A Review on Chittodvega w.s.r to Generalized Anxiety Disorder and its Management

Introduction

Man is approaching the Raja and Tama Prakopaka Ahara - Vihara in order to carve out a place in this fiercely competitive world, and as a result, he is leading an extremely stressful life. All of it contributes to the disruption of Vatadi Doshas, which creates an aberrant state in the body and mind. Ayurveda speaks of a number of psychological problems that bear some resemblance to anxiety disorders; Chittodvega, one of the mental ailments that Acharya Charaka [1] describes, appears to be the term that most closely corresponds to anxiety disorders. In modern terms too, emotional disorders, including anxiety disorders are considered minor mental disorders. Generalized anxiety disorder (GAD) is a mental health disorder that produces fear worry and a constant feeling of being overwhelmed. It is characterized by excessive, persistent and unrealistic worry about everyday things. This worry could be multifocal such as finance, family, health and future. It is excessive, difficult to control, and is often accompanied by many non-specific psychological and physical symptoms. Excessive worry is the central feature of GAD [2]. Given the seriousness of the issue, safe and effective therapy is required. Despite its wealth of knowledge, modern medicine is not without its negative effects and environmental influences. Thus, extensive research is being done to determine which Ayurvedic treatment is the safest for treating this illness.

Ayurvedic Review

According to Ayurveda psychic factors are involved in almost all the disease processes along with physical disturbance as both are interdependent. Mind is one of the substratum of diseases and having its own Doshas (Rajasa and Tamasa). Many psychological conditions caused by these Doshas like-Kama (passion), Krodha(Anger), Lobha (greed), Moha (confusion), Irshya (envy), Mana (conceit), Mada (arrogance), Chittodvega (anxiety), Bhaya (fear), Harsha (exhilaration) [3] etc. Chittodvega is a Manasavikara mentioned by Charaka which is considered as a perfect word for highlighting the status of anxiety, Generalized Anxiety Disorder. Chittodvega can exists as a separate disease or can be an etiological factor for other psychic and psychosomatic diseases.

Ayurvedic classics has mentioned many words related to mental status, which are

• Chittavibhramsha [4]
• Chittakshobha [5]
• Asvastha Chitta [6]
• Anavasthita Chitta [7]
• Chittodvega

Etymology and Definition of Chittodvega

The term Chittodvega comprises of two words i.e. Chitta and Udvega.

Chitta is derived from root “Chit” which denotes the following meanings:

To perceive, fix the mind upon, attend to, be attentive, to observe, take notice of, to aim at, intend, to be anxious about, care for, to resolve, to understand, comprehend, know, make attentive, remind of. (Sanskrit – English dictionary of Sir Monier Williams) Udvega: According to Sanskrit – English Dictionary of Sir Monier Williams Addition of “Vin” Pratyaya to “Ud” i.e. Ud + Vin leads to Udvega, which has the following meanings: Trembling, waving, shaking, agitation, regret, fear, distress, admiration, astonishment. With the above interpretations Chittodvega can be defined as – Chitta (Mind) + Udvega (Agitation) = Chittodvega (Anxious state of mind).

Modern Review

Anxiety disorder, as defined by Harrison’s principles of internal medicine is “a subjective sense of unease, dread, or foreboding, can indicate a primary psychiatric condition or can be a component of, or reaction to, a primary medical disease”.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) specifically describes GAD as excessive worry and apprehensive expectations, occurring more days than not for at least 6months, about a number of events or activities, such as work or school performance etc [10].

Diagnostic Criteria

Patients will be diagnosed on the basis of signs and symptoms of General anxiety disorder (DSM-V criteria) [10]

1. Excessive anxiety and worry (apprehensive expectations) occuring more days than not for atleast 6 months , about a no. of events or activities (such as work or school performance).
2. The individual finds it difficult to control the worry.
3. The anxiety and worry are associated with three (or more) of the following six symptoms (with atleast some symptoms having been present for more days than not for the past 6 months): • Restlessness or feeling keyed up or on edge. • Being easily Fatigued • Difficulty concentrating or mind going blank. • Irritablity • Muscle tension • Sleep disturbance (difficulty in falling or staying sleep or restless, unsatisfying)
4. The anxiety worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
5. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
6. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

Management

As separate description of Chittodvega is not given in Ayurvedic texts. The disease can be managed according to the Mansika Roga Chikitsa given by Acharyas.

Curative Aspect

Acharya Charaka explains three types of therapies of physical and mental disorders [14],

• Daivavyapashraya – Divine/ spiritual therapy
• Yuktivyapashrya – Rational/ physical therapy
• Sattvavajaya – Mental therapy

Discussion

There is scattered description about Chittodvega in Ayurvedic texts. It cannot be correlated exactly to any disease in modern medicine. Because of similarity in symptomatology, it has closest resemblance to anxiety disorder. Patient suffering from GAD tends to expect failure due to its severity of chronicity. Seeing the severity of symptoms and its deleterious effect in present scenario many researches are being done to see the best way to manage GAD. The current study is entitled as “Randomized comparative clinical evaluation of efficacy of Brahmi Taila Nasya and Yoga Module in Chittodvega (GAD)”. Nasya Karma and Yoga both can have tremendous effect in the treatment of mental disorders. Nasya Karma is claimed to cause clarity of sense organs, sound sleep, cheerful appearance, and can give mental and sensorial happiness. Yoga helps to restraint unnecessary mental fluctuations and thus help in stabilizing and calming the mind.

Conclusion

Ayurveda has Psychosomatic approach to health. The condition of Dosha, Dhatu and Mala components effects both the Sharirika and Mansika Swasthya condition of the body. The current scenario of Manas Roga also depicts the irregularities in diet and lifestyle. In this regard Ayurvedic diet and therapeutic regimes are of great relevance because of high efficacy with least side effects. It works in all the three domains preventive, curative and rehabilitative aspect.