an inherent enthusiasm and joy.
 
Pitta dosha is the energy of metabolism or transformation, composed primarily of fire but always contained within water. When pitta is in balance, or perception is clear and we are logical, understanding, and quick to learner. As pitta goes out of balance, anger, jealousy, criticism and hate arise. Pitta is related to tejas, the strength of the intellect and the capacity of the mind to understand, discriminate, and know truth.17
 
Kapha dosha consists of water and earth, and creates structure, strength and immunity. What kapha is balanced, love, compassion, and gentleness are expressed. When there is a vitiation of kapha dosha, the mind tends towards attachment, greed, and clinging. Kapha is related to ojas, the force of stability and contentment. When our ojas is strong and healthy, we have endurance and are able to withstand
 
14 Complete Book of Ayurvedic Home Remedies. p. 11.
15 Ibid. p. 11.
16 Ibid. p. 12.
17 Principles of Ayurvedic Medicine. p. 237.
 
physical and mental stress. Without adequate ojas, we lack the reserve strength to contain all the motion and activity of prana and tejas. Ojas is the protective foundation of good health.18
 
Another important concept in Ayurvedic physiology and psychology is ama, or toxicity. Ama is like a viscous sludge that forms when foods or experiences are not fully digested. In the physical body,
ama can clog up all bodily systems and suppress their healthy function. The same is true of the mind. Things that we see or hear stay with us, often leaving negative traces on our psychic fabric. Remnants of abusive, hateful, or violent things that we have heard or experienced become a cloudy haze in our consciousness, adversely affecting our ability to see clearly, love fully, and act harmoniously. A process of purification or detoxification is often necessary to return to a state of optimal health.
 
Finally, Ayurvedic psychology offers us the language of the three gunas of sattva (clarity), rajas (activity), and tamas (ignorance) to describe the state of a person’s consciousness. The state of the gunas is reflected in the mind and the lifestyle. As a person evolves from ignorance to understanding, and
from understanding to transcendent awareness, the state of mind and actions of the person reflect this evolution. The cultivation of sattva is of great importance in rising above the negative and compelling dramas of the mind.
 
Sattvic consciousness is joyous, calming witnessing and observing, non-judgemental and compassionate, unconditionally loving, and without attachment. It creates a clarity and purity of mind, which allows
the divine spark to shine through and a person’s highest qualities to manifest. The state of sattva is a transcendent state, in which the dualities of good/bad no longer exist. It is achieved not by analyzing and resolving one’s personal dramas and conflicts, but by letting them go.19
 
Rajasic consciousness is turbulent and dramatic, distorting the truth of experience through the muddy lens of the ego. It is in this state of consciousness that most of humanity finds itself. Always desiring,
 
18 Principles of Ayurvedic Medicine. p. 238.
19 Ibid. p. 191.
 
striving, and struggling, rajas lacks stillness and peace. The constant internal chatter obscures the truth of our divine nature, and blinds us to our purpose and potential. As one moves from rajas towards sattva, there is a process of questioning and reevaluation. Glimpses of awareness create emotional repercussions, and there is often attachment to the cycle of growth and learning and the pain that comes with it.  The rajasic state of consciousness is characterized by constant mental activity.20
 
The tamasic state of consciousness is rooted in ignorance, darkness and inertia. An individual with a predominance of tamas will usually not have a connection to anything beyond him/herself, seeing the world in a simplistic, self-centered framework. There is little mental activity or deep thinking, and dullness predominates. In its more extreme forms, tamasic consciousness will express itself through violent or harmful behavior.
 
Thus, the essence of the treatment of depression and all mental disease is to move from tamas to rajas, then from rajas to sattva, and finally to transcend sattva entirely as the mind becomes liberated from the bonds of individual egoic identity.21  Usually the totality of this process takes many lifetimes, although it doesn’t have to. By bringing the doshas into balance, purifying ama, and increasing sattva guna, an individual learns to skillfully use the human mind and the human body as tools. Remembering one’s true identity as a divine being, one wields the tools of the human form with awareness and intention, using them in the service of all beings.
  • The sense faculties, together with the mind, get vitiated by excessive utilisation, non-utilisation and wrong utilisation of the objects concerned. This causes an impediment to the respective sense perceptions. If, again, due to correct utilisation, they come to normalcy, they bring about the respective sense perceptions properly. Thinking constitutes the object of the mind. So
  • the proper utilisation of mind or mental faculty is responsible for normal or abnormal mental conditions. This is to say, if mind or mental faculties are properly utilised, this is conducive to the maintenance of the normal mental conditions; if not, abnormal conditions prevail.22

This condition of normal utilisation of the mind is the goal that Ayurveda strives for, using many methods of treatment including diet, herbs, mantra, pranayama, and pancha karma therapies.

20 “Anxiety and Depression.” Lecture Notes.
21 Ayurvedic Psychology: Anxiety and Depression. Disc 6.
22 Caraka Samhita. Volume 1, Chapter 8. Principles of Psychopathogenesis. V. 15-16.
 
Classical Ayurvedic texts offer an understanding of mental illness that addresses many of the symptoms, root causes, and treatments of depression. They also provide instruction on the maintenance of health and prevention of disease.
  • Normally, mind and sense faculties remain undisturbed. In order that they are not disturbed in any way, one should make all efforts to maintain their normal condition. This can be achieved by the performance of duties after duly considering their pros and cons with the help of the intellect together with the sense faculties applied to their respective wholesome objects and by
  • acting in contradistinction with the qualities of place, season, and one’s own consitution including temperament. So one, who is desirous of his own well being should always perform noble acts with proper care.23
  •  
  • The person of a strong mind who does not indulge in meat and wine; who eats only healthy food, remains clean both physically and mentally, does not becomes affected by unmada.24
Mental health issues are present in vata, pitta, and kapha forms.  Mental illness of all types is addressed in classical texts under the category of ‘unmada,’ insanity, which presents itself in different forms according to the dosha(s) affected. Many of the characterizations of unmada are applicable to modern clinical manifestations of depression.
  • Intellectual confusion, fickleness of mind, unsteadiness of the vision, impatience, incoherent speech and a sensation of vacuum in the heart (vacant mindedness) - these in general are the signs and symptoms of unmada. Such a patient, with bewildered mind becomes incapable of experiencing pleasure and sorrow. He becomes incapable of conducting himself appropriately. Therefore, he loses peace of mind altogether and becomes devoid of memory, intellect and recognition.  His mind wavers here and there.25
Vata type depression can often be triggered by loss, which by creating emptiness in one’s life, increases the elements of air and ether. Loss of a partner, a job, a friend or family member, or a home can all contribute to vata type depression. Certain symptoms of depression, such as emaciation, are particularly linked to disturbances in vata dosha.26
 
Attachment, or clinging, to the object that is lost, is an attribute of kapha type depression, characterized
 
23 Caraka Samhita. Volume 1, Chapter 8. Principles of Preventing Psychic Disturbance. Verse 18.
24 Ashtanga Hrdayam. Volume 3, Chapter 5. Treatment of Insanity. V 59.
25 Caraka Samhita. Volume 3, Chapter 9. Treatment of Unmada: Signs and Symptoms. V 6-7.
26 Ibid. Etiology, Signs, and Symptoms of Vatika Unmada. V 10.
 
by an increase in the elements of water and earth. Water creates cohesion and attachment, an enduring sense of connection, whereas earth creates a stubborn and enduring stability, a resistance to and discomfort with change. Sluggishness, lack of appetite, desire for solitude, and excessive sleep are kaphic manifestations of depression.27
 
Pitta type depression is often associated with the perception of failure or burnout, the state of mind that arises when one does not live up to one’s own expectations of performance or achievement. Getting fired, failing a class, or not passing an exam can all be triggers of pitta type depression. Irritablility and ‘continuous anguish’28 are classical symptoms of pitta type depression.29
 
It is important to remember that multiple doshas can be simultaneously vitiated, and that a patient’s experience of depression may be dual-doshic or tridoshic (sannipatika). Traumatic events or abuse may trigger depression in all individuals, although those with a vata imbalance have less stability and often less endurance in the face of trauma. In treating depression, it is important to consider which doshas are out of balance and design treatment to restore balance.
 
An important aspect in treating depression is reestablishing a harmonious relationship with the cycles of nature. Healthy routines include waking in the morning, around the same time as the sun. Rushing should be avoided as this creates anxiety and disrupts the mind. Food should be fresh, free of chemical residues, and well-prepared, and should be consumed mindfully. Sattvic spices such as ginger, cardamom and basil open the mind and the heart.30 Herbal formulas are instrumental in lighting the path towards growth and healing. Intake of ghee builds ojas and is recommended for those suffering from diseases of “impaired intelligence and memory.”31  Healthy eating habits include sitting still while eating, resting after meals to give food time to digest, chewing all food to an even consistency, and eating without
 
27 Ibid. Etiology, Signs, and Symptoms of Kaphaja Unmada. V 14.
28 Caraka Samhita. Volume 2, Chapter 7. Diagnosis of Insanity. V 7.
29 Caraka Samhita. Volume 3, Chapter 9. Etiology, Signs, and Symptoms of Pattika Unmada. V 12.
30 Ayurvedic Healing. p. 325.
31 Sarngadhara Samhita. Section 3. Chapter 1. V. 12.
 
distractions like music or television. Bedtime should be early, around 10 pm, to avoid aggravating vata. Daily practice of asana, pranayama, mantra and meditation is recommended to increase sattva.
 
Pancha karma is recommended in the classical texts as a treatment for mental illness.32  Internal and external oleation as well as fomentation are powerful methods of liquefying ama and purifying the channels of the body.  Therapeutic emesis removes excess kapha and can alleviate depression, grief and attachment. Therapeutic purgation alleviates anger and irritability (pitta), and enema therapy treats fear, anxiety, insomnia and many other symptoms of vata mental disturbance.33
 
The practice of pranayama, control of the breath, is the main way to increase prana, the vital life force. This can be a powerful practice for alleviation depression, especially of kaphic type. Pranayama increases the flow of energy in the nervous system and strengthens the mind. Alternate nostril breathing brings balance to the right and left hemispheres of the brain.  Solar breathing can be used to alleviate kaphic depression as well. Inhaling through the right nostril and exhaling through the left burns ama and unblocks the flow of energy. The mantras RAM and YAM can be used in conjunction with this practice to bring in the energies of fire and air, respectively.  Lunar breathing, which consists of breathing in through the left nostril and exhaling through the right, is calming and sedating, creating a grounding and stabilizing effect. This can be very helpful for vata and/or pittagenic depression. The mantras VAM and LAM can be used in conjunction with the solar breathing technique to activate subtle energies of water and earth.34
 
The practice of pratyahara, or internal withdrawal of the senses, can alleviate the negative effects of sensory overstimulation and purify the mind from the barrage of sounds and image that often prevail in modern society. One could begin treatment by reducing those sensory inputs that are most negative or injurious to the mind and senses. The mind is fed by the senses in much the same way that the body is fed by food, and junk impressions create toxicity and disease. Going hiking, spending time in nature, gardening, and contemplating the sky, clouds, and stars are all forms of bathing the senses in
 
32 Sarngadhara Samhita. Section 3. Chapter 1 & 3.
33 Ayurveda and the Mind. p. 203.
34 Ayurvedic Psychology: Anxiety and Depression. Disc 6
 
harmonious impressions. Fasting from the media, especially screen-based media, can be a very effective method of reducing vata.35
 
Color and aromatherapy also have applications in the treatment of depression. Use of the color gold can help to build ojas and increase mental endurance, stability and immunity.36  It is gently uplifting and transforms the consciousness to a sattvic state. Essential oils of tulsi, calamus, camphor and wintergreen can help to detoxify the channels of the mind and promote emergence from the dull haze of depression.37 Myrrh, frankincense, sage and mint promote the powers of perception.38
 
Mantra is a powerful tool to change the energy field of the mind.  All sounds, thoughts and words have their own vibratory power that affects the mind on the subconscious level. By repeating a mantra, it is embedded into one’s consciousness. This repetition gives us the power to change the dominant thought forms of our minds.  Bija mantras are single syllable sounds that have no meaning beyond the vibratory power inherent in their sound. Mantras or prayers that invoke the names of God or the divine create positive thinking patterns and help to create connection with divine forces. Extended mantras, which can also be described as prayers, invocations, or affirmations, exist in all spiritual traditions and can be used to increase intentionality and work on particular aspects of healing. The use of mantra helps the mind develop its power of concentration and memory.39
 
Ayurveda offers many tools in healing from depression, and as an ancient and evolving science is open to expansion and utilisation of new technologies and methods. By bringing balance to the doshas, increasing sattva, building ojas, and purifying ama, optimal health of mind and body can be achieved. Individualized treatment plans incorporate a diversity of modalities that address all aspects of the human being. Ayurvedic approaches to the treatment of depression can be combined with Western approaches
 
35 Ayurvedic Psychology: Anxiety and Depression. Disc 6.
36 Principles of Ayurvedic Medicine. p. 334.
37 “Anxiety and Depression.” Feb 2011. Lecture notes.
38 Ayurvedic Healing. p. 322.
39 Ayurvedic Psychology: Anxiety and Depression. Disc 7.
 
to mental health care. The journey to perfect health is approached as a journey of spiritual development, a philosophy which heals not only the individual but also has positive repercussions throughout society.
 
References
 
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