Many people who take psychiatric medications may experience relief through their first couple of tries with medication and therapy, but what if you’re not one of them? You might have something called “treatment resistance.” This isn’t a rare condition, with studies showing that treatment resistance affects 20-60% of patients with psychiatric disorders.
Fortunately, treatment resistance doesn’t mean recovery is impossible. It just means that you might benefit more from specialized care or alternative treatments. Here’s a breakdown on how to know if you’re treatment-resistant and what treatments may be available.
If you’ve ever felt “stuck” in your mental health journey, you might be treatment-resistant. This happens when your mental health condition doesn’t improve much, or at all, even though you’ve tried treatments that work for most people.
It’s important to note that this isn’t the same thing as trying a medication that didn’t help or having a therapist who wasn’t a good fit. Treatment resistance is a pattern where your symptoms stick around despite multiple attempts to address them.
For your condition to be considered treatment-resistant, you’ll typically have:
Treatment resistance can happen across many conditions like depression, bipolar disorder, OCD, and schizophrenia. Fortunately, treatment-resistant doesn’t mean untreatable. It just means you might have to explore different options outside of standard treatment protocols.
Finding the right treatment plan for mental health conditions involves a bit of trial and error. While patience is important, there are clear signs that your current treatment may not be providing enough relief.
Patience is key when starting psychiatric medications, but there’s a difference between waiting for a medication to work and recognizing when it’s not working for you.
Most psychiatric medications don’t work overnight. Antidepressants usually take 4-8 weeks to reach their full effect. During this time, you might notice improvements in sleep, appetite, and energy levels before you feel any change in your mood. Similarly, antipsychotics may take up to 6 weeks before you experience their full benefits.
However, if you’ve taken your medication as prescribed for the recommended timeframe and don’t notice any improvement in your symptoms, this could be a sign of treatment resistance. Of course, meaningful improvement can mean something different from person to person, but generally, you should feel some type of reduction in symptom severity or frequency.
It’s also common to try several medications before finding one that works well for you. Each person’s brain chemistry is unique, which is why a medication that works well for someone else might do little for you. Your doctor may need to adjust your dosage or switch medications entirely several times before finding the right fit.
Note: Never stop taking your medication without consulting with your doctor, even if you feel it isn’t working or you’re feeling better. Abrupt discontinuation can cause withdrawal symptoms or symptom rebound. Your doctor can help you safely taper off while transitioning to a different treatment.
You’ve done everything right–taken your medication consistently, attended therapy regularly, and practiced all the coping skills you’ve learned. Yet somehow, your symptoms keep returning. This pattern of recurring episodes despite following maintenance treatment is another sign that your condition might be treatment-resistant.
Maintenance treatment is meant to prevent relapse once your symptoms have improved. For many people, this works well as they remain stable for years with minimal, or no, symptoms. But for some, maintenance treatment isn’t enough. You might experience:
Remember that experiencing occasional symptoms doesn’t automatically mean your treatment has failed. Even well-managed conditions can fluctuate, especially during times of stress. However, if your episodes are becoming more frequent or serious despite treatment, it may be time to try something else.
When determining whether a treatment is effective, you want to take into account how well you tolerate a medication in addition to whether or not it reduces your symptoms. When side effects are unbearable, they can make an otherwise effective treatment impossible to continue.
Many psychiatric medications come with side effects that can cause disruption in your day-to-day life, especially when you first start taking it. For example, about one-third of people taking SSRIs experience sexual dysfunction, including little desire, difficulty reaching orgasm, or erectile problems.
Other common side effects include:
When these symptoms last and don’t go away, you might find yourself in a difficult position of choosing between your mental health condition and avoiding the negative effects of the medication.
Even the most proven treatments can fail when certain things are missing from your care. Treatment resistance sometimes has less to do with your condition itself and more to do with how your treatment is approached.
Incomplete assessments can mean you’re receiving the right treatment for the wrong diagnosis. Mental health conditions can overlap, and what appears to be treatment-resistant depression might actually be bipolar disorder, depression with ADHD, or a mood disorder accompanied by substance abuse. Without a thorough evaluation, your treatment plan can start off at a disadvantage.
The relationship between you and your therapist can also affect treatment outcomes. Research shows that a strong therapeutic alliance built on trust, collaboration, and open communication is one of the best predictors of success. When providers actively involve you in decision-making and regularly check in about the therapy itself, treatment outcomes improve significantly.
If you’ve discovered that you’re treatment-resistant, there’s hope. Here’s a look at some non-standard treatments that might be worth discussing with your doctor.
Electroconvulsive therapy (ECT) is often a go-to treatment for severe, treatment-resistant depression. Research shows remission rates of approximately 50-63% in patients with depression who haven’t responded to multiple medication trials.
ECT works by causing a brief, controlled seizure that affects brain chemistry and provides rapid relief for severe symptoms. It involves a series of treatments, usually 6-12 sessions administered 2-3 times per week. While temporary memory issues are common side effects, they typically resolve after treatment.
Originally made as an anesthetic, ketamine has been found to quickly relieve depression symptoms within hours or days, unlike traditional antidepressants that can take weeks to work. In a clinical trial of 403 patients, 55% of those who received ketamine treatment experienced sustained improvement in depressive symptoms without major side effects.
Ketamine is typically administered as a series of infusions in a doctor’s office. Researchers are still studying exactly how it works, but it appears that ketamine repairs neural connections damaged by depression and stress. This essentially allows the brain to form new pathways.
Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It targets specific areas that are associated with mood regulation and doesn’t require anesthesia or cause memory problems like ECT.
Recent research comparing TMS to medication for treatment-resistant depression found significantly better outcomes with TMS. Response rates were 37.5% for TMS versus just 14.6% for medication, while remission rates were 27.1% versus 4.9%, respectively. Patients receiving TMS therapy also showed greater improvements in anxiety and anhedonia (inability to feel pleasure) compared to those on medication.
TMS typically requires daily sessions for several weeks, each lasting about 20 minutes. Side effects are generally mild, including headache and scalp discomfort during treatment. As a non-invasive option with no systemic side effects, TMS is a promising alternative for patients who are treatment-resistant.
If you’ve tried multiple medications or therapies without finding relief, you’re not alone, and you’re not out of options. At Cura Behavioral Health, we are committed to helping people who haven’t responded to standard treatments find their path to recovery through comprehensive, holistic care.
We offer medication management, evidence-based therapy, and innovative treatments like TMS to address even the most stubborn mental health conditions. Don’t settle for partial improvement or uncomfortable side effects that won’t go away. Contact Cura Behavioral Health today to learn more about our personalized treatment options that can help you break through the resistance.
Treatment resistance in psychiatry: state of the art and new directions – Molecular Psychiatry
Mental Health Medications – National Institute of Mental Health
Treatment-Resistant Depression Revisited: A Glimmer of Hope – Journal of Personalized Medicine
Better relationships with patients lead to better outcomes – American Psychological Association
Electroconvulsive therapy in treatment resistant depression – Journal of the Neurological Sciences
Ketamine found effective in treating severe depression – The Harvard Gazette
TMS Outperforms Medication in Study of Treatment-Resistant Depression – Psychology Today
Determining if TMS therapy suits your mental health journey should involve consultation with a qualified professional. At Cura Behavioral Health, we provide comprehensive assessments to help you make informed treatment decisions.
Don’t let a mental health condition hold you back any longer. Schedule a consultation with Cura Behavioral Health today. Our experienced team is ready to answer your questions and create a personalized treatment plan tailored to your unique needs.
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Dr. Kevin Simonson, an esteemed Medical Director at Cura Behavioral Health, brings over 15 years of experience in psychiatry. A graduate from a top medical school, he specializes in the treatment of mood disorders and anxiety, employing a patient-centered approach. His dedication to evidence-based care and his commitment to advancing mental health practices have made him a respected figure in the field. Dr. Simonson’s leadership ensures the highest standard of care for the community at Cura Behavioral Health.
