Guidelines for the management of treatment-resistant depression (TRD) do not meet the criteria of evidence-based medicine and better-quality research is required to inform clinical practice. Current treatments of resistant depression remains largely empirical. There are no benchmark antidepressants. Clear and justifiable rationale should be followed while initiating new treatment strategies; systematic planning and careful monitoring of progress implemented while new treatment components are added. Biological psychiatrists should give due importance to the non-biological aspects of depression and psychotherapists should not overlook the biological correlates. Unidimensional solution will not work for a complex illness like refractory depression and a single answer should not be sought as a cure because the aetiology of depression is multifactorial and the pathophysiology itself remains unknown. Psychopharmacological interventions are still the main stay of treatment of TRD. There are two major alternatives to pharmacotherapy: neuromodulation and psychotherapy. Alternative terminologies for TRD like MTR-MDD (Multiple Therapy Resistant-Major Depressive Disorder) are being introduced reflecting the frustrations of clinicians and patients with the conventional definition of TRD and treatment modalities.

The novel antipsychotics have reduced the use of depot medications, but the introduction of the atypical depot antipsychotic has rekindled an interest in the long-acting antipsychotic formulations. The use of atypical antipsychotics is recommended, except where patients are otherwise stable on classical antipsychotics without unwanted side effects.

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Only precautionary measures are practical at the moment in controlling the COVID-19 pandemic and one such measure is balancing self-immunity. The recent findings about the durability of COVID-19 antibodies in the infected people has put some concerns about the prospects of long-term immunisation methods. In such circumstances, one way of protecting from COVID-19 is by enhancing one's own immune mechanisms. Unfortunately, there is less discussion about this serous issue. Elderly patients are at a higher risk of getting infected with SARS-CoV-2 and should be mindful of balancing the immunity. Adherents of Integrated medicine seem to have more awareness of different facets of immunity and they go beyond the conventional methods. Immunological research is in a standstill. This paper is an attempt to evaluate balancing immunity through all the known practices done in different disciplines of medicine.

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