AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA

Abstract

Proportion of elderly population around the world is on rise. Indian context is no different and estimated prevalence of Geriatric Depression (GD) in India was found to be high as 34.4 % in a meta-analysis published in 2019. It's a huge burden upon the health system to manage this proportion of mental health disorders in elderly. In Ayurveda, Major Depressive Disorder (MDD) can be reciprocated to Kaphaja Unmada (KU). KU is manifested as the astavibhrama (confusion of eight faculties) of manas (psyche) namely; mana (mind), buddhi (intelligence), smriti (memory) etc. Depression is a sustained state of low mood and affect, anhedonia and causes the impact in person's personal life, profession and social interactions. Moreover, GD presents as a proper psychosomatic disease after diminution of physical vigour and mental acuity added upon other life crises. So, a clinical study was carried out to evaluate the effect of Brahma Rasayana (BR) in managing the sign and symptoms of GD using Geriatric Depression Scale (GDS) along with its effect on quality of life using WHO Quality of Life Brief Scale (WHOQOL-BREF). On observation, percentage of remission in GDS was 28.57% and improvements in other domains of WHOQOL-BREF Scale were Psychological Domain (66.53%), Social Relationships (67.67%) and Environment (33.49%). All results were statistically significant P value (= or <0.001). Thus, BR is an ideal mind-body rejuvenator for a psychosomatic condition like GD.

Full text

International Journal of AYUSH; 2022: 11 (4); 46-58
46
DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
Original Research Article Volume 11 Issue 4 July-August 2022
AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC
DEPRESSION W.S.R TO KAPHAJA UNMADA
1Dr. Prashant Basnet*, 2Dr. Vijayendra Bhat G. 3Dr. Dhaneshwari HA
1Final Year PG Scholar, Department of Kayachikitsa and Manasaroga, SDM College of
Ayurveda, Udupi
2Associate Professor, Department of Kayachikitsa and Manasaroga, SDM College of
Ayurveda, Udupi
3Assistant Professor, Department of Kayachikitsa and Manasaroga, SDM College of
Ayurveda, Udupi
*Corresponding author's Email ID: pacificbasnet18@gmail.com
ABSTRACT
Proportion of elderly population around the world is on rise. Indian context is no different and estimated
prevalence of Geriatric Depression (GD) in India was found to be high as 34.4 % in a meta-analysis
published in 2019. It’s a huge burden upon the health system to manage this proportion of mental health
disorders in elderly. In Ayurveda, Major Depressive Disorder (MDD) can be reciprocated to Kaphaja
Unmada (KU). KU is manifested as the astavibhrama (confusion of eight faculties) of manas (psyche)
namely; mana (mind), buddhi (intelligence), smriti (memory) etc. Depression is a sustained state of low
mood and affect, anhedonia and causes the impact in person’s personal life, profession and social
interactions. Moreover, GD presents as a proper psychosomatic disease after diminution of physical vigour
and mental acuity added upon other life crises. So, a clinical study was carried out to evaluate the effect of
Brahma Rasayana (BR) in managing the sign and symptoms of GD using Geriatric Depression Scale (GDS)
along with its effect on quality of life using WHO Quality of Life Brief Scale (WHOQOL-BREF). On
observation, percentage of remission in GDS was 28.57% and improvements in other domains of
WHOQOL-BREF Scale were Psychological Domain (66.53%), Social Relationships (67.67%) and
Environment (33.49%). All results were statistically significant P value (= or <0.001). Thus, BR is an ideal
mind-body rejuvenator for a psychosomatic condition like GD.
KEYWORDS: Kaphaja unmada; Geriatric Depression; Brahma Rasayana

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DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
INTRODUCTION
Elderly person is the one whose age has crossed 60 years. Along with the increase in life
expectancy, geriatric population all over the world is on rise. India has been having more
than 7% of its population as a geriatric population since the start of this millennium thus
referred as a “Greying Nation”. In 2017, it was reported to have reached 9.4 %. It is
steadily increasing and prediction is being made that India will be home for 300 million
elderlies by 2050 and it will make 19% of the total population. 1,2 At old age, people start
experiencing not only physical morbidities like degenerative joint disease, diabetes
mellitus etc., but also mental acuity also starts compromising like memory, executive
functions etc. This causes the limitations for elderlies to participate in social activities.
Thus, three important aspect of health physical, mental and social are in jeopardy at old
age. Mental infirmities are very common in geriatric population, geriatric depression
being the most common. In Indian context, breakdown of family support systems, social
isolation and decrease in economic independence are also equally important causative
factors of GD.3 GD has its own diagnostic and management challenges like older adults
who are depressed may not all report of being sad. Likewise, they may attribute their
symptoms to physical causes or stressful life events. Depressed patients may not
participate in physical, speech and occupational therapy.4Due to the decreased hepatic
blood clearance and enzyme activity in elderly patients, side effects of psychiatric
medications are seen more in elderlies like orthostatic hypotension, cardiac toxicity and
conduction abnormality, sedation etc. are seen in elderlies.5
The pathology and symptomatology of kaphaja unmada resembles major depressive
disorder. Perversion of eight functional faculties of mental framework of an individual
characterizes unmada, which are namely; mana (mind), buddhi (intellect), samjnajnana
(consciousness), smriti (memory), bhakti (devotion), sheela (character) and achara
(behavior).6 When these perversions are associated with the vitiation of kapha and
tamas dosha then kaphaja unmada is manifested. Its characteristic features are
tushnibhava (depressed look), mandvakcheshta (slowness in activities and speech),
anaannabhilasha (disinclination for food).7 Depression in a geriatric patient is
considered as GD. Depression is a pervasive low mood state with anhedonia. It affects a
person’s thoughts, behavior and most importantly the sense of wellbeing. Depressed

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DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
person has a typical distorted cognitive triad of worthlessness like I am worthless,
people and surrounding are hot helpful and it is not going to improve in future.8
Due to increased side effects, adverse events, and drug-drug interactions of
antidepressants in elderlies, lack of mind-body holistic and economic approaches, this
study was planned in rasayana-shamana line of management with avaleha (paste form)
formulation ‘Brahma Rasayana’ mentioned in Abhayaamalakipada of Charaka Samhita
Chikitsasthana.
MATERIALS AND METHODS
Study design and sampling:
Twenty patients diagnosed as kaphaja unmada/Geriatric Depression aged between 60-
80 years irrespective of their gender, caste and creed were selected from OPD and IPD of
SDM Ayurveda Hospital, Udupi. 20 patients were registered to the study. Study was
interventional, open labeled, having single group with pre and post-test design. Patients
were selected purposively. Follow up of the patients were planned twice for assessment
first after the completion of medicine course and second was after 1 month of
completion of the medicine course.
Criteria for diagnosis:
The diagnosis was made on the basis of signs and symptoms of kaphajaunmada;
tushnibhava, mandavakcheshta, rahaskamata (wanting secrecy), sthanamekadeshe
(confining oneself to one area), bibhatsatvam (nauseating), shauchadwesha (aversion for
cleanliness) etc. and criteria for depressive disorder in DSM V TR.9
Inclusion Criteria:
1. Patients fulfilling the diagnostic criteria
2. Patients with age group of 60-80 years of either sex.
3. Patients signed for informed consent.
Exclusion Criteria:
1. Patients of other types of nijaunmada, bhutonmada, other psychiatric illnesses and
depression due to substance abuse, other organic causes.
2. Patients with severe grade depression.

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DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
3.Patients suffering from major systemic illness necessitating long-term drug
treatment.
Intervention:
Patients were orally treated with Brahma Rasayana 12 gm minimum one hour before
food (7am and 7pm) BD with warm milk as anupana and was continued for 28 days.
Ingredients of the drug:
The ingredients are mainly panchapanchamula (roots of 25 plants) for kwatha dravya
(decoction material), haritaki (Terminalia chebula)and amalaki (Phyllanthus emblica) as
pishthidravyas (powder material) and as prakshepa dravyas (dry fine powder) comprises
15 drugs out of which few drugs are having medhya (intellect enhancer) property;
shankhapushpi(Convolvulus pluricaulis), vacha (Acorus calamus), mandukaparni (Centella
asiatica), yesthimadhu (Glycyrrhiza galbra) like medhya drug are used.10 Drug was
procured from SDM Ayurveda Pharmacy, Udupi.
Assessment:
Assessment was done using Geriatric Depression Scale (GDS)11, KaphajaUnmada
Validated Scale (KUVS), Manasabhava Rating Scale and WHO Quality of Life Brief Scale
(WHOQOL-BREF)12 before treatment i.e., 0th, after treatment i.e., 28th and on 56th day for
follow up. Statistical analysis of the results was done by Wilcoxon signed rank test using
the scoring of parameters done on day 0 and 28thday.
OBSERVATION AND RESULTS
The observation made on the 20 patients showed that majority of patients i.e., 65% of
the patients belonged to age group of 60-64 years, 85 % patients were females, 80 % of
the patients belonged to Hindu Religion and 65.0% were married. Regarding the
educational status maximum of patients i.e., 35 % were uneducated. These all
observations are congruent to the characteristic features of population nearby the
hospital area. More females are shown even in general population to have more
depression rates than males. Majority of the patient belonged to middle-class i.e., 70%,
while home-makers made 70 % of the sample, 80 % had the gradual onset of the
symptoms and 55 % had the continuous course of disease. About the severity of the

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DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
disease, 55% reported mild severity of the symptoms and maximum of patients i.e., 40%
had duration of disease >2 months to <12months. (Table No. 1)
Table No. 1: Distribution of Patients According to Majority of Observations (n=20)
Observations
No of Patients
Percentage
(%)
AGE GROUP (60-64 years)
13
65
FEMALES
17
85
HINDU
16
80
MARRIED
13
65
UNEDUCATED
7
35
SOCIOECONOMIC STATUS-MIDDLE CLASS
14
70
HOME MAKERS
14
70
GRADUAL ONSET
16
80
CONTINUOUS COURSE
11
55
MILD SEVERITY
11
55
>2 MONTHS TO <12MONTHS DURATION
8
40
The analysis of the data obtained after the completion of medicine course revealed that
percentage of remission obtained in GDS was 28.57% and that in kaphaja unmada
Validated Scale was 22.40%. Regarding the effect of intervention on manasabhavas
(emotions of mind), 30.51% reduction in intensity of Negative Manasabhavas was
achieved after treatment, while concurrently 40.73%improvement in Positive
Manasabhavas was achieved. Improvement in physical health domain of WHOQOL-BREF
was 34.73%, improvement in other domains of WHOQOL-BREF Scale were Psychological
Domain (66.53%), Social Relationships (67.67%) and Environment (33.49%). All results
were statistically significant P value (= or <0.001). The analyses of the data obtained on
follow up revealed that the effect of intervention on different parameters of assessment
were still sustained and improving too. (Table No. 2-9)

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DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
Table No. 2: EFFECT OF TREATMENT ON SCORE OF GDS-SF
GRO
UP
n=20
BT
Mean
AT
Mea
n
Diff
D
BT-
AT
% OF
Relief
Wilcoxon’s Signed rank test
SD
SEM
MEDIA
N
Z
VALUE
P
VALUE
8.750
6.25
0
2.50
28.57
%
BT:1.41
0
BT:0.31
5
BT:9.00
0
-3.961
<0.001
AT:1.74
3
AT:0.39
0
AT:6.00
0
Table No. 3: EFFECT OF TREATMENT ON SCORE OF KUVS
GRO
UP
n=20
BT
Mean
AT
Mean
Diff
D
BT-
AT
%
OF
Relief
Wilcoxon’s Signed rank test
SD
SEM
MEDIA
N
Z
VALUE
P
VALUE
12.50
0
9.700
2.800
22.40
%
BT:2.09
0
BT:0.4
67
BT:12.0
00
-3.896
<0.001
AT:2.47
3
AT:0.5
53
AT:9.50
0
Table No. 4: EFFECT OF TREATMENT ON INTENSITY OF NEGATIVE
MANASABHAVAS
GROUP
n=20
BT
Mea
n
AT
Mea
n
Diff
D
BT-
AT
% OF
Relief
Wilcoxon’s Signed rank test
SD
SEM
MEDIAN
Z
VALUE
P
VALUE
10.65
0
7.400
3.25
30.51
%
BT:
1.631
BT:0.17
9
BT:0.365
-3.953
<0.001
AT:
1.536
AT:0.13
5
AT:
0.343

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DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
Table No.5.:EFFECT OF TREATMENT ON INTENSITY OF POSITIVE MANASABHAVAS
GROUP
n=20
BT
Mea
n
AT
Mea
n
Diff
D
BT-
AT
% OF
Relief
Wilcoxon’s Signed rank test
SD
SEM
MEDIAN
Z
VALUE
P
VALUE
19.15
0
26.95
0
7.8
40.73
%
BT:
3.031
BT:0.6
78
BT:
18.500
3.937
<0.001
AT:
3.486
AT:0.7
80
AT: 25.00
Table No. 6: EFFECT OF TREATMENT ON QUALITY OF PHYSICAL HEALTH
GROUP
n=20
BT
Mea
n
AT
Mea
n
Diff
D
BT-
AT
% OF
Relie
f
Wilcoxon’s Signed rank test
SD
SEM
MEDIAN
Z
VALUE
P
VALUE
22.60
0
30.45
0
7.85
34.73
BT:
7.089
BT:1.5
85
BT:25.00
0
2.990
=0.001
AT:
8.488
AT:
1.898
AT:31.00
0
Table No. 7:EFFECT OF TREATMENT ON QUALITY OF PSYCHOLOGICAL DOMAIN-
WHOQOL-BREF
GROU
P
n=20
BT
Mea
n
AT
Mea
n
Diff
D
BT-
AT
% OF
Relie
f
Wilcoxon’s Signed rank test
SD
SEM
MEDIA
N
Z
VALUE
P
VALU
E
25.70
0
42.80
0
17.10
0
66.53
BT:
14.73
7
BT:
3.295
BT:22.0
0
3.638
<0.00
1
AT:
12.72
2
AT:
2.845
AT:44.0
0

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DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
Table No. 8: EFFECT OF TREATMENT ON QUALITY OF SOCIAL RELATIONSHIPS-
WHOQOL-BREF
GROU
P n=20
BT
Mea
n
AT
Mea
n
Diff
D
BT-
AT
% OF
Relief
Wilcoxon’s Signed rank test
SD
SEM
MEDIA
N
Z
VALU E
P
VALU E
24.75
0
41.50
0
16.75
67.67
%
BT:
12.80
2
BT:
2.863
BT:
22.000
3.844
<0.001
AT:
13.31
2
AT:
2.977
AT:
37.500
Table No. 9: EFFECT OF TREATMENT ON QUALITY OF ENVIRONMENT
GROU
P n=20
BT
Mea
n
AT
Mea
n
Diff
D
BT-
AT
% OF
Relief
Wilcoxon’s Signed rank test
SD
SEM
MEDIAN
Z
VALUE
P
VALUE
30.60
0
40.85
0
10.25
33.49
%
BT:
14.56
5
BT:
3.257
BT:
28.000
3.834
<0.001
AT:
14.73
0
AT:3.
294
AT:
38.000
Overall effect of therapy:
On analyzing all the data recorded before and after the treatment, majority of the
patients 70% had shown average remission of symptoms, 5% of patients had shown
moderate remission. 25% of patients had shown poor remission and none had shown
worsening of the symptoms. (Figure No. 1)

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DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
Figure No. 1: Overall Effect in Percentage
Note-
Complete Improvement -100% Improvement
Good Remission - Improvement from 76-99.99%
Moderate Remission - Improvement from51-75.99%
Average Remission - Improvementfrom26-50.99%
Poor Remission - Improvement from1-25.99%
Worsening - Worsening
DISCUSSION
Geriatric Depression is a body-mind disease, which has been inadequately diagnosed
and treated around the world; even lower in the developing countries like India.
Sampurana (over nourishment) and mandacheshta (sedentary habits) are the two
clinically objective etiological factors of KU that can be marked out.13 But especially in
the case of the GD, the factors like the progressive loss of bulk and function of body

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DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
tissues like mamsa (muscle tissue), asthi (bone tissue), snayu (nerve tissue) and mind
with increasing age is noteworthy in the process of causation and exacerbation of the
condition.14 The better clinical outcome can be expected if the intervention is initiated in
the earlier stages of disease process when prodromal symptoms like shira sunyata
(feeling of emptiness in head), unmatta chittam (fickle mindedness), udwega asthane
(anxiety at improper place)are noted.15 Jara (geriatric) aspect of GD is non-modifiable
risk factor as it is swabhvaja vyadhi, meaning that it culminates naturally after certain
time but still its effect on body and mind can be minimized by administering rasayana
chikitsa (rejuvenation therapy).16 Brahma Rasayana is one unique formulation among
rasayana (rejuvenation drug) due to the fact that it is fortified with adequate number of
medhya dravyas to make it efficacious for the patients of GD as well.
This formulation contains multiple drugs like distinguished drug like amalaki for the
rejuvenation and antioxidant action. While, medhya ingredients like shankhapushpi,
vacha, mandukaparni acts to keep mind alert, contented mood and efficient cognition.
Panchapanchamula pacifies associated vata features (related to dosha responsible for
movement and cognition) of old age. Most of the drugs are having the kashaya
(astringent), katu (pungent), tikta (bitter) rasa (taste) predominance and tridoshahara
(pacifying all three dosas), kaphavatashamaka (pacifying mainly vata and kapha)
property. Amalaki, ghrita (ghee) are jeevaniya ganadravyas (vitalizing drugs) helps in
balancing ushna-tikshna (hot and sharp) property to give balya (strengthening) effect to
the geriatric depressed patients. The selected formulation has the desired property to
act on Geriatric Depression/ Kaphaja unmada. Ghrita, madhu (honey) and tila taila
(sesame oil) further increases the efficacy of the active chemical constituents by
increasing their bioavailability. 17
Due to all above reasons, drug caused average and moderate remission 70% and 5% of
patients respectively though the intervention was instituted for only a single month.
None of the patients showed worsening of the symptoms. This result proves the
therapeutic efficacy of Brahma Rasayana in the management of Geriatric Depression/
kaphaja unmada.
As the proper diagnosis still remains difficult in the primary care center in the rural
areas where most of the older population resides, available health care manpower

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DR. PRASHANT BASNET ET AL AN OPEN LABELLED CLINICAL STUDY TO EVALUATE THE EFFICACY OF
BRAHMA RASAYANA IN THE MANAGEMENT OF GERIATRIC DEPRESSION W.S.R TO KAPHAJA UNMADA
should be trained adequately to note the usually masked important signs of GD like
depressed mood or to differentiate co morbid cognitive deficits. Indian culture has
always seen elders as the torchbearers, source of knowledge and wisdom for the society.
But due to recent breakdown in family systems in India, elder lies have felt downgraded
in their own families and society. Every care should be taken to make them feel cared
and understood. This is the need of the hour to assimilate the resources in the direction
of screening, diagnosing and managing the maximum number of GD cases in a country
like India where prevalence rate is high as 34%.18 Intervention which is economical,
palatable and with minimum side effect and adverse reaction profile should be chosen.
Brahma Rasayana can be one such drug with most of those qualities.
CONCLUSION
The unique features of the GD should always be considered to successfully manage the
condition. Those features are mainly the reduced cognitive abilities, physical strength
and reduced or misleading expression of the pertaining features. So, Brahma Rasayana
acted to improve the cognition as well as the physical strength. Thus, remission in all the
sign and symptoms of GD was achieved. The quality of life being directly related to the
mental health, also improved in all four domains. But this study was limited to only 20
participants due to the time limitation of post graduate study. Further study is suggested
in multicentric format with larger sample size considering the prakriti (natural somatic
and mental constitution), satva (tolerance capacity of mind), satmya (habituation) like
dashavidha pariksha (tenfold examination) of patients to further strengthen and
generalize the findings of this study.
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