Abstract
Major Depressive Disorder (MDD) in the geriatric population is frequently underdiagnosed due to atypical presentation, coexistence of medical comorbidities, and social misconceptions related to aging. Elderly individuals are also more susceptible to adverse effects of conventional pharmacotherapy. Homoeopathy, with its individualized and holistic approach, may offer a safe and effective alternative. This case study presents a 72-year-old male diagnosed with Major Depressive Disorder, managed successfully with individualized homoeopathic treatment. Assessment included detailed psychiatric evaluation, Mental Status Examination (MSE), Mini-Mental State Examination (MMSE), and the Geriatric Depression Scale (GDS-30). Significant clinical improvement was observed, with reduction in GDS score from 25/30 to 10/30 over a follow-up period of five months.
Keywords: Major Depressive Disorder, Geriatric Depression, Homoeopathy, Aurum metallicum, Mental Status Examination, GDS-30
Introduction
Major Depressive Disorder (MDD) is a disabling psychiatric condition characterized by persistent disturbances in mood, cognition, and neurovegetative functions. In geriatric individuals, depression often presents atypically with somatic complaints, grief-related symptoms, and functional decline, leading to under-recognition and delayed treatment. Age related physiological changes, psychosocial stressors, and medical comorbidities further complicate management. Homoeopathy, based on the principle of Similia Similibus Curentur, emphasizes individualized treatment considering mental, emotional, and physical dimensions, making it a potentially beneficial approach for managing depression in the elderly population.¹–⁴
Case Presentation
A 72-year-old widowed male, retired from service, presented with complaints of generalized weakness aggravated in the morning, persistent sadness, lack of motivation for routine activities, disturbed sleep, and occasional crying spells for the past eight months. He expressed a passive death wish but denied any suicidal attempts or plans. The patient reported amelioration of symptoms in open air.
Associated complaints included occasional forgetfulness of recent names and pain in the lower extremities. He was a known case of hypertension for three years, well controlled on medication, and reported occasional acid reflux relieved by antacids. There was no personal or family history of psychiatric illness.
A significant psychosocial stressor was the death of his spouse two years prior, after which he gradually developed emotional withdrawal, loneliness, restricted communication, introversion, loss of interest in daily activities, and feelings of worthlessness. His premorbid personality was described as mature and well adjusted.
Mental Status Examination (MSE)
- Appearance and Behaviour: Well dressed, cooperative, appropriate eye contact
- Psychomotor Activity: Normal
- Speech: Relevant and coherent
- Mood: Subjectively sad
- Affect: Flat
- Thought Process: Goal-directed
- Thought Content: Passive suicidal ideation; feelings of worthlessness Perception: No hallucinations or perceptual disturbances
- Cognition:
- Orientation:
- Oriented to time, place, and person
- Orientation: Oriented to time, place, and person
- Attention and Concentration: Adequate
- Memory: Delayed recall present
- Insight: Good
- Judgment: Intact
- Impulse Control: Adequate
Mini-Mental State Examination (MMSE): 25/30 (No significant cognitive impairment)⁷
Psychometric Assessment
Geriatric Depression Scale – 30 (GDS-30):
Baseline score: 25/30, indicating severe depression⁶
Physical Examination
Vitals were within normal limits. The patient was lean built. Systemic examination revealed no abnormalities in respiratory, cardiovascular, gastrointestinal, or central nervous systems.
Diagnosis
Based on DSM-5 criteria, clinical evaluation, and psychometric assessment, the diagnosis of Major Depressive Disorder was made.¹
Differential Diagnosis
- Nutritional deficiency-related mood disorder
- Predementia changes
Relevant laboratory investigations were advised to rule out organic causes.
Homoeopathic Case Analysis
Evaluation of Symptoms
| Category | Symptoms |
| Mental Generals | Sadness, ailments from grief, death desire, feelings of worthlessness, sensitivity to noise, frightful dreams |
| Physical Generals | Weakness worse in the morning, desire for cold drinks, amelioration in open air |
| Particulars | Pain in lower extremities |
Totality of Symptoms
Ailments from grief; sadness with death desire; worthless feeling; sensitive to noise; frightful dreams; weakness in the morning; desire for cold drinks; amelioration in open air; pain in lower limbs.
Repertorial Rubrics (Kent Repertory)
Mind – Ailments from grief
Mind – Death, desires
Mind – Delusions, worthless, he is
Mind – Sensitive to noise
Dreams – Frightful
Generals – Weakness, morning
Generals – Food and drinks, cold drinks, desire
Generals – Air, open, ameliorates
Extremities – Pain, lower limbs
Justification of Remedy Selection
Aurum metallicum was selected based on the predominance of characteristic mental symptoms and the etiological factor of grief. Kent describes a profound perversion of the will in Aurum, where the natural love of life is replaced by loathing of life, despair, self-reproach, and suicidal ideation.¹² These features closely corresponded with the patient’s sadness, feelings of worthlessness, grief-induced depression, and passive death wish.
Bailey identifies loathing of life as the keynote of Aurum metallicum, with deep, seemingly hopeless depressions and a persistent inner darkness even between episodes.¹³ Vithoulkas emphasizes depression as the core expression of Aurum, describing individuals as closed, reserved, and intensely self-critical.¹⁴ The close similarity between the patient’s mental state and the classical picture of Aurum metallicum justified its selection as the similimum.
Prescription
Aurum metallicum 200C, single dose
Followed by Saccharum lactis as placebo
Supportive advice regarding nutritious diet, light physical activity, and stress reduction was given.
Follow-up and Outcome
The patient was followed for approximately five months with regular assessments. There were not any major concern on routine blood work-up. Gradual improvement was observed in mood, motivation, appetite, sleep, and social interaction. Suicidal ideation and crying spells resolved completely. A temporary relapse occurred following a significant family bereavement, which responded to repetition of the indicated medicine and placebo.
Objective Outcome
- Initial GDS-30 score: 25/30
- Final GDS-30 score: 10/30
Discussion
Depression in geriatric age is frequently precipitated by grief, loneliness, and loss of purpose and often presents with somatic and affective symptoms. In this case, grief following spousal loss was the primary etiological factor. The use of standardized psychiatric tools such as MSE, MMSE, and GDS-30 strengthened diagnostic accuracy and allowed objective monitoring of therapeutic response. The significant improvement observed supports the role of individualized homoeopathic treatment in managing geriatric depression safely and effectively.²,³,⁶
Conclusion
This case highlights the potential role of individualized homoeopathic treatment in the management of Major Depressive Disorder in geriatric patients. A holistic approach addressing mental, emotional, and physical dimensions, along with objective psychiatric assessment tools, can lead to meaningful clinical improvement and enhanced quality of life in elderly individuals.
Limitations
- Single case study
- Longer follow-up and larger sample size are required for generalization
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