Holistic Approaches to Mental Health: Homoeopathy as a Treatment for Depression in Young Adults
Abstract: Depression, historically referred to as “melancholia,” is a prevalent and debilitating mental health disorder that significantly affects emotional, cognitive, and physical functioning. Rooted in ancient beliefs that associated mental illness with spiritual causes, the understanding of depression has evolved over centuries. Modern psychiatry identifies depression as a complex interplay of biological, psychological, and social factors. The DSM-5 outlines diagnostic criteria including persistent low mood, loss of interest, and cognitive and physical disturbances lasting at least two weeks. Epidemiological data indicates a high prevalence among young adults aged 18–25, with significant variations across countries, often exacerbated by stigma and limited mental health resources. Conventional management includes psychotherapy, pharmacotherapy, and electroconvulsive therapy, complemented by patient education. Despite advancements, treatment resistance and side effects remain significant concerns. Homeopathy offers a holistic, individualized approach to treatment, emphasizing the dynamic action of potentized remedies and whole-person analysis. This review highlights the historical evolution, diagnostic framework, epidemiology, treatment modalities, and the potential role of homeopathy in managing depression among young adults.
Keywords: Depression, Melancholia, DSM-5, Young Adults, Epidemiology, Homeopathy, Holistic Treatment, Psychotherapy, Pharmacotherapy, Electroconvulsive Therapy, Mental Health, Individualization, Similimum, Learned Helplessness, Global Burden of Disease.
Introduction
According to DSM-5, Depression is a common and serious mental health disorder. It involves feelings of sadness, a lack of interest in activities, and various emotional and physical symptoms. According to the DSM-5, this condition is diagnosed when a person experiences five or more symptoms for at least two weeks. These symptoms include: Feeling sad or having a low mood, feeling tired or having low energy, Having trouble concentrating, and Changes in appetite or weight. Sleeping too much or too little, feeling worthless or guilty, Having repeated thoughts of death or suicide.1
EPIDEMOLOGY
The 18–25 age group has one of the highest prevalence rates of depression compared to other age groups. Studies show that about 17–22% of young adults experience at least one major depressive episode each year (NIMH, 2021). Depression is one of the main causes of disability in this age group worldwide
(WHO). Many cases are not diagnosed or treated because of stigma or lack of access to mental health care.2 According to World Health Report 2001, depression is the 4th cause of Disability Adjusted Life Years in all ages, and 2nd cause in the age group 15-44 years. According to the World Health Report 2001, 121 million people worldwide suffer from depression. According to a study, depression is a leading cause of the global burden of disease especially in low and middle-income countries. In 2015, the prevalence of depression in the general population was estimated at around 322 million people or equivalent to 4.4 per cent of the world population.3
National surveys in the United States have revealed the prevalence of Depression in young adults increased from 2005 to 2014. Prevalence increased from 8.9 per cent to 10.1 per cent for the age group 18-20 years and 8.7 per cent to 9.3 per cent for the age group 21-25 years. In Australia, the prevalence of depression in young adults was 19.8 per cent. According to a WHO report,27 per cent of people with depression worldwide live in southeast Asia. A study conducted in Malaysia identified the prevalence of moderate depression at 25 per cent and the prevalence of severe depression at 4.4 per cent among young adults. The national prevalence of depression among young adults in Indonesia was 29.3 per cent for moderate and 8 per cent for severe depression. Depression was higher in males [29 per cent] than in females [25.5 per cent].
The prevalence of depression increased from 4.13% in 2017 to 6.88% in 2021 among those aged 18 to 22 years.4
Classification– In the early 20th century, Kraepelin viewed manic -depressive illness as a broad condition that included both severe and milder forms of mood disorders. Over time, it is divested into two categories: unipolar (only depression) and bipolar (alternating between depression and mania) According to ICD-10, mood disorder is classified into -Dysthymia, Single episode of depression, atypical depression, Psychotic depression, Recurrent depressive disorder, Cyclothymia, Hypomania and depression, Mania and depression.5
Eitology
Depression in young adults is complex, with no single underlying cause. According to the Beck cognitive model, individuals with cognitive distortion and dysfunctional attitudes and beliefs, negative life events, neuroticism, substance misuse etc.14Young adulthood (ages 15 to 24) is an important stage of life that connects adolescence to adulthood. During this time, young people face family and community expectations. If they struggle to meet these expectations, they may experience mental health issues or develop unhealthy habits. Depression during this stage is also a key risk factor for suicide.6
DSM-5 Diagnostic Criteria
Five (or more) of the following symptoms occurred within the same 2-week period and five (or more) of the following symptoms occurred within the same 2-week period and represent a change from the previous activity; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
- Depression most of the day, almost every day, as indicated by the subjective report (eg, feeling sad, empty, hopeless) or observation by others (eg, feeling tearful)
- Markedly decreased interest or enjoyment in all or nearly all activities most of the day, almost every day (as indicated by subjective report or observation) Significant weight loss without dieting or weight loss (eg, weight change of more than 5% per month) or decrease or increase in appetite almost every day
- Insomnia or hypersomnia almost every day
- Psycho motor acceleration or deceleration almost every day (observable by others, not just subjective restlessness or slowing down)
- Tiredness or loss of energy almost every day
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) almost every day (not just self-loathing or guilt about getting sick).
- Impaired thinking or concentration, or an almost daily inability to make decisions (either subjectively or as perceived by others).
- Recurrent thoughts about death (not just fear of death), recurrent thoughts about suicide without a specific plan, or a suicide attempt or a specific suicide plan.
- Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.The episode is not due to a physiological effect of the substance or another disease.7
Diagnostic criteria as per ICD-10
Under the section [F32] heading-DEPRESSIVE EPISODE
In typical depressive episodes of all three varieties [i.e., mild moderate and severe). The individual usually suffers from depressed mood, loss of interest and enjoyment, and reduced energy leading to increased fatigability and diminished activity. Feeling very tired after just a little effort is common. Other common symptoms are:
- Reduced concentration and attention;
- Reduced self-esteem & self-confidence;
- Ideas of guilt and unworthiness (even in a wild type of episode)
- Gloomy and negative views of the future,
- Plan or acts of self-harm or suicide,
- Disturbed sleep,8
Risk factor of Depression- Psychological risk factors included distorted thinking, emotional abuse, high emotional reactivity, trauma exposure, poor coping skills, loss and grief, low self-esteem, neglect, deprivation, other mental health issue, physical abuse; and sexual abuse. Environmental risk factors included school-related stress, bullying, limited access to resources, discrimination, environmental pollutants, family dynamics, gender roles and expectations, humanitarian crises, family loss, migration challenges, poverty, social relationship issues, and other factors.
Pathophysiology:
The neurogenic theory of depression, also known as the monoamine theory, proposes that antidepressants work by activating second messenger systems like cyclic adenosine monophosphate (cAMP). This activation increases brain levels of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), which can help reverse the harmful effects of stress in brain regions like the cerebral cortex and hippocampus. The neurogenic theory of depression is key to the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and the changes in hippocampal function caused by adrenal steroids in depression. Elevated cortisol to dehydroepiandrosterone (DHEA) ratios are commonly found in affective disorders and contribute to hippocampal atrophy. Excess cortisol impairs neurogenesis in the hippocampus, whereas DHEA may offer some protection. People who are depressed have higher
ratios of cortisol to DHEA. It can occur by two routes: genetic predisposition (a high familial loading for affective disorder); and early adverse experiences such as childhood sexual abuse.
Psychosocial views like life events and environmental stress, stressful life experiences have a long-lasting effect on the brain, which changes the way neurotransmitters operate and results in the death of neurons. Events in daily life are a major factor in depression.
Psychodynamic view: As per Sigmund Freud and Karl Abraham-Disturbance in the infant-mother relationship during the oral phase, predisposes to depression, Depression can be linked to real or imagined object loss, Introjection of a departed object, Because the lost subject is regarded with a mixture of love and hate, feeling of anger are directed inward at self. Depression is a phenomenon that occurs when someone cannot achieve their high goals. According to Heinz Kohut, a child experiences loss of self-esteem,
which manifests as depression, when the needs that give him a positive feeling of self esteem and self-cohesion are not met. Cognitive theory: Aron Beck postulated a cognitive triad of depression that consists of- View about Negative self-perception, about environment- Tendency to experience a hostile world and, about future Expectation of suffering and failure.9
Complications-Depression is a serious condition that affects you and your family. If it is not treated, it can get worse and cause problems in your emotions, behavior, and health, impacting your whole life. Some difficulty is linked to depression include: weight increased too much, which can lead to heart disease and diabetes, physical pain or illness, using alcohol or drugs, anxiety or fear, trouble with relationships or work/school, being alone, feeling like you want to die, trying to hurt yourself, and dying early from a health problem.
Management of Depression-Psychotherapy- It is considered a good treatment for depression alone, or together with medications for gentle to moderate sickness like social medical aid, marital status medical aid, and bound problem-solving techniques is also effective as treatment or adjuvant treatment in patients with substantial psychosocial stressors, social difficulties.
Electroconvulsive Therapy- ECT can be Preferred when there is an urgent want for response, along with patients who are suicidal or are refusing meals and nutritionally
compromised. Response of ECT is typically achieved within 3 weeks and may also be useful in patients who are medication-resistant or pregnant.
Patient Education- Education regarding the responsiveness of symptoms to treatment, risks of treatment, issues related to suicide, and the recurrent nature of the disorder must be included. The National Mental Health Programme (NMHP) conducted by the Indian government provides life skills training and counselling in educational institutions, workplace stress management, and suicide prevention services. There are 3 phases in the treatment of depression- acute phase, continuation phase, and maintenance phase. Conventional treatment for depression typically involves starting antidepressants at low doses, which are gradually increased based on the patient‘s response and any side effects. Once a positive response is achieved, treatment may continue for up to nine months after remission.
The primary goals of treatment are to eliminate residual symptoms, restore the patient‘s previous level of functioning, and prevent recurrence or relapse. However, some patients may not respond to these medications, and they can sometimes cause side effects. Common side effects include nausea, increased appetite, weight gain, fatigue, drowsiness, insomnia, dry mouth, blurred vision, constipation, dizziness, and agitation. Other potential issues include liver problems, irritability, anxiety, loss of sexual desire, erectile dysfunction, and reduced ability to achieve orgasm.9
In homoeopathy, proper case-taking deals with the whole analysis of the patient on a mental as well as physical plane then the similimum found after the evaluation of symptoms. The holistic approach of homoeopathy cures the patient from the inner core to the periphery. Homoeopathy treats the patient not the sickness, individualisation is completed among every patient. The dynamic impact of the extremely potentised homoeopathic medicines on one-sided sicknesses like the psychological state is extremely effective in management and cure.
- Arsenicum album – It serves as a holistic remedy for addressing severe distress, especially in individuals who fixate on their health and pursue perfection in all aspects of life. Such individuals tend to experience depression when they fall short of their high personal standards.
- Aurum metallicum -It is most suitable for individuals who are workaholics, and experience feelings of worthlessness, distress, and heightened self-destructive thoughts following setbacks in their professional or personal life.
- Calcarea carbonica – When individuals become entangled in their work and experience stress from their job responsibilities, this medication has a significant impact on them. During such times, a person may experience fatigue, anxiety, self-pity, sorrow, and
disorientation. It proves beneficial for those who struggle with sleep disturbances and episodes of lethargy.
- Causticum- When an individual grieves a loss, they may encounter forgetfulness, extended periods of crying but empathy or mental dullness. During certain moments, these individuals may exhibit empathy toward others, while at other times, they might adopt an irritated and pessimistic perspective towards their surroundings.
- Ignatia amara – Ignatia is beneficial for individuals who are sensitive and tend to be overwhelmed by feelings of frustration or distressing thoughts. Such individuals typically do not wish to come across as helpless, irritable, or moody to others. Occasionally, they may burst into laughter or tears.
- Kai phosphoricum – If an individual is consistently receiving Kali Phos treatment, it indicates that they are grappling with feelings of depression. These feelings of persistent tension or emotional distress are accompanied by restlessness; exhaustion, difficulty concentrating, headaches, and sleep disturbances.
- Natrum carbonicum- Individuals who possess a natural inclination towards sensitivity and patience, yet occasionally seek to evade conflict, often experience episodes of depression following setbacks. They also tend to experience loneliness, isolate themselves, withdraw to rest or listen to sad music.
- Natrum Muriaticum: People who are reserved, responsible, and private—yet have strong inner feelings (grief, romantic attachment, anger, or fear of misfortune) that they rarely show.. Natrum perfectionists are often workaholics, Natrums are workaholics for two reasons. Avoiding feeling, means feeling ‘worthwhile’ in some way (i.e.avoiding the feeling of worthlessness). When Natrum cannot work, he is liable to get both irritable and depressed.9
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5.Hf UK. He is currently involved in a neuropsychological and genetic study of mood disorders in young adults (funded by the Kate Hodgson Memorial Fellowship). Vol. 537. Morningside Park, Edinburgh
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8.World health organization ICD-10: International statistical classification of disease and related health problems:tenth revision.
9.Hf UK. He is currently involved in a neuropsychological and genetic study of mood disorders in young adults (funded by the Kate Hodgson Memorial Fellowship). Vol. 537. Morningside Park, Edinburgh
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11.Hf UK. He is currently involved in a neuropsychological and genetic study of mood disorders in young adults (funded by the Kate Hodgson Memorial Fellowship). Vol. 537. Morningside Park, Edinburgh
12.Hf UK. He is currently involved in a neuropsychological and genetic study of mood disorders in young adults (funded by the Kate Hodgson Memorial Fellowship). Vol. 537. Morningside Park, Edinburgh
