Depression and Insomnia – A Case Report

INTRODUCTION:

Insomnia and Depression are coexisting disorders. The higher frequency of concurrence suggests that in the absence of sleep disorders, the diagnosis of depression should be made with caution.¹

Insomnia is characterized by difficulty in initiating or maintaining sleep or poor quality of sleep, accompanied by a decreased daytime functioning². Insomnia is said to occur in 60% – 80% of people with depression. Prolonged sleep deprivation can cause false-memory and decline in cognitive functioning.³

Sleep abnormalities in people with depression maybe due to disruption in the homeostatic and circadian drives to sleep¹. A number of studies have demonstrated that insomnia increases the risk of new onset of depression and relapse of depression.⁴

The management plan for insomnia includes comprehensive evaluation of the underlying medical or psychiatric causes, medications or other sleep-related disorders⁴. While antidepressant drugs have a significant role in causing further sleep disorders, a combination of pharmacotherapy and cognitive interventions, behavioral interventions and psychoeducational interventions are suggested.⁵

CASE REPORT

October 2020

A 31-year-old woman, during homeopathic consultation, complained of depression and insomnia. She was 10 weeks pregnant at the time of consultation. She had trouble falling asleep – she would stay sleepless for many nights and would startle awake multiple times during the night if she slept. This was accompanied with drowsiness during the daytime inability to fall asleep then too.

She was deeply disturbed by the very fact that she could not fall asleep and dwelt on the idea that she could not live without sleep or would go crazy without it. She was extremely anxious about her daughter.

Besides insomnia, she had an altered emotional state with a sense of hopelessness, joyless state without any desires, weeping tendencies. She was desperate for recovery. She felt estranged from her family – did not want to communicate with anyone and wanted to be left alone.

She gave a history of being subjected to physical and emotional traumas such as intentionally being scalded by her elder sister at the age of 3 years, abusive relationships, periods of insomnia and depression, panic attacks and two miscarriages.

PAST HISTORY:

Five years ago (in 2015), at the age of twenty-six, she underwent termination of pregnancy due to medical negligence. She was depressed and was aggressively medicated for suspected appendicitis followed by surgery for the same.

She was prescribed antibiotics and indomethacin for three months. She discontinued indomethacin due to two episodes of panic attacks and did not have another episode post cessation of the drug.

The patient later conceived and delivered a baby in July 2017 without any complications. The pregnancy was uneventful, and the patient was happy for the first year and half after the birth of her daughter.

In the Spring of 2019, she had the first episode of insomnia following the stress of overworking and exhaustion of living with her sister and two children. When she could not fall asleep for two consecutive nights, she was administered sleeping pills. She was able to sleep with the aid of the pills but did not make a full recovery.

The second episode of insomnia began in the summer of 2019, when she was subjected to further stress as she had to live alone in a village with her daughter in a mortgaged house, with the husband away most of the time for work. In the months that followed, she faced a hard winter, financial stress, the global lockdown, and all communication was made online.

She developed chronic weakness and fatigue.The insomnia worsened and the patient’s husband could not understand her suffering. Following consecutive nights of sleeplessness, they called an ambulance. She was trembling and was administered sleeping medications.

Since then, she could sleep only with pills. She was administered Imuvan (Zapeklon)) and Grandaxin. In July 2020, she was hospitalized for insomnia and sleep got better for a while. She was administered atarax for some period. With the current pregnancy, she developed cystitis and nausea. Severe nausea persisted.

CLINICAL EXAMINATION:

The pregnancy was developing normally. There were no physical complaints, besides insomnia.

DIAGNOSIS:

Depression (ICD-10-CM F32)⁶

Insomnia (ICD-1-CM G47)⁶

HOMEOPATHIC INTERVENTION:

The patient consulted a homeopath on 29/10/2020 for the severe insomnia and the state of sadness.

Sleep:

• Sleeplessness: starting during sleep, which prevents falling asleep and wakes her up.

Mind:

• Sadness with loathing of life; accompanied with fear of suicide.
• Anxiety about her daughter, but cannot stay with her due aversion to company, and wants to be left alone.
• Aversion to presence of strangers while urinating.

Generalities:

• Aversion to garlic, onions, meat, milk.
• Decreased thirst, desire warm drinks.
• Lack of vital heat with coldness of extremities.
• Lack of appetite.

Particulars:

• Dizziness and slight dyspnea with physical exertion.
• Extremities: trembling hands
• Offensive perspiration
• Aching pains in the stomach – eating after
• Severe nausea – pregnancy during.

Remedial results based on the symptoms mentioned above:

Figure 1: Remedial results based on the symptoms

PRESCRIPTION WITH RATIONALE:

Rx: Kalium carbonicum 200C, one dose.

(Severe insomnia with starting during sleep is a strong indication of Kalium carbonicum. Although the patient’s chronic remedy is Natrum phosphoricum (with the background of multiple griefs – scalded by elder sister, past abusive relationships tragic miscarriage, chilliness, desire for fried eggs when not pregnant, cannot urinate in the presence of people behind the door), with the pregnancy, the remedial indication had changed to Kalium carbonicum.

FOLLOW UP:

Date	Observation	Intervention
12 November 2020	–         Sleeplessness persisted.	Rx: Kali carbonicum 200C one dose
25 November 2020	–         After the remedial intervention on the 12th November 2020, she was vomiting all day. –         Sleep quality had slightly improved in the first week: she was waking up frequently but was able to go back to sleep. Startling in sleep stopped for a week. Sleeplessness and startling recurred after the first week.	Rx: Kali carbonicum 200C one dose
26 November 2020	–         Quality of sleep increased. The patient is able to sleep for 3 hours in a stretch. –         Nausea has decreased. She had lost 7kg of weight due to nausea and gained back 1kg. –         Trembling of hands, buzzing in the occiput, pain in the stomach has decreased. –         Anxiety persists; causeless, and is felt in the chest. Complaints of constant internal torment, feeling of hopelessness and dullness in head. She feels relieved by crying. –         Has no interest towards life, does not want to meet people.	Rx: Kali carbonicum 10C daily.
6 december 2020	–         The improvement had stopped, and there was no initial aggravation after last 200C. The patient wrote a message saying she was in a fragile state.	Rx: Kali carbonicum 1M, one dose
14 January 2021	After Kali carb 1M, the patient had an initial aggravation on the emotional plane for 2 days: internal torment, anxiety, was weeping a lot. The term of pregnancy: 21 weeks. –         Sadness and sleeplessness are much better; episodes of sadness and depression are seldom and shorter. –         The patient sleeps well. No startling in the sleep. She wakes up to urinate and falls back asleep right after. –         Anxiety decreased, wants to communicate with people. Dullness is gone. –         Sinusitis since 11 days. (Relapse of old complaint from 10 years ago.) –         There is pain in the forehead, heaviness in the area of maxillary sinus with heat in the head. –         Nose obstruction with greenish discharge and a sensation of inner swelling. Obstruction < lying position. –         Warm blooded since 2-3 weeks. –         Desire for open air; sinusitis ameliorated in open air. –         Appetite is good, and has started craving for eggs. –         Thirst for warm drinks. (Repertorial result and remedial indication in figure 2 & 3)	Rx: Kalium iodatum 200C one dose.
3 February 2021	–         Relapse of sleeplessness due to startling.	Rx: Kalium carbonicum 1M, one dose.
15 April 2021	The term of pregnancy: 34 weeks. –         Insomnia and depression – absent. –         Rarely disturbed nights but does not disturb the patient. –         Aversion to presence of strangers while urinating persists. –         The patient is calm and happy. She developed a strong desire to communicate. –         No marked complaints.	Nil.

Figure 2 repertorisation of symptoms dated 14 January 2021

Figure 3Remedial indication for the follow up dated 14 January 2021.

OUTCOME: The patient was cured of depression and insomnia. Further, the patient delivered a girl baby without any complications and has been breastfeeding.

DISCUSSION:

In this case, a series of emotional and physical traumas established a deep-seated pathology in the patient that led to severe depression and insomnia that was initially tackled with conventional drugs. When the pregnancy made her general and pathological conditions worse and as the previously used drugs were negatively indicated, the need for a therapy without the weight of side effects was needed.

Studies have suggested the appearance of acute inflammatory diseases considerably improved the condition of the existing chronic conditions.⁷ Repeated suppression of acute inflammatory conditions will result in the cessation of the acute symptoms which may be mistaken as a cure, but the inflammatory processes continue on a deeper level by agitating deeper organ or systems, eventually deteriorating the level of health of the organism.

With the right remedial intervention for the treatment of chronic diseases, the acute diseases reappear with simultaneous improvement of chronic diseases, suggesting the subsequent improvement in the level of health⁸. In this case, in the due course of treatment, the patient had a reappearance of acute sinusitis that she had 10 years ago.

As Dr. Samuel Hahnemann wrote and the system of medicine truly abides to, “The highest ideal of cure is rapid, gentle, and permanent restoration of health, or removal and annihilation of the disease in its whole extent, in the shortest, most reliable, and most harmless way, on easily comprehensible principles.”⁹

CONCLUSION:

The case illustrates the efficacy of individualised classical homeopathy in successfully treating a case of depression and insomnia. Further studies are necessary to prove the effectiveness of this therapeutic method.

BIBLIOGRAPHY

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