“My grad faculty had free remedy. If it didn’t, I’d have failed,” N Dhar, 25, stated about residing with treatment-resistant melancholy. And she or he isn’t exaggerating. Even brushing her enamel felt unimaginable some days, so she swished mouthwash as an alternative. Meals had been changed with bananas. Showers gave strategy to merely becoming clear garments and slapping on sturdy deodorant. These weren’t acts of laziness or self-pity; they had been lifelines, micro-strategies for surviving when your mind insists it’s over… once more.
In India, psychological well being challenges are sometimes dismissed as “simply stress” or “dangerous days,” with structured help remaining scarce or unaffordable. For Dhar, identified with melancholy in 2019 after years of silent unravelling, remedy resistance was a brutal actuality. “I used to be at all times depressed—even earlier than I knew what melancholy was,” she stated, recalling obscure childhood recollections of unexplained unhappiness as early as third grade. “It was like being homesick for one more world. However I used to be solely seven. What different world may I even know?”
Dhar’s story is each deeply private and strikingly acquainted. Recognized with melancholy in 2019, after years of silently unravelling, she discovered that treatment after treatment failed her. “I used to be at all times depressed—even earlier than I knew what melancholy was,” she says, describing childhood recollections of unexplained unhappiness as early because the third grade. “It was like being homesick for one more world. However I used to be solely seven. What different world may I even know?”
Dhar is an element of a rising inhabitants in India grappling with treatment-resistant psychological problems (TRMD) —a time period that sounds scientific however carries a heavy human value. For these people, therapeutic isn’t a straight line. It’s a maze filled with trial and error, excessive monetary stakes, misunderstood ache, and a healthcare system typically ill-equipped to assist.
What does remedy resistance actually imply?
In line with Vikram Kirtikar, senior psychologist at Mpower The Centre, Mumbai, “A treatment-resistant psychological dysfunction is outlined as a psychological well being situation that doesn’t reply to standard types of remedy, together with treatment and psychotherapy. The failure of two or extra evidence-based therapies, regardless of correct adherence, typically raises pink flags.”
This resistance can manifest in melancholy, anxiousness, bipolar dysfunction, schizophrenia, and obsessive-compulsive dysfunction (OCD). Sufferers might endure a number of pharmacological therapies and varied remedy modalities like cognitive behavioural remedy (CBT) or interpersonal remedy (IPT) but present little to no enchancment.
Vishnu Priya J, a consulting psychologist and CEO of Aathma The Therapeutic in Trivandrum, stated, “It’s not nearly remedy failure—it’s in regards to the psychological toll of continually feeling such as you’re combating an uphill battle. I had a affected person, Chithra (identify modified), who underwent remedy and drugs for years with out progress. Her deep anxiousness and melancholy, regardless of greatest practices, exemplify remedy resistance.”
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The lived expertise: Stigma, isolation, and disruption
“Life with treatment-resistant melancholy is simply charmless,” Dhar stated. “Generally, I don’t even have the creativeness to have desires.” For her, the analysis gives an odd type of validation: “Earlier than, individuals dismissed my unhappiness. Now, with the paper, it’s as if my unhappiness is authenticated.” But validation just isn’t the identical as help.
Accessibility stays a serious hurdle—remedy prices are excessive, availability of medicines is inconsistent, and stigma persists even on the chemist’s counter. “In locations like Chennai and Guwahati, I couldn’t entry widespread selective serotonin reuptake inhibitors (SSRI), widespread antidepressants. Generally, the chemist even questioned if the meds had been ‘actually’ for me,” she stated.
Usually, a affected person might endure a number of pharmacological therapies and remedy modalities like CBT or IPT, however present minimal to no enchancment. (Supply: Freepik)
For individuals like Dhar, the dysfunction disrupts each facet of life. “The worst half wasn’t the signs,” she stated, “it was being instructed I needs to be getting higher. After I didn’t, individuals assumed I wasn’t attempting exhausting sufficient.” Fundamental duties turn out to be monumental struggles, social relationships endure, and academic or profession paths stall. The result’s typically profound isolation.
Priyamvada Tendulkar, a scientific psychologist, harassed the hidden weight of such situations: “For treatment-resistant sufferers, it’s not nearly not feeling higher—it’s about dropping religion within the very techniques meant to assist them. It results in self-doubt, disgrace, and disconnection from the world.”
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Kirtikar stated, “Persistent psychological well being points can alienate people from their communities and households. The stigma connected to ‘not getting higher’ solely worsens their isolation.
Resistance is greater than diagnostic challenges and medicine
Therapy resistance just isn’t solely about drugs that don’t work. Generally, TRMDs stay undiagnosed for years on account of misdiagnosis or ignored underlying medical points—equivalent to thyroid problems or vitamin deficiencies. “Revisiting the analysis is essential. A correct analysis ought to embrace an intensive overview of remedy historical past, ruling out comorbidities, and typically rethinking the analysis altogether,” Kirtikar stated.
A treatment-resistant psychological dysfunction is outlined as a psychological well being situation that doesn’t reply to standard types of remedy, together with treatment and psychotherapy (Supply: Freepik)
Vishnu Priya stated, “When a affected person exhibits no enchancment after a number of therapies, we should reassess every thing—from the analysis to the supply of remedy.”
The idea of “resistance” itself is layered. It may come up from organic variations, trauma histories, genetic vulnerabilities, and even environmental components equivalent to ongoing stressors or lack of help techniques. But this scientific framing, though helpful, can really feel soulless. “We should ask: immune to what? A protocol? Or immune to not being seen?” Tendulkar stated. For a lot of, resistance just isn’t about organic non-responsiveness alone; it’s the results of years of misdiagnosis, unaddressed trauma, and an absence of actually compassionate care.
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Take Dhar’s case, as an illustration. Since her analysis in 2019, she has cycled via almost each class of antidepressants—SSRIs, Serotonin-norepinephrine reuptake inhibitors (SNRI), and atypicals like bupropion—with no sustained aid. “Every psychiatrist go to is at least Rs 1,500 and each trial takes weeks. It does really feel such as you’re blowing time and cash. I want I may ask for a refund,” she stated, half in jest.
Tendulkar defined that after years of being mislabeled or under-supported, some shoppers not solely lose religion within the therapies but additionally within the very chance of therapeutic. She recounts a shopper who ceased to talk in remedy after receiving seven mismatched diagnoses in 5 years. “She was labeled ‘resistant,’ however in reality, she suffered from advanced post-traumatic stress dysfunction (PTSD). Nobody ever requested, ‘What occurred to you?’”
This disconnect between scientific labels and lived expertise can inflict wounds deeper than the dysfunction itself. In India, the place trauma literacy continues to be rising—even amongst professionals—the chance of additional hurt is important.
Psychologists urge households and associates to supply presence, not prescriptions (Supply: Freepik)
Help past a ‘treatment’
Therapy-resistant melancholy typically strains relationships. When restoration stalls, family members might really feel helpless. “What breaks the loop isn’t magic—it’s attunement and radical acceptance,” stated Tendulkar. She encourages presence of family and friends over prescriptions and celebrating small wins—sleeping properly, journaling, strolling—over chasing a treatment.
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For Dhar, that help seems like grace throughout ghosting durations, and an understanding of her irritability. However she’s additionally attempting to satisfy her family members midway—by bettering her personal communication and setting reasonable expectations. She talks in regards to the “unsexy truths” of self-care. “Sure, being depressed just isn’t my selection, but it surely stays my downside. I need to take some company to resolve it, like a diabetic particular person managing their blood sugar. Bold, sure, I do know,” she stated.
Regardless of the grim prognosis, there may be hope. “Residing with a treatment-resistant dysfunction doesn’t imply residing a joyless life. It means discovering a brand new language for survival—via group, creativity, or different practices like mindfulness, nature remedy, or body-based interventions,” stated Tendulkar.
The objective in treatment-resistant problems will not be to eradicate signs. “You redefine restoration not as ‘no ache’ however as ‘residing with ache and nonetheless loving life’,” stated Tendulkar. This reframing—of befriending the self moderately than fixing it—is central to long-term therapeutic.
Vishnu Priya echoed this sentiment: “We might not at all times obtain full remission, however we will intention for administration, resilience, and that means. The objective shifts from ‘treatment’ to ‘dealing with dignity’.”
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The highway forward
Tendulkar stated, “The one strategy to serve somebody in that darkish place is to sit down with them in it. To say: ‘I see you. You’re nonetheless price combating for’.”
Therapy-resistant psychological problems are usually not an endpoint; they’re detours––painful, complicated, and lonely. They problem us to rethink what therapeutic seems like. They name for a deeper dedication—from households, clinicians, and techniques—to see individuals as greater than diagnoses.
As India’s psychological well being motion evolves, we owe it to voices like Dhar’s to carry house for complexity. As a result of therapeutic isn’t at all times about changing into symptom-free. Generally, it’s nearly discovering the need to strive once more tomorrow. Even within the shadows.