Depression is an illness that we must take seriously.

While it is true that a majority of patients having depression do get better with treatment from
Psychiatrists, there is a significant proportion of people who do not get better. This proportion can range
from 20 to 30%. That is a huge number. It is painful for them to move between psychiatrists searching
for a solution and the family members being burdened emotionally, socially and financially in search of
an improvement.

Depression takes away the person’s ability to talk and sit with the family, enjoy, make jokes, to work,
make money, spend or even to smile. It is a whirlpool of disastrous negativity that often results in
continuous pain, unhappiness, dissatisfaction and thoughts of dying.

Of the many factors that contribute to treatment resistant depression, there are two that you might
want to focus on.

One factor under our control, (to a large extent), is to seek treatment as early as possible and not stop
treatment the moment you get better. Across the world, what psychiatrists see is that the longer you
have been suffering from symptoms of depression, and yet not taking proper treatment, the more
chances of incomplete recovery, chances of relapse and or chances of treatment resistance. Similarly, if
you do get better but decide, despite the advice of your psychiatrist, to stop your antidepressant very
early, then the illness comes back, often more virulent than before and with very poor response to
antidepressants. Unfortunately, the noise surrounding depression is so cacophonous, so loud that it
convinces people to dismiss the sane advice of us psychiatrists.

Come take treatment as early as possible and do not stop treatment very early.

The second factor contributing to treatment failures for depression is at the other end of the spectrum
of human behavior. Medical science requires more thought, more research, more funding and more
resources to understand depression much better than we do today and to find out treatments that will
work in those patients who have not benefited from present day treatments.

Research is progressing very slowly in this area. A large amount of thought process in the treatment of
depression is still given to Serotonin Reuptake Inhibitors.

We are moving forward to find, identify and understand finer aspects of the brain’s functions and
systems which do not work when depression hits us. Some of the other neurotransmitters like
dopamine, norepinephrine, acetylcholine, glutamate have not been studied as extensively as serotonin
but do show some promise in some research.

I believe that there are other chemicals in understudied areas of the brain that need to be found,
studied and examined for their role in depression. In my opinion, the key to solving the suffering of the
significant 30% of people who do not get better on present day treatment of depression lies in new
areas, new ideas, new neurotransmitters.

This is not under individual control but more a societal issue. India lacks in the social altruism concept.
Public Health being such a low priority in our country, government funding for research is less than 1%.
And on mental health issues like depression the proportion is abysmally low. It is therefore, the need of
the hour for non-governmental organizations to get together and fund, support and encourage more
research in this area. Such that we can find solutions for treatment resistant depression which is specific
to our Indian population, which is accessible and affordable to people in this country and which is
effective and safe.