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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 55-61

Homoeopathy for management of type 2 diabetes mellitus in a patient of major depressive disorder - A case report


1 Central Council for Research in Homoeopathy, New Delhi, India
2 Dr. DP Rastogi Central Research Institute of Homoeopathy, Noida, Uttar Pradesh, India

Date of Submission21-Feb-2019
Date of Acceptance23-Feb-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Karanpreet Nahar
Central Council for Research in Homoeopathy, 61-65, Institutional Area, Opp. ‘D’ Block, Janakpuri, New Delhi - 110 058
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijrh.ijrh_12_19

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  Abstract 


Introduction: Major depressive disorder in diabetic individuals represents a multifactorial phenomenon resulting from interactions between biological and psychosocial factors, which may intensify the probability of developing type 2 diabetes mellitus (T2DM) in otherwise healthy individuals. Case Summary: A case of T2DM is reported in a 38-year-old woman suffering from major depressive disorder who was treated successfully with individualised homoeopathic medicines. The patient reported to the Lifestyle Disorders clinic of Homoeopathic Hospital, Noida, with recently diagnosed diabetes of 8 months. After individualised homoeopathic treatment, the patient's fasting plasma glucose, postprandial glucose, HbA1c levels, fasting plasma insulin and Hamilton Depression Rating Scale score were reduced within 6 months. The findings in this case report are encouraging and provide evidence in supporting the effectiveness of individualised Homoeopathy in reducing hyperglycaemia in a patient with major depressive disorder.

Keywords: Homoeopathy, Lifestyle disorder, Major depressive disorder, Natrum muriaticum, Type 2 diabetes mellitus


How to cite this article:
Nahar K, Kaushik S. Homoeopathy for management of type 2 diabetes mellitus in a patient of major depressive disorder - A case report. Indian J Res Homoeopathy 2021;15:55-61

How to cite this URL:
Nahar K, Kaushik S. Homoeopathy for management of type 2 diabetes mellitus in a patient of major depressive disorder - A case report. Indian J Res Homoeopathy [serial online] 2021 [cited 2021 Apr 23];15:55-61. Available from: https://www.ijrh.org/text.asp?2021/15/1/55/312625




  Introduction Top


Depression is known to be the single largest contributor to global disability and in India, according to National Mental Health Survey 2015–16, nearly 15% of Indian adults need active intervention for one or more mental health issues. One in every 20 Indians suffers from depression.[1] Depression might influence both the occurrence and consequences of type 2 diabetes mellitus (T2DM). Major depressive disorder in diabetic individuals represents a multifactorial phenomenon resulting from interactions between biologic and psychosocial factors, which may intensify the probability of developing T2DM in otherwise healthy individuals.[2] It is noted that people with moderate and severe depressive symptoms at baseline have a 2.3 times higher risk of developing T2DM.[3] Individuals with newly diagnosed diabetes were 30% more likely to have a prior history of depression as compared to people without diabetes.[4] The prevalence of depression in diabetics varies from 8.5% to 27.3%.

Monoamine oxidase inhibitor use is limited by the possible severity of the induced hypoglycaemia, induced weight gain and required diets. The tricyclic antidepressants may lead to hyperglycaemia, an increase in carbohydrate craving and impaired memory.[5] An independent role of depressive symptoms has been established in the development of diabetes in populations with low educational attainment.[6] Furthermore, patients with newly diagnosed T2DM tend to have a reduced mental quality of life and an elevated depression score.[7] Depression negatively impacts the quality of life in diabetic population and enhances chances of mortality in T2DM.[8] Depression in T2DM seems to be predominant more in the northern states as compared to the southern states of India. Age above 50 years, female gender, low literacy rate, lower socioeconomic status and duration of T2DM >2 years show a statistically significant association between diabetes and depression.[9] India ranks second in terms of newly detected cases of diabetes and has earned the moniker as the diabetes capital of the world.[10] The cost-effectiveness of homoeopathic treatment in such diabetes cases with depression imposes a direct relation to the reduction in medical expenses related to its long-term complications and improvement in the quality of life of patients suffering from this silent killer. This is the reason why Homoeopathy can be viewed as a substitute for traditional strategies of treatment.

The following case was diagnosed with major depressive disorder with T2DM, with high fasting and postprandial blood glucose levels and the patient was receiving oral hypoglycaemic drugs at the time of the homoeopathic consultation. The evolution of the case under homoeopathic treatment is presented here. The uniqueness of this case is that the patient showed massive improvement in the diabetic profile parameters including Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) which is computed with the formula of fasting plasma glucose (FPG) (mmol/l) times fasting serum insulin (mU/l) divided by 22.5[11] and Hamilton Depression Rating Scale (HDRS) score which explores the role of Homoeopathy in combating depression with insulin resistance.

This case has been reported according to HOM-CASE CARE guidelines.


  Case Report Top


A 38-year-old female reported to the Lifestyle Disorder Clinic in Dr. DP Rastogi Central Research Institute for Homoeopathy, Noida, on 19 August 2017 with diagnosis of major depressive disorder for 2 years and newly diagnosed T2DM in the last 8 months. She presented with chief complaints of polyuria, polyphagia and polydipsia. There was uncontrolled hyperglycaemia along with weight loss, blurring of vision, generalised weakness, itching in the whole body and pain in bilateral calf muscles. There was a history of repeated upper respiratory tract infections (URTIs), fatigue and frequent sun headaches. The patient did not adhere to dietary recommendations usually followed in diabetes. She followed a sedentary lifestyle and there was no evidence of acanthosis nigricans. No other chief complaints were noted.

Her appetite was increased (5–6 chapatis [an Indian bread]/meal, 3 meals/day) and had a desire for salt with extreme thirst for large quantities of water. Her tongue was mapped. Urine was mildly offensive, passed 9–12 times a day of moderate quantity with more urgency felt in the evening. She felt heaviness at the back of her head, weakness and lack of concentration in her daily work, disturbance with loud voices of anyone, especially of males, which caused shivering in the body.

The patient was also a diagnosed case of major depressive disorder and reported of weak memory, distressing dreams disturbing her sleep and erstwhile weeping without any reason. 'I need to know that everyone else is okay before I enjoy myself. I want everything tidy and sorted out. I feel guilty when I try to relax and try to enjoy myself. Even on holiday I must organize everything so that they are all happy.' She had been living separately from her husband for 2 years as she suffered domestic violence during her marriage, and even after separation, her husband kept torturing her on phone causing her persisted anxiety. She had filed for divorce 9 months ago. Her illness appeared to have been precipitated by the emotional strain of disappointment in her relationship, sadness due to marital disharmony and sustained anxiety. Her psychosocial circumstances were likely to have a negative impact on her quality of life and on her ability to self-manage this chronic disease as well as her ability to set and achieve lifestyle goals. Although she was aware of the importance of diet and exercise, due to her constant emotional strain affecting her day-to-day life, she did not make any effort towards it. The patient had been taking metformin 500 mg orally twice a day, since diabetes was diagnosed. Yet, her fasting blood glucose was above 200 mg/dl.

The patient's previous medical history was insignificant.

Before initiation of the treatment, the patient's FPG, postprandial plasma glucose, HbA1c levels, fasting plasma insulin (FPI) as well as her HDRS score were measured, and the values were used to establish a baseline status. Further, these parameters were monitored regularly for 6 months. The baseline and follow-up of the patient have been mentioned [Table 1].
Table 1: Baseline and follow.up values of the patient

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Clinical findings

Physical examination

The patient weighed 56 kg; had a body mass index of 22.4 kg/m2 and waist–hip ratio was 0.958.

The blood pressure in the right arm was 134/96 mmHg in a lying position and 140/90 mmHg in the sitting position.

Pulse rate was 88 beats per min; respiratory rate was 20 per min.

She used corrective lenses, pupils were equal and reactive to light and accommodation, fundi were clear and no retinopathy was observed during examination.

Bilateral dorsalis pedis arterial pulses were absent. The absent dorsalis pedis arterial pulse is known to be an independent predictor of major microvascular and macrovascular event in T2DM.[12]

Diagnostic assessment

Type 2 Diabetes Mellitus with Major Depressive Disorder.

Diagnostic methods- PE, laboratory testing of Diabetic profile, HOMA-IR calculation, HDRS scoring.

Basis of prescription

Repertorisation was done with the help of RADAR 10 software.[13] Natrum muriaticum, Cocculus indicus, Carbo vegetabilis, Pulsatilla, Sulphur, Zincum metallicum, Causticum and Nitric Acid were the leading drugs in this case with the symptoms, namely ailments from grief, introspection, tendency to catch cold, desire for salt and constipation. After repertorisation, Natrum muriaticum secured the highest rank, as seen in [Figure 1].
Figure 1: Repertorisation chart of the patient

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The mapped tongue, depression particularly in chronic disease, psychic cause of disease, sun headaches and craving for salt were so prominent in this patient that after consulting various homoeopathic materia medica books.[14] Natrum muriaticum, a deep acting anti-psoric medicine, was selected for this case. A few drugs are mentioned including Natrum muriaticum under the rubric 'Urine-sugar' which is considered indicative of diabetes mellitus.[15] Therefore, Natrum muriaticum 30C was prescribed.. The timeline including the follow-up details of the patient is given in [Table 2].
Table 2: Timeline including follow-up of the case

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In addition, there was a decrease in HDRS score from 25 (very severe depression) to 4 (normal) in the 6-month follow-up under homoeopathic treatment.

Therapeutic intervention

Natrum muriaticum 30 three times a day for 3 days followed by placebo for 15 days was prescribed during the first visit on 19 August 2017. She was also advised for regular exercise for 35–40 min/per day, eating small meals at short regular intervals, including fibre-rich foods, avoiding junk/fast food/high-calorie diet, practise pranayama and meditation. This case was followed up till 24 February 2018. The timeline including the follow-up details of the patient are given in [Table 2].


  Discussion Top


This case report shows an improvement in blood glucose levels while she was under homoeopathic treatment. There was a decrease in blood glucose, FPI, serum cholesterol and serum low-density lipoprotein which indicates an overall improvement in the patient. The patient gradually tapered and then discontinued metformin 500 mg under the physician's guidance when she started the homoeopathic treatment since there was an overall general improvement. The HOMA-IR value of the patient has been reduced from 3.72 to 0.1 which has thrown light on the positive effect of homoeopathic treatment on β-cell function and IR. The patient has receded from 'significant IR' state to 'optimal insulin-sensitive' level, showing that Homoeopathic treatment can substantially improve IR. Weight of the patient was maintained at 56 kg and did not further decline (as weight reduction is expected in diabetics). Blurring of vision, generalised weakness, itching in the whole body or pain in bilateral calf muscles also improved with homoeopathic treatment. The patient did not have as frequent URTIs as before. The patient had thyroid-stimulating hormone of 5.8 μIU/ml at baseline which reduced to 0.7 μIU/ml at the end of 6 months of homoeopathic treatment. This depicts an improvement in the thyroid status also by Natrum muriaticum whose sphere of action is on the glands.[16] The absence of bilateral dorsalis pedis pulse encountered during clinical examination at baseline indicated the risk of peripheral arterial disease; however, the pulse was palpable again when checked again later on during the follow-ups under homoeopathic treatment. The case suggests the effectiveness of homoeopathic treatment in the management of hyperglycaemia with comorbidity of major depressive disorder. Although the study of a single case does not constitute a strong opinion, the outcome is encouraging. The causal attribution was established using the Modified Naranjo Criteria, the score was 7, i.e., 'possible' as given in [Table 3].[17] No side effects were observed. Under homoeopathic treatment, the patient's HDRS score also decreased greatly, mood became good, energy levels became higher and her coping also ability improved. In this case report, the effect of homoeopathic treatment in controlling the IR and combating depression has been noted. We propose that a study be taken up on a larger population to validate the results of Homoeopathy in such comorbid clinical conditions to generalise the outcome of this case study on a wider population.
Table 3: Assessment by Modified Naranjo Criteria during follow-up of the case

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  Conclusion Top


Although no studies relating to the short-term or long-term effects of Homoeopathy on blood glucose levels of a patient of major depressive disorder have been published, based on this clinical case report, it is suggested that future studies are needed to investigate in a larger population of patients with depression-induced T2DM. This case also shows the significance of individualisation in Homoeopathy. Homoeopathy considers 'man as a whole' and thus this patient too improved subjectively, as well as there was an improvement in blood glucose levels along with other investigations. The aim of homoeopathic treatment is not only to treat T2DM but also to address its underlying cause, miasmatic background, individual susceptibility, etc. The effect of Natrum muriaticum in controlling the blood glucose values as well as HDRS score demonstrates its antidiabetic capabilities under the ambit of depression which is documented in this case report, which is found in homoeopathic literature[18] too.

Declaration of patient consent

The authors certify that they have obtained the patient's written consent form. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that due efforts will be made to conceal her identity.

Financial support and sponsorship

Nil.

Conflicts of interest

None declared.



 
  References Top

1.
Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National Mental Health Survey of India, 2015-16: Summary. Bengaluru: National Institute of Mental Health and Neuro Sciences, NIMHANS; 2016. Available from: http://www.indianmhs.nimhans.ac.in/Docs/Summary.pdf. [Last accessed on 2021 Feb 23].  Back to cited text no. 1
    
2.
Talbot F, Nouwen A. A review of the relationship between depression and diabetes in adults: Is there a link? Diabetes Care 2000;23:1556-62.  Back to cited text no. 2
    
3.
Kawakami N, Takatsuka N, Shimizu H, Ishibashi H. Depressive symptoms and occurrence of type 2 diabetes among Japanese men. Diabetes Care 1999;22:1071-6.  Back to cited text no. 3
    
4.
Brown LC, Majumdar SR, Newman SC, Johnson JA. History of depression increases risk of type 2 diabetes in younger adults. Diabetes Care 2005;28:1063-7.  Back to cited text no. 4
    
5.
Goodnick PJ, Henry JH, Buki VM. Treatment of depression in patients with diabetes mellitus. J Clin Psychiatry 1995;56:128-36.  Back to cited text no. 5
    
6.
Carnethon MR, Kinder LS, Fair JM, Stafford RS, Fortmann SP. Symptoms of depression as a risk factor for incident diabetes: Findings from the National Health and Nutrition Examination Epidemiologic Follow-up Study, 1971-1992. Am J Epidemiol 2003;158:416-23.  Back to cited text no. 6
    
7.
Rathmann W, Kuß O, Anderson D, Busch S, Hahn M, Engelhard J, et al. Increased depression symptom score in newly diagnosed type 2 diabetes patients. Psychiatry Res 2018;261:259-63.  Back to cited text no. 7
    
8.
Kleefstra N, Landman GW, Houweling ST, Ubink-Veltmaat LJ, Logtenberg SJ, Meyboom-de Jong B, et al. Prediction of mortality in type 2 diabetes from health-related quality of life (ZODIAC-4). Diabetes Care 2008;31:932-3.  Back to cited text no. 8
    
9.
Naskar S, Victor R, Nath K. Depression in diabetes mellitus – A comprehensive systematic review of literature from an Indian perspective. Asian J Psychiatr 2017;27:85-100.  Back to cited text no. 9
    
10.
Kannan. India is home to 77 million diabetics, second highest in the world. November 14, 2019. Available from: https://www.thehindu.com/sci-tech/health/india-has-second-largest-number-of-people-with-diabetes/article29975027.ece. [Last accessed 16th March 2021].  Back to cited text no. 10
    
11.
Salgado AL, Carvalho Ld, Oliveira AC, Santos VN, Vieira JG, Parise ER. Insulin resistance index (HOMA-IR) in the differentiation of patients with non-alcoholic fatty liver disease and healthy individuals. Arq Gastroenterol 2010;47:165-9.  Back to cited text no. 11
    
12.
Mohammedi K, Woodward M, Zoungas S, Li Q, Harrap S, Patel A, et al. Absence of peripheral pulses and risk of major vascular outcomes in patients with type 2 Diabetes. Diabetes Care 2016;39:2270-7.  Back to cited text no. 12
    
13.
RADAR Computer Programme. Belgium: Version 10 Developed by Archibel Homoeopathic Software Company; 2009.  Back to cited text no. 13
    
14.
Hering C. The Guiding Symptoms of Our Materia Medica. Reprint ed., Vol. VIII. New Delhi: B. Jain Publishers (P) Ltd.; 2005.  Back to cited text no. 14
    
15.
Boger CM. Boenninghausen's Characteristics Materia Medica and Repertory with Word Index. New Delhi: B Jain Publishers (P) Ltd.; 2008.  Back to cited text no. 15
    
16.
Boger CM. A Synoptic Key to the Materia Medica (A Treatise for Homoeopathic Students). Student edition. New Delhi: B Jain Publishers (P) Ltd.; 2010.  Back to cited text no. 16
    
17.
Lamba CD, Gupta VK, van Haselen R, Rutten L, Mahajan N, Molla AM, Singhal R. Evaluation of the Modified Naranjo Criteria for Assessing Causal Attribution of Clinical Outcome to Homeopathic Intervention as Presented in Case Reports. Homeopathy. 2020;109:191-197. doi: 10.1055/s-0040-1701251. Epub 2020 Mar 25. Erratum in: Homeopathy. 2020 Oct 21;: PMID: 32215892.  Back to cited text no. 17
    
18.
Clarke JH. A Dictionary of Practical Materia Medica. New Delhi: B Jain Publishers (P) Ltd.; 2005.  Back to cited text no. 18
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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