Treatment resistance in mental health means patients have tried conventional treatments (at least two) and have not seen improvements. Any mental health disorder can be treatment-resistant, but currently, a majority of research is focused on treatment-resistant depression (TRD).
Patients with TRD have only a 20% chance of achieving remission and suffer from higher rates of hospitalization, self-harm, and suicide attempts, highlighting the need for innovative therapeutic approaches[1].
Read on to learn more about the severity of TR mental health disorders and breakthrough treatments.
What Does It Mean to Be Treatment Resistant?
Treatment resistance means that conventional treatments such as medication or therapies such as Cognitive Behavioral Therapy (CBT) have failed, leaving patients and their clinicians searching for more effective approaches. Patients labeled with “treatment-resistant depression” or other mental health challenges often experience frustration after having tried multiple treatment modalities [1].
The societal costs of treatment-resistant depression and other mental health disorders are estimated to range between $29 and $49 billion annually due to expenses such as hospital stays, emergency room visits, missing work, and disability claims [2].
Addressing treatment-resistant mental health disorders such as depression requires integrated approaches, including targeted biological interventions, behavioral therapy, psychosocial and emotional support.
What Causes Treatment Resistance?
Treatment resistance can come from a variety of factors, including [1] [3]:
- Medication regimens that aren’t adequate, such as only taking one antidepressant, being on the wrong kind of medication, or the wrong dose.
- Misdiagnosis or unawareness of co-occurring conditions. Several mental health disorders share similar symptoms, which can lead to an incorrect or incomplete diagnosis.
- Incomplete therapy, such as a lack of regular follow-up, or short-term sessions without integrated care.
- Lack of attention in treatment to underlying psychosocial factors such as trauma, economic burdens, systemic racism, and historical or community trauma.
How Are Treatment Resistant Mental Health Conditions Diagnosed?
There is no specific diagnosis in the DSM-5 for treatment-resistant mental health disorders. Rather, treatment resistance is based on how an individual responds to treatment for an already existing disorder.
For treatment-resistant depression, the typical criteria include [1]:
- A diagnosis of a depressive disorder, such as Major Depressive Disorder (MDD).
- Failure to respond to at least two different antidepressant treatments from different pharmacologic classes given at adequate doses and for proper duration (usually 6 to 8 weeks).
Which Disorders Are Treatment-Resistant?
Any mental health disorder can be treatment-resistant; however, depression and mood disorders, eating disorders, and personality disorders have some of the highest levels of treatment-resistant cases.
Mood Disorders: According to the World Psychiatric Association, 12% to 20% of individuals with depression develop treatment-resistant symptoms [1].
Eating Disorders: Approximately 10% of patients in specialized inpatient programs for eating disorders are treatment resistant, and other research shows between 20% and 30% of individuals with anorexia nervosa develop chronic EDs that are difficult to treat due to deep-rooted cognitive distortions and the complex interplay of psychological, social, and biological factors [4].
Personality Disorders: Those with Borderline Personality Disorder (BPD) and other personality disorders often engage in long-term, destructive patterns that create barriers to treatment, making it harder to engage in traditional therapies without specialized intervention.
Evidence-Based Interventions for Treatment-Resistant
Treatment-resistant conditions often require a multidimensional approach to care, combining medication, therapy, social support, and specialized interventions. In the case of treatment-resistant depression, adding medications like atypical antipsychotics, lithium, or thyroid hormones has been found to improve treatment outcomes of typical antidepressants [5].
Ketamine Therapy and Transcranial Magnetic Stimulation (TMS) are two breakthrough treatments showing promising results for resistant mental health conditions such as treatment-resistant depression (TRD), bipolar disorder, and obsessive-compulsive disorder (OCD).
Other emerging therapies for treatment-resistant depression and mental health problems include deep brain stimulation (DBS) and psychedelic therapies (e.g., psilocybin) [5].
Ketamine Therapy and Transcranial Magnetic Stimulation (TMS)
Ketamine Assisted Therapy (KAT) uses a low dose of the dissociative ketamine to induce a trance-like state that makes it easier to process deep distress, emotional turmoil, and trauma. According to a report in Current Neuropharmacology, around 50% to 70% of patients with TRD are responsive to ketamine treatment and show relief of symptoms [6].
TMS (Transcranial Magnetic Stimulation) is a non-invasive treatment that uses magnetic pulses to target specific brain regions involved in emotional regulation, impulse control, and mood. It was FDA-approved for Major Depressive Disorder (MDD) in 2008 and has also been reported by patients to improve symptoms of treatment-resistant OCD and anxiety.
Breakthrough Ketamine and TMS Therapy for Depression at Maple Mountain
If you’ve already tried conventional methods of mental health treatment with no relief, ketamine or TMS may be a good option for you. At Maple Mountain Mental Health and Wellness, we offer both of these growing, innovative approaches to target treatment-resistant depression.
Through a holistic, blended approach, we address each aspect of your health and recovery needs to support long-term healing. Contact our admissions team to learn if you are a candidate for TMS or ketamine assisted therapy today.
Sources
[1] Maj, M. et al. (2023). Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World psychiatry : official journal of the World Psychiatric Association (WPA), 22(3), 394–412.
[2] Mrazek, D. et al.2014. A Review of the Clinical, Economic, and Societal Burden of Treatment-Resistant Depression: 1996–2013. Journal of Psychiatry Services.
[3] Pillinger, T. et al. (2022). Treatment resistance in psychiatry: state of the art and new directions. Molecular psychiatry, 27(1), 58–72.
[4] Woodside, B. et al. (2021). Characterizing Treatment-Resistant Anorexia Nervosa. Frontiers in psychiatry, 11, 542206.
[5] Proietti, L. et al. (2015). Pharmacologic approaches to treatment resistant depression: Evidences and personal experience. World journal of psychiatry, 5(3), 330–341.
[6] Amore, M. et al. (2014). The role of ketamine in treatment-resistant depression: a systematic review. Current neuropharmacology, 12(5), 444–461.