Treatment-Resistant Conditions

How Common is Treatment Resistance?

Treatment resistance is seen in people with many mental health disorders, including:

• ADD/ADHD: Studies show that as many as 80% of adults with ADD/ADHD don’t stick with their treatment plan.
• Depression: A 2014 study found that after taking antidepressants, over 50% of depressed patients failed to experience full remission of their symptoms. And one-third still didn’t get the relief they sought after four courses of antidepressants.
• Anxiety: Research shows that only about 60% of people with anxiety see any significant relief of their symptoms with treatment.
• Bipolar disorder: Bipolar disorder treatment is still “plagued by inadequate response in acute mania or depressive episodes or in long-term preventive maintenance,” according to a review in Molecular Psychiatry. Experts in a 2015 article suggest that treatment resistance in bipolar disorder is indicated when two trials of medications have provided clinically unsatisfactory results.
• Addictions: Substance use disorders are notoriously difficult to treat effectively for the long-term and the relapse rate is estimated at 40-60%.
• Schizophrenia: Up to 30% of people diagnosed with schizophrenia don’t respond to treatment with two or more medications.

What Causes Treatment Resistance?

There are a number of reasons why people may not get well when treated for psychiatric symptoms. Some of the more common causes are outlined here:

• Misdiagnosis: Unfortunately, traditional psychiatry remains the only medical specialty that rarely looks at the organ it treats. In conventional psychiatry, diagnoses are typically made based on symptom clusters, but because so many of the symptoms overlap with multiple mental health conditions, misdiagnosis is common. Without an accurate diagnosis, treatment usually consists of throwing darts in the dark. Healthcare professionals are quick to prescribe medications that may work for some people but can make other people worse!
• Co-occurring conditions: Having multiple mental health conditions, such as anxiety and depression, or also suffering from substance abuse can make it difficult for traditional healthcare providers to make an accurate diagnosis.
• Ignoring subtypes: At Amen Clinics, our brain imaging work shows that mental health conditions aren’t single or simple disorders. Based on our brain imaging work, we have identified 7 types of anxiety and depression, 7 types of ADD/ADHD, and 6 types of brain patterns associated with addiction. Giving everybody with depression the same treatment will never work. Knowing your type is critical to getting the most effective treatment.
• Lack of compliance: Some patients have difficulty following a treatment plan, which prevents them from getting well. In some cases, this may be due to underlying brain issues that hamper their ability to plan and follow through. In other cases, it may be related to the stigma attached to taking psychiatric medication.
• Intolerance to medication: Side effects associated with prescription medication may be so bothersome to certain individuals that they stop taking them.
• Lack of social support: In order to get well, it’s important to have a solid support network. People who don’t have family or friends who are willing to help them in the healing process may have a more difficult time on the path to wellness.
• Underlying risk factors: Traditional mental healthcare professionals may also miss underlying biological issues that can mimic or contribute to psychiatric symptoms. We have identified 11 risk factors that can create symptoms of mental illness. We use the mnemonic BRIGHT MINDS to make it easy to remember these risk factors:

• • • B is for problems with Blood Flow
    • R is for Retirement/Aging
    • I is for Inflammation
    • G is for Genetics (family history)
    • H is for Head Trauma
    • M is for Mind-Storms
    • I is for Immunity/Infections
    • N is for Neurohormones
    • D is for Diabesity
    • S is for Sleep