Interview:
Dr. P. Murali Doraiswamy
A physician and teacher at Duke University in the United States, is an internationally renowned expert in the fields of mind-body medicine and aging. He has earned acclaim for his pioneering research into traditional and complimentary strategies to enhance mental fitness and brain longevity.

Dr. Doraiswamy has lectured in more than 30 countries around the world and has been featured on more than a hundred TV, radio and print reports such as NBC Nightly News, Wall Street Journal, New York Times, The Today Show, USA Today and National Public Radio.

Qus.1- What are the most recent advances in psychiatry visavis medication?
Ans - The biggest advance over the past decade has the advent of medicines to treat major depression, generalized anxiety, panic disorder, social phobia, post-traumatic stress, obsessive compulsive disorder, schizophrenia and dementia. We are also seeing good large scale trials comparing these drugs against each other so that we can find out which drug is the best. The safety of these medications is also being systematically tested in children. As more and more people take treatments, we are seeing a reduction in the stigma associated with mental illness. All of this has lead to earlier recognition and better outcomes. Many people with schizophrenia or depression are now able to live productively in the community. Also, as the human genome is better characterized, we will discover causes of variious mental disorders and find cures.

Qus.2- Many mentally ill patients and their families even today do not have any faith in medication as they do not see and perceptible drastic changes in the symptoms of mental illness.Also many of the drugs seem to be treating only the external symptoms and not the underlying cause of the illness?
Ans - We use medicines because by and large they are better studied than nondrug options such as yoga or herbals. Also, doctors do not receive any training in alternative treatments and hence are more knowledgabela and comfortable with medication. Medications treat the external symptoms by correcting chemical imbalances. That is not to say nondrug options are not useful - many patients with anxiety or depression can recover with psychotherapy or exercise or relaxation. External symptoms can be debilitating and deadly. Depression can lead to suicide and psychosis can lead to violence. Drug response rates vary by disease. About 60% of people with depression will improve significantly on antidepressants or psychotherapy compared to about 50% on an dummy pill (placebo). As a society, we have decided that this 10% additional response is valuable since we are not ethically allowed to give dummy pills. Newer drugs are often more expensive and so one has to judge the merits more skeptically to separate the marketing hype from the actual data. Make sure your doctor informs you about all the side effects and the different treatment options available. All drugs have side effects. If your doctor does not have time to talk with you about all these issues, it's time to find a new doctor.

Qus.3 - As in the case of a physical illness like T.B. where relapses occur due to non compliance by the patient on partial recovery, the same appears to occur with mental illnesses.What can be done to ensure effective compliance of consumers/patients who are diagnosed with this illness?
Ans - Consumer education, making medicines affordable, reducing stigma and not hyping the benefits of these drugs. Belief in your treatment also helps.

Qus.4 - Can alternative healing therapies like Yoga and Ayurveda help in the treatment of mental illness?
Ans - Definitely but if you have a serious illness its best to use them initially under medical guidance and after learning about risks and benefits. Our studies have shown that regular aerobic exercise is as effective as the best antidepressant medicine for treating depression and likely more effective in improving overall health and quality of life. However, one has to be skeptical before choosing unproven therapies because you may be delaying your recovery and your illness can worsen. Also, just because something is herbal or alternative does not mean it is any safer than prescription drugs. Serious side effects have been reported with many herbal preparations and it is well documented that unscrupulous shops may spike herbals with steroids or metals or drugs like aspirin.

Qus.5 - Coming to your recent Research on side effects of popular antipsychotics, what can be the consequences of the Research Findings for Consumers?
Ans - In the absence of alternatives they will have to live with the side effects. With most drugs, we do not find out about all their side effects until the drug has been used in tens of thousands of patients. For example our research has highlighted that many of the newer antipsychotic drugs may lead to blood sugar troubles or diabetes. My recomendation is that anyone taking the newer medicines for schizophrenia should get their blood sugars tested periodically if they have a family history of diabetes or if they have had a lot of weight gain recently. While most of the newer medications can be life saving and effective in the short run, we now need studies looking at the long term safety.

Qus.6 - What can be the role of the state in helping to prevent, provide treatment as well as Rehabilitation for the mentally ill? What has been the experience in America and what can be the lessons for India from the American Experience?
Ans - The government should play an active role in education, research and treatment. Accurate estimates of people with each of the different mental illnesses will help in prioritizing resources. The US Surgeon General took up suicide as a major campaign and it has helped increase awareness, reduced stigma and raised funding. Mental wellness should become a national priority along with fighting malnourishment, infectious diseases and poverty.

Qus.7 - What is the scope for Indian organisation researching mental illness to collaborate with Researchers abroad and vice versa? What are the existing linkages?
Ans - There is a lot of scope for such projects. For example there are collaborative studies underway in dementia, depression and schizophrenia. Many US based doctors visit India frequently and give lectures and vice versa. Multinational pharmaceutical companies also are testing new psychiatric treatments in India which is acceptable as long as ethical principles are not violated and the companies follow high safety standards.

Qus.8 - In India there is no insurance for mentally ill people.What is the experience in USA.Does the state intervene in providing insurance?
Ans - Most people in the US also do not have good insurance coverage for mental illness. Their main sources for care involve state funded mental clinics as well as state funded insurances.

Qus.9 - Can ECT be given to a patient without their prior permission?Leaving aside the legal position what is your opinion?
Generally not unless the patient is felt to either not be competent or be at risk to harm themselves or others. In certain patients, it can be more effective than anything else. My opinion is that it is an acceptable choice for severe mental conditions that do not respond well to other interventions.

Qus.10 - Any message for the mentally ill in India?
Ans - It is important for your voice to be heard and to be active politically. Organizations like NAMI and NARSAD play a critical role. Only then will the public recognize that mental illness is a biologically driven condition just like diabetes or hypertension.