Hi,

Thanks for your question.

I can understand what you are going through and how distressing it can be to go through such difficult and trying times. As a psychiatrist, I am able to empathize with you because I often see the loved ones / care givers of patients go through a lot of stress themselves, and I believe that it is very important that they also need emotional support and encouragement.

Firstly, let me appreciate you for having this much determination and patience to not only keep ensuring that your wife is getting the necessary treatment, but also to keep holding on to your family and keeping life as normal as possible. I think you are doing a great job.

Now, regarding your wife's depression, you have mentioned that she has been suffering from recurrent episodes, despite being on regular medication. Now, though many people respond well to anti-depressant medication, there will be a proportion of people who respond only partially or have a poor response to treatment. If there has been poor or inadequate response despite receiving an adequate dosage and duration of different types of antidepressants, then it is likely that your wife may be suffering from a "treatment-resistant depression".

Now, don't get alarmed by that word as it does not imply that there is no treatment option available. It just means that these particular proportions of people need a special way of approach and management.

The management approach first involves investigating for any causes for treatment resistance, for example, certain medical causes, like thyroid problems, certain vitamin deficiencies, etc. can be contributory. If so, they have to be detected and treated appropriately. Further treatment options include trying different combination of anti-depressants, augmenting the antidepressant with other psychiatric medication like an anti-psychotic or a mood-stabilizer, thyroxine supplementation, etc. Combining intensive psychological therapies (such as Cognitive Behavioural Therapy - CBT) with medication often gives good results. Sometimes, if medication and psychotherapy fail, Electro-convulsive Therapy (ECT) can also be used as an option.

So, don't get dejected or give up hope at all. There are many options available to tackle her 'resistant' depression. Just manage to stay afloat till your doctor is able to find her a suitable form of treatment that gives positive results. This can take some time because each option must be systematically tried before writing it off and often anti-depressant medication can take a few weeks to bring about their full potential. Do continue to have faith in the doctors treating her and do continue to keep up your courage and patience. It is also important that you have some vents for letting out your steam periodically and relaxing yourself, so that you don't get very stressed out. It is a good idea to keep talking to someone close and share your feelings, as this can be a good de-stressor. I am confident that that with your determination and the continued efforts from her doctors, she will surely be able to come out of her depression soon.

All the best.

-Dr. Jonas Sundarakumar
Consultant Psychiatrist

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