Recent Updates in The Management of Kaphaja Unmad a Vis-À-Vis Major Depressive Disorder

121 million people worldwide suffer from depression, making it a severe burden. It causes the majority of disabilities and lasts for two weeks with constant drowsiness. Planning a treatment framework requires an understanding of psychopathology through fundamental ayurvedic concepts. Outside of the traditional medical system, interest has been generated by the difficulties in treating patients without undesirable effects. According to Ayurveda, depending on the stage of the disease, it is likely to be associated to kaphaja unmada . The phases of the illness and symptomatology provide the basis for therapeutic approaches. All psychiatric disorders are managed according to the fundamental Unmada management principles. Depressive disorders are treated holistically, using pharmaceutical therapy, non-pharmacological


Introduction
Humans have basic feelings called emotions. We've all experienced sadness or discouragement. In reality, depression is a part of everyday life. Almost everyone has experienced depression at some point in their lives, whether it was due to a loved one's death, the loss of a job, a setback, a loss, or simply "everyday misery," as Freud put it. There are many situations in life that might make a person feel depressed and hopeless. But persistently depressed feelings that interfere with day-to-day functioning could be a sign of a depressive disorder. 121 million people worldwide suffer from depression, making it a severe burden [1]. Normal melancholy or discouragement can be distinguished from a depressive disorder based on severity, duration, and the presence of additional symptoms [2]. Unmada is a prevalent entity in Ayurveda that stands in for various psychological diseases. According to Kaphaja Unmada, the suppression of mental capabilities results in lack of interest, social retreat, intellectual decline, and other cognitive impairments. This causes discord in interpersonal, familial, and social relationships. The symptoms of Kaphaja Unmada are most likely comparable to those of depression. The present review will explore all the possible line of management in Kaphaja Unmada vis-à-vis Major Depressive Disorder.

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Volume 5, Issue 2, March-April 2023 3 According to studies, it aids in the digestion of food that has accumulated and prevents the channels from adhering, both of which are crucial in preventing the disease from manifesting 5 . Shodhana Karma (bio purificatory procedures): Shodhana karma is followed as a protocol where it encompasses proper snehana (oleation), swedana (sudation) followed by Panchakarma such as medicated induced emesis, therapeutic purgation, therapeutic enema, nasal instillation of medicines, and bloodletting therapy 9 . In MDD, the drugs having teeksha (sharp) nature should be used to clear the obstruction in the channels and also to eliminate the dosha ( Table 2). By removing toxins from the body and facilitating the pharmacokinetic effect of therapeutic treatments given, it enables the biological system to return to normal.
In studies of neuropsychiatric disease, these modalities have shown a considerable impact on psychoneuroimmunologic parameters. Vamana (medicated induced emesis): Vamana is the procedure used to systematically evacuate vitiated Doshas through the oral route. In Kaphaja unmada vamana is highly beneficial. This has been validated in the study carried out by Sushil et al [10]. Virechana: The process of removing diseased humors from the body through the downward route is known as virechana. The procedure that results in toxin evacuation is known as virechana. Some research findings linked histamine to Kapha, catecholamine to Pitta, and acetylcholine to Vata. According to  [9]. It also eliminates all morbid Doshas from all micro to macro nourishing channels. In clinical practice, virechana is easier to perform rather than vamana as it poses lower risk. Basti: In this procedure, medicine is administered through rectal route. Basti is suggested in the patients who generally cannot digest the medicine orally. In MDD, Hapushadi basti, Mustadi Yapana Basti is typically advised. The medicines which are suggested for oral administration may be given through rectal route as well, in given condition. Nasya (Errhine therapy): When medicated drugs are instilled through nasal route, it is called as Nasya.
Here, lipid-soluble tiny molecules cause the medicine to diffuse over the nasal mucosal barrier and pass directly from the sub-mucus region of the nose into the CSF. The medication may penetrate the arachnoid membrane and enter the olfactory CSF before being absorbed into the circulation at the superior sagittal sinus. After trans-nasal injection, formulations with therapeutic drugs linked with receptor epitomes and antigens have been reported to offer a way to improve delivery to specific CNS areas. In MDD, Ghrita yogas (Lipid base medicines) are commonly used as Nasya dravya. In severe illness Pradhamana nasya (in powder form) and Avapida nasya has proved to be beneficial. Siravedha: It involves extracting the contaminated blood by surgical or non-surgical means. Blood-letting from temple veins, a central vein near the joint of the jaw bones, and the points of the eyes are advised treatments for unmad [9]. Daivavyapashraya Chikitsa (divine therapy): The divine therapy where sacrifice, sacred herb use, valuable gem wear, and incantation are all taken into consideration. The religious offering known as Homa (Oblation) was created to combat brain-related disorders [7]. Satvavayajaya chikitsa: It is a form of psychotherapy where in ayurveda strategy is used. In Depression satvavajaya Chikitsa is administered through Jnana (knowledge), Vijnana (analytical thinking), Dhairya (courage), Smrti (memory) and Samadhi (concentration) [7].

Shamana in Kapahaja unmada
The oral administration of formulations having Medhya property is utilized here.

Conclusion
Depressive disorder is a disabling condition that significantly impairs daily functioning. A significant risk of death and morbidity is associated with depression. Effective management is hampered by difficulties in diagnosis, rising frequency, and complicated pathophysiology. According to Ayurveda, Major depressive illness and Kaphaja unmada can be connected depending on the severity of the aetiology. The multifactorial therapeutic strategy has shown promise in the treatment of depression. Different