10 SIGNS OF MENTAL HEALTH TREATMENT FAILURE

1. Your symptoms aren’t improving.

One of the clearest signs that your mental health treatment isn’t working is the lack of improvement in your symptoms. Whether you’re managing clinical depression, anxiety disorders, post-traumatic stress disorder (PTSD), or another condition, effective treatment should lead to measurable progress over time.

According to statistics from the National Library of Medicine, up to 50% of people with depression do not respond to their initial treatment plan. If you feel like you’re running in place, it’s time to discuss alternative options with your provider.

2. You feel worse over time.

It’s not uncommon to experience emotional discomfort when diving into tough topics during therapy, but constantly feeling worse without relief could signal a deeper problem. A 2023 study found that treatment-resistant mental health issues often worsen without appropriate adjustments.

So, if your symptoms are intensifying, it’s crucial to reevaluate your approach with your mental health professional.

3. You lack a sense of connection with your therapist.

Clear and comfortable communication provides therapeutic rapport that plays a significant role in a successful mental health treatment plan. If you don’t feel heard, understood, or respected by your therapist, it can hinder your progress.

Research from Frontiers in Psychiatry Journal shows that a strong therapist-client alliance can be a powerful predictor of therapeutic success, impacting nearly 8% of success in therapy. If this connection is missing, consider seeking a different provider to ensure you’re giving yourself the best chance for treatment.

4. Your treatment plan feels generic.

A cookie-cutter approach to mental health treatment often fails to address the specific needs of an individual. For example, stimulant medication for ADHD may be highly effective for one person, but could make another person’s symptoms worse.

Personalized treatment plans often allow space for better outcomes. If your current plan doesn’t feel tailored to you, discuss customized options with your provider.

5. Side effects from medication outweigh benefits.

While medication can be a lifeline for many, the wrong prescription or dosage can lead to side effects that worsen your quality of life. According to a 2023 report by the JAMA Network Research Journal, about 25% of people experience adverse effects from antidepressants that cause them to discontinue treatment within the first month and 68% within three months.

If you have questions or feel your medication isn’t improving your mental health and creating additional challenges, it’s essential to work with your doctor to find a better solution.

6. You’re not learning new coping strategies.

Effective mental health treatment should equip you with tools and strategies to manage stress, triggers, and symptoms. If you’re not gaining actionable coping skills, you might not be receiving the full benefit of therapy.

You can feel more empowered to support your own brain health alongside your choice of therapy by incorporating practical strategies that have been proven to work like:

• Practicing gratitude journaling to shift focus toward positive daily experiences
• Having a creative outlet like painting, music, or crafting to better express yourself emotionally
• Spending time in nature to reduce stress, improve mood, and get your body moving
• Practicing mindfulness meditation to increase self-awareness which calms the mind and restores control over your emotional health
• Using aromatherapy with calming scents like lavender or eucalyptus to promote relaxation

If your sessions lack this focus, it’s worth discussing with your therapist and your doctor.

7. You’re avoiding therapy sessions or assignments.

If you find yourself dreading therapy sessions or avoiding assigned homework, it could be a sign that your current approach isn’t resonating with you. A 2019 article by the American Psychological Association found that client engagement is a critical predictor of success and continued attendance in mental health treatment.

If your treatment feels like a chore, consider exploring alternative therapies that align better with your needs.

8. Your goals are unclear or unmet.

A clear roadmap is vital for effective mental health treatment. Goal setting has been shown to help young people with anxiety or depression by improving communication, building trust, and making their care feel more manageable.

If you haven’t set specific goals with your provider or feel like you’re not making progress toward them, it’s a red flag. Measurable progress is a key indicator of treatment success. If your sessions feel aimless, request a structured plan with clear milestones.

9. You’re only addressing surface-level issues.

Some therapy models focus on immediate symptom relief without digging into the underlying causes. While short-term relief is important, ignoring the root cause can lead to recurring problems and disengagement when things don’t work out.

Comprehensive mental health treatment should address both immediate symptoms and long-term factors like trauma or lifestyle. If your sessions lack depth, it may be time to switch approaches.

10. You’re relying solely on one form of treatment.

Mental health treatment often works best when it’s multifaceted. For instance, combining therapy with lifestyle changes, medication, or brain-healthy habits can amplify results.

Decades of research and clinical practice at Amen Clinics underscores the value of integrating brain health practices like proper nutrition, exercise, and mindfulness into treatment plans. If your current approach feels one-dimensional, consider supplementing it with additional strategies.

WHAT TO DO IF YOUR MENTAL HEALTH TREATMENT ISN’T WORKING

If any of the above signs resonate with you, it’s time to act. Here’s how you can advocate for better mental health therapy outcomes starting now:

1. Communicate openly with your provider: Share your concerns in detail and ask for adjustments to your treatment plan.
2. Seek a second opinion: Consulting another mental health professional can offer fresh insight and alternative approaches to find new ways to heal your brain.
3. Build brain-healthy habits: Learn about how your brain and body work together to help or hinder your progress. Take steps to tailor your lifestyle to support brain function and mental clarity, including a nutrient-rich diet, regular exercise, and mindfulness practices.
4. Consider innovative therapies: If traditional talk therapy isn’t working, explore options like EMDR therapy, neurofeedback, or group coaching.
5. Explore personalized care: The brain SPECT imaging and integrative approaches at Amen Clinics help address root causes of mental health issues, so you can get a targeted treatment plan for your individual needs. 

Identifying when your mental health treatment isn’t working can feel discouraging, but think of it as an opportunity for growth and positive change. By recognizing the signs and taking proactive steps, you can find a treatment plan that truly supports your overall wellness. Mental health is a journey, not a destination—and the right support can make all the difference.  

WHAT IS LONG COVID?

Long COVID – also known as post-COVID condition – is a syndrome that occurs in individuals with a history of likely or confirmed SARS CoV-2 infection, usually about three months from the onset of COVID-19. 

Long COVID comes with an array of symptoms that last for at least two months and cannot be explained by an alternative diagnosis to be considered long COVID. The most common symptoms may include any of the following:

• Fatigue
• Malaise
• Brain fog
• Memory issues
• Heart palpitations
• Blood clots
• Persistent cough
• Chest pain
• Loss of lung function
• Muscle pain and joint aches
• Headache
• Hair loss
• Loss of smell
• Altered taste
• Sexual dysfunction
• Sleep disturbances
• Gastrointestinal issues
• Anxiety
• Depression

These symptoms often have an impact on everyday functioning. Symptoms may appear for the first time following initial recovery from an acute COVID-19 episode, or they can persist from the time of the initial illness. Additionally, they may vary or relapse over time.

One of the most recent scientific surveys of nearly 30,000 participants revealed that about 8% of U.S. adults reported having ever had long COVID. Just under 4% of U.S. adults reported currently having the condition or currently having activity-limiting long COVID.

Of course, the SARS CoV-2 infection is the original initiator of long COVID, but more research is needed to fully understand what transpires at the cellular and molecular levels that brings about long COVID health complications and symptomology.

WHAT DRIVES LONG COVID?

Scientists see long COVID more as an umbrella term because it appears there are likely multiple mechanisms that lead to its development and these conditions are not mutually exclusive—and may even coexist.

According to 2023 research, the leading theories about what drives long COVID include damage/alteration to the immune system, the persistence of residual COVID viral components that lead to chronic inflammation, endothelial (lining of blood vessels) dysfunction or activation, reactivation of pre-existing chronic infections, microflora imbalances in the gut, and unrepaired tissue damage.

Here’s a closer look at a few of them.

1. Viral Persistence

Viral persistence is characterized by ongoing shedding of SARS-CoV-2 after the acute infection has run its course. These persistent infections from long COVID shedding may fly under the radar, but their subclinical viral presence is thought to continuously aggravate the immune system – which, in turn, may trigger chronic inflammation.

Indeed, persistent COVID viral RNA was found in the feces of a group of individuals months after clearing the initial infection, according to one study reported by researchers at the Yale School of Medicine. These individuals also reported experiencing residual GI symptoms months after being diagnosed with COVID.

If long COVID develops due to subclinical levels of the virus persisting in the body, that would make the condition similar to other infection-associated chronic conditions (also called post-acute infection syndrome) such as CFS, Lyme disease, EBV, or herpes zoster (shingles) that develop after the acute infection has passed.

2. COVID and Dormant Infections

Because COVID can cause immune system dysfunction, scientists sought to explore an important question: Can COVID reactivate infections? After all, a compromised long COVID immune response could leave an opportunity for previously dormant viral or bacterial infections to re-emerge—especially the IACC’s just mentioned.

There’s a likely connection between COVID and immune system reactivation, evidence suggests. EBV, which causes mononucleosis and other illnesses, appears to be reactivated in some long COVID patients. Indeed, research shows that an increase of EBV antibody levels are present in some individuals with continuing long COVID symptoms.

Additionally, research has found many overlaps between long COVID symptomatology with clinical presentation of chronic fatigue syndrome. Twenty-five out of 29 known chronic fatigue symptoms were noted in one COVID study. However, it is still not exactly clear how COVID impacts chronic illnesses.

3. Autoimmunity

SARS-CoV-2 infection may trigger autoimmune disease. Some patients with long COVID have elevated levels of autoantibodies (malfunctioning immune cells), which are thought to play a role in autoimmune disorders such as rheumatoid arthritis, lupus, or Sjögren’s syndrome, Yale Medicine reports.

Antibodies help to protect against foreign invaders, such as bacteria and viruses. However, autoantibodies can attack the body’s own cells, leading to inflammation and tissue injury.

In some patients with long COVID, antinuclear autoantibodies have been observed up to one year after acute infection. They can target parts of cell nuclei, which may promote inflammation and damage organ systems.

For instance, in the inner lining of blood vessels (the endothelium), these antinuclear autoantibodies can create a hyper-inflammatory state or alterations to blood cells that can lead to inappropriate clotting.

4. Inflammation

Inflammation, or recruiting white blood cells and the release of cytokines that initiate tissue swelling and injury, may also underlie some types of long COVID. The acute phase of COVID infection alters tissue function and unleashes a chronic inflammatory state in cells, specifically cells in the brain that are longer-lived. Inflammation is one of the major chronic illness triggers after COVID.

All of the theories noted above may possibly contribute to the sustained inflammation seen in long COVID cases.

WHAT IS LYME DISEASE?

Lyme disease is a bacterial infection that develops after a person is bit by a tick carrying the infection-causing bacterium, Borrelia burgdorferi. In rare cases, Lyme can develop from another tick-carrying bacterium called Borrelia mayonii.

While cases of Lyme have been reported in all 50 sates in the U.S., the vast majority of Lyme disease is found in the Northeast, mid-Atlantic, and upper-Midwest.

LYME DISEASE SYMPTOMS 

When Lyme disease infection first occurs, the most common symptom is an erythema migrans rash. It appears like a red circle with a bullseye on the skin. Research has found about 70-80% of cases have this rash, which appears at the site of the tick bite.

Over time, other symptoms of Lyme disease may appear. However, some people may not notice any symptoms initially. The CDC notes that any of the following early symptoms of Lyme disease typically appear three to 30 days after the tick bite:

• EM rash
• Headache
• Fatigue
• Fever
• Chills
• Muscle and joint aches
• Swollen lymph nodes

Days or even months after the tick bit, these later symptoms may appear:

• EM rashes that appear on other areas of the body
• Severe headaches and neck stiffness
• Arthritis (particularly in large joints like the knees)
• Pain that comes and goes in the tendons, joints, muscles, and bones
• Facial paralysis or severe weakness of facial muscles
• Heart palpitations or an irregular heartbeat
• Bouts of dizziness or shortness of breath
• Shooting pain, tingling, or numbness in the feet and or hands
• Nerve pain
• Brain and spinal cord inflammation
• Sometimes if an individual receives treatment right away, before the condition develops, they may not experience these later symptoms of Lyme disease.

Lyme disease may also trigger symptoms related to mental health conditions, such as:

• Brain fog
• Anxiety
• Depression
• OCD
• Memory loss

And similar to long COVID, some Lyme patients continue to have ongoing symptoms, which can be severe and debilitating. The CDC calls this phenomenon post-treatment Lyme disease syndrome (PTLD), also known as chronic Lyme disease.

Many researchers and clinicians believe that the persistence of bacteria is the cause of these lingering symptoms. The antigen that triggers the inflammatory responses in chronic Lyme symptoms is found on the outer layer of the bacterial cell wall.

Pieces of these bacterial cell walls can linger in the body—undetected in the neurons or spinal cord, even post infection. This may contribute to the prolonged inflammation that leads to chronic illness.

According to a recent 2024 study in the Journal of Infectious Diseases, prevalence of PTLD varies from 0% to 48%, depending on how chronic Lyme disease is measured and defined. Some advocacy groups settle on a prevalence rate of 30%.

LONG COVID AND LYME DISEASE

COVID symptoms and Lyme disease share similar symptoms, but that’s not all. In a 2022 study, researchers found that chronic Lyme and COVID-19 are linked as having a history of Lyme disease correlated to increased risk of severe COVID-19.

In fact, long COVID and Lyme disease have so many overlapping similar features, research has been conducted to find biomarkers that differentiate between the two conditions.

Unfortunately, without clear biomarkers, the lack of differences between them impedes scientific research, according to some experts. A potential participant in a trial might be sick from long COVID, Lyme, or another infection-associated chronic condition.

At Amen Clinics, brain SPECT imaging and lab work play important roles in helping determine the underlying root cause of symptoms.

At this point, there are currently no FDA-approved treatments for chronic Lyme, or full-scale clinical therapy trials, which is very common among chronic conditions. But there’s hope that with the prevalence of long COVID, new research will reveal therapies that may help treat all of these similar chronic conditions, such as COVID, Lyme, EBV, CFS, and the herpes zoster.

MANAGING POST-COVID LYME SYMPTOMS

Until an effective treatment is found, post-COVID Lyme symptoms can be managed through lifestyle changes. (Of course, an acute Lyme infection requires antibiotics.) Here’s what you can do for chronic Lyme and long COVID symptoms:

• Support from a qualified mental health professional, good sleep hygiene, consuming a brain healthy diet and avoiding alcohol, excess sugar, and refined carbohydrates can all help to support a healthy mood and keep inflammation levels down.
• Additionally, practicing deep breathing or mindfulness practice like yoga, tai chi, or meditation can help keep anxiety levels down, and inflammatory cortisol levels in check.
• Acupuncture, gentle massage, heat, stretching and toning exercises, and water therapy are all good for managing pain.

WHAT IS REJECTION SENSITIVE DYSPHORIA?

Rejection sensitive dysphoria is a form of emotional dysregulation. Although it is not classified as a mental disorder, it can be highly disruptive in daily life.

People with rejection sensitive dysphoria experience an overwhelming emotional response to real or perceived rejection, criticism, judgment, or being left out. They may lash out in anger, dwell on negative thoughts, feel hopeless, think they’re a failure, or feel their self-esteem plummet.

Their moods may drop so rapidly and dramatically, it can feel like major depression and can lead to suicidal thoughts and behavior.

As a result of these intensely distressing feelings, people with RSD tend to avoid social situations, become perfectionists, develop an extreme fear of failure, and adopt people-pleasing attitudes.

Because the symptoms and consequences associated with rejection sensitivity are similar to those seen in many other mental health conditions, it is often overlooked or misdiagnosed.

WHO’S AT RISK FOR REJECTION SENSITIVE DYSPHORIA?

RSD is real, and it can affect anyone, but it is more commonly seen in people who have one or more of the following three mental health conditions:

1. Anxiety:

   People with anxiety are generally more sensitive to criticism, and they tend to be people pleasers. Prior to the pandemic, over one-third of Americans struggled with anxiety. Those numbers have since increased.

According to the American Psychiatric Association’s 2024 mental health poll, 43% of Americans reported feeling more anxious than the year before. Some of the top anxiety-inducing issues reported in 2024 were the economy, the presidential elections, and gun violence.

2. ADD/ADHD:

   Research has found a strong connection between people with attention-deficit hyperactivity disorder (ADHD)—also known as attention-deficit disorder (ADD)—and RSD. In fact, it is estimated that almost all ADHD sufferers also experience hypersensitivity to rejection.
   
   

ADHD is a brain-based disorder that is associated with an array of behavioral and emotional symptoms, including short attention span, distractibility, poor impulse control, irritability, being easily stressed, and a sense of insecurity. Having ADD tends to amplify emotions, including those related to rejection.

3. Autism:
   

   Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication problems, abnormal social skills, and learning and behavioral issues. People with ASD often have trouble understanding social cues and difficulty recognizing and expressing emotions. 

Combined with heightened sensory reactions, this adds up to extreme hypersensitivity to criticism. Emerging research suggests that people with autism may experience greater rejection-induced social pain, which can then lead to psychological distress.

Other research has found that people who are highly sensitive to rejection are at increased risk of depression, borderline personality disorder, and body dysmorphic disorder.

REJECTION SENSITIVE DYSPHORIA IN THE BRAIN

According to brain-imaging research in Social Neuroscience, people with higher levels of rejection sensitivity experience activation in specific regions of the brain when looking at faces displaying disapproval.

At Amen Clinics, which has built the world’s largest database of functional brain scans related to behavior, people who are hypersensitive to rejection tend to have overactivity in certain regions of the brain. Single photon emission computed tomography (SPECT) scans performed at Amen Clinics show that these areas include:

• Basal ganglia (the brain’s anxiety center)
• Anterior cingulate gyrus (the brain’s gear shifter)

Too much activity in the basal ganglia is associated with heightened anxiety. When there is hyperactivity in the ACG, it is linked to getting stuck on negative thoughts and worries, like “I’m going to say the wrong thing, and everybody will laugh at me.”

DO YOU HAVE REJECTION SENSITIVE DYSPHORIA?

How can you tell if you have RSD? Only a professional who performs a comprehensive examination including functional brain imaging and lab tests to help identify possible root causes for your symptoms can give an accurate diagnosis.

However, if you recognize yourself in the following traits, it’s worth investigating RSD further with an integrative neuropsychiatrist.

• Overwhelming emotional reactions to any form of rejection
• Extremely sensitive to the mere possibility of rejection, fear of failure
• Perfectionism, or setting higher standards for yourself than for others
• Quickly feeling intense shame and guilt when your actions don’t live up to your expectations
• Lashing out with anger or rage in response to criticism, judgment, or exclusion
• Social withdrawal as a way to avoid rejection
• Approval-seeking behavior
• Low self-esteem, or needing validation from others
• Overreact or misinterpret facial expressions

5 HELPFUL TIPS IF YOU’RE HYPERSENSITIVE TO REJECTION

If you’re struggling with rejection sensitivity, here are 5 strategies that can help.

1. Don’t believe every stupid thought you have.

   If you get stuck on thoughts—such as, “I messed up and gave the wrong statistic during my work presentation, now everybody thinks I’m stupid”–you can stop the loop by challenging your thoughts.

Learn to kill the ANTs (automatic negative thoughts) that make you feel rejected. Ask yourself if your thoughts are really true and talk back to them. This is especially true if you have suicidal thoughts. Many people have thoughts of taking their own life, but they don’t act on them.

One study found that over half of all college students had suicidal thoughts during their lifetime. Suicide is a permanent solution to a temporary feeling. And if you hurt yourself, you’re teaching your kids that this is how grown-ups solve problems.

2. Learn the 18-40-60 rule.

   If you’re overly sensitive, remember this. When you’re 18, you think everybody is judging you, and you care deeply about what they think of you. When you reach 40, you no longer care what anybody thinks about you. Once you hit 60, you realize nobody has been thinking about you at all because most people only think about themselves.
   
   

3. Accept that teenage children will reject you.

   You may feel hurt when your teen pushes you away, but this is a normal part of life. During adolescence, teens have the psychological tasks of creating their own identity separate from their parents and developing independence. Accepting this fact of life can help you cope with the rejection.
   
   

4. Stay connected.

   Isolation and loneliness are not good for people with RSD. Rather than retreating from people, find ways to stay connected.
   
   

5. Take care of your brain.

   Fueling your brain with healthy foods, healthy behaviors, and healthy thinking patterns can help you handle criticism in a healthier way.