1. Introduction

• India is one of the world’s largest consumers of antibiotics.

• While Antimicrobial Resistance (AMR) is recognised as a major public health threat, its impact on mental health via the gut-brain axis remains underexplored.

• The problem is compounded by easy access, self-medication, and unregulated prescriptions in India.

2. The Gut-Brain Axis and Mental Health

• The gut microbiota regulates neurotransmitters like serotonin and dopamine, influencing mood, stress response, and cognition.

• Antibiotics disrupt this microbiota balance (dysbiosis), leading to:

  • Anxiety and depression

  • Cognitive decline

  • Neurodevelopmental disruptions

• Indian studies (NIMHANS, AIIMS) are exploring gut dysbiosis as a factor in psychiatric illnesses.

3. India’s Antibiotic Culture

• Overuse & misuse: OTC sales, patient demand, fee-for-service prescription incentives.

• Statistics:

  • AMR caused 2.67 lakh deaths in 2021 in India; projected to rise to 1.2 million by 2030. (IHME)

  • Nearly 50% of antibiotics consumed are unapproved formulations (Lancet, 2022).

• Socio-cultural factors: Quick-fix mindset, low awareness, reliance on pharmacies in rural/semi-urban areas.

4. Mental Health Implications

• Biological pathway: Dysbiosis → Inflammation (↑ cytokines IL-6, TNF-α) → altered neurotransmission.

• Psychosocial dimension: Stress, anxiety, depression worsened by poor gut health.

• Emerging therapy: Psychobiotics (probiotics & prebiotics) show promise in reducing depressive symptoms (Frontiers in Psychiatry, 2020).

5. Policy and Public Health Interventions

a) Education & Awareness

• Embed gut-brain literacy in school curricula, NHM, and Ayushman Bharat programmes.

• Campaigns on dangers of self-medication and importance of balanced diet (fermented foods, probiotics).

b) Regulatory Reform

• Central Drugs Standard Control Organization (CDSCO): Strict prescription-only antibiotic policy.

• Penalise pharmacies and practitioners violating norms.

c) Surveillance & Research

• Strengthen INSAR (Indian Network for Surveillance of AMR) with integration of mental health metrics.

• Invest in India-specific microbiome research to develop psychobiotic interventions.

d) Clinical Practice

• Integrate antibiotic stewardship into medical education.

• Encourage psychiatrists to include GI health assessments in evaluations.

• Nutrition counselling as part of mental health care.

e) Leveraging Traditional Knowledge

• Promote fermented foods (curd, idli, dosa, pickles) as natural probiotics.

• Combine Ayush & modern psychiatry approaches for holistic care.

6. Challenges

• Weak enforcement of drug regulations.

• Low doctor-patient ratios, esp. in rural India.

• Pharma–market linkages incentivising over-prescription.

• Limited mental health infrastructure (India spends ~1.3% of GDP on health, <0.1% on mental health).

7. Conclusion

• AMR is not just a physical health crisis but also a mental health crisis in the making.

• India must adopt a One Health + Gut-Brain Axis perspective, integrating microbiology, psychiatry, nutrition, and public health.

• With rising mental health burden and AMR fatalities, responsible antibiotic use + gut-friendly interventions are indispensable for sustainable health security.