{
  "id": 13362949,
  "title": "Treatment-resistant depression: what happens when antidepressants do not work?",
  "url": "https://urgent.news/2026/10/10/treatment-resistant-depression-what-happens-when-antidepressants-do-13362949",
  "topic": "health",
  "section": "Health & Medicine",
  "published": "2026-10-10T08:04:52.000Z",
  "source": {
    "name": "The Hindu Health",
    "slug": "the-hindu-health",
    "url": "https://www.thehindu.com/sci-tech/health/treatment-resistant-depression-what-happens-when-antidepressants-do-not-work/article71564456.ece"
  },
  "original_language": "en",
  "account": "Priya, a 32-year-old resident of Kerala, had been battling recurring bouts of depression that impeded her daily life. Despite adhering to her prescribed medication regimen for several weeks, her symptoms persisted. Seeking additional guidance, Priya began undergoing repetitive transcranial magnetic stimulation (rTMS), a non-invasive treatment that employs magnetic pulses to activate specific brain regions. This case highlights the complexities in managing depression, according to experts. While antidepressants often prove effective for many, some individuals continue to experience symptoms even after treatment, necessitating doctors to reevaluate the diagnosis and explore alternative interventions.\n\nDepression encompasses persistent feelings of sadness, diminished interest in activities, disrupted sleep patterns, fatigue, diminished concentration, variations in appetite, and can significantly impact an individual's capacity to work, maintain relationships, and manage everyday tasks. Treatment-resistant depression is typically diagnosed when a person has not shown sufficient response to at least two distinct antidepressants, taken at appropriate doses and for adequate durations, generally six to eight weeks each. Approximately 30% of individuals with major depressive disorder who have tried antidepressants may encounter treatment-resistant depression. According to the National Mental Health Survey of India, the lifetime prevalence of depressive disorders among adults stands at 5.25%, while the current prevalence is estimated at 2.68%.\n\nHowever, it falls to physicians to determine whether the lack of improvement stems from treatment resistance or other factors, such as missed doses, inadequate dosage or duration, side effects, drug interactions, and coexisting medical conditions. Dr. Venkatesh Madankumar, a consultant psychiatrist at Prashanth Hospitals in Chennai, emphasizes that before concluding treatment-resistant depression, all other factors must be thoroughly assessed. Dr. Vivian Kapil, another consultant psychiatrist at SRM Prime Hospital in Chennai, adds that doctors must also consider substance use, psychotic symptoms, post-traumatic stress disorder, and other coexisting conditions, as well as physical health issues like anemia and thyroid disorders that may exacerbate symptoms or impede treatment.\n\nIf an antidepressant fails to provide adequate relief, doctors meticulously review the individual's response, medication adherence, dosage, treatment duration, and side effects before deciding on the next course of action. If there is some improvement and the medication is well-tolerated, increasing the dosage may be considered. If there is little or no improvement after an adequate trial, doctors may switch to another antidepressant. Combining medications or incorporating psychotherapy, particularly cognitive-behavioral therapy, are additional options. In certain instances, supplementary medications may be prescribed alongside an antidepressant, but these decisions necessitate specialist oversight and proper monitoring. Emerging treatments like ketamine and esketamine may be considered in specific cases of treatment-resistant depression, particularly when a more rapid response is desired. While some patients experience symptom improvement within hours or days, the response can vary and may not be enduring. Potential adverse effects include dizziness, nausea, elevated blood pressure, and temporary alterations in perception, necessitating medical supervision. Electroconvulsive therapy (ECT) may be contemplated when depression is severe, other treatments have proven ineffective, or urgent intervention is required, such as when a person is at high risk of suicide, exhibits symptoms like losing touch with reality, or is unable to maintain adequate food or fluid intake. ECT is administered under anesthesia, and while some patients may experience headaches, confusion, or memory issues in the aftermath of the procedure, these effects can differ from person to person.\n\nDr. Vasanth R., a consultant psychiatrist at Apollo Speciality Hospitals in OMR, Chennai, underscores repetitive transcranial magnetic stimulation (rTMS) as one of the newer treatment options available in India. The availability of rTMS varies across centers, and its cost, coupled with the requirement for multiple sessions, may impact accessibility. rTMS involves the application of repeated magnetic pulses to stimulate specific brain regions associated with mood regulation. Its suitability and potential benefits depend on the patient's medical history and clinical assessment. Individuals may require further treatment if symptoms return after an initial response. Unlike ECT, rTMS does not require general anesthesia, as the person remains conscious during the procedure, typically involving repeated outpatient sessions over several weeks. Improvement may be observed during treatment, but the duration and extent of improvement vary among individuals. Side effects may include scalp discomfort and headaches, with seizures being a rare but recognized risk. Before initiating treatment, doctors evaluate the patient's medical history, including seizure risk and the presence of any implanted metal or electronic devices that could interfere with the procedure. The choice of treatment, including the use of rTMS and ECT, depends on the patient's clinical condition, past treatment response, and individual needs.",
  "summary": "An estimated 30% of people with major depressive disorder who have tried antidepressants may experience treatment-resistant depression",
  "key_points": [],
  "editors_take": null,
  "illustration": null,
  "coverage": {
    "outlets": 2,
    "also_reported_by": [
      {
        "outlet": "The Hindu - Sci-Tech",
        "title": "Treatment-resistant depression: what happens when antidepressants do not work?",
        "url": "https://urgent.news/2026/10/10/treatment-resistant-depression-what-happens-when-antidepressants-do",
        "published": "2026-10-10T07:51:33.000Z"
      }
    ]
  },
  "ai_generated": true,
  "disclaimer": "Summaries, key points and the editor’s take are written by software from other outlets’ reporting and may contain errors — always check the linked original."
}