I remember the first time I heard the time “treatment resistant.” It was from a friend as they shared with me their mental health story. As this conversation took place some years before my schooling or work in the mental health field, I wondered if this meant that my friend’s illness was untreatable. As a clinician today, I know that this is far from true in most cases.
The Truth About Treatment Resistance
When a person does not receive significant relief from the traditional interventions for mental health symptoms, their condition may be deemed treatment-resistant. Yet, this is a fair number of individuals receiving mental health care.
A systemic review found that, on average, 36 percent of people living with schizophrenia met the criteria for treatment resistance (Diniz and colleagues, 2023), meaning that they did not respond to the first two medications tried. Another study found that 30 percent of people living with major depressive disorder were treatment-resistant as they did not achieve recovery after two antidepressant trials (Zhdanava and colleagues, 2021).
It takes incredible strength to reach out for help. When someone does not feel that progress is being made, it can be discouraging. Those who try multiple treatments without benefit may worry that they can not be helped and can face frustration from those around them.
Treatment for Treatment-Resistant Conditions
Still, what is not mentioned, is that both depression and schizophrenia each have more than 50 potential treatment options available. These interventions can include medication, psychotherapy, transcranial magnetic stimulation, electroconvulsant therapy, and investigational treatments. A significant number of people do not feel better after their first few rounds of treatment can be discouraging, but this doesn’t mean that nothing will work.
One option for individuals living with treatment-resistant schizophrenia is an arguably underutilized medication called Clozapine. Clozapine can sometimes cause a rare, but serious side effect and, therefore, can not be prescribed as a first-line option for schizophrenia. Yet, it has a greater effect size than any other antipsychotic medication (Wagner and colleagues, 2021).
Transcranial magnetic stimulation (TMS) is utilized in treatment-resistant cases of depression. TMS involves using a coil to stimulate areas of the brain believed to be underactive in people living with depression. An analysis of studies that compared “true” TMS to “sham” controls found that a sizable number of people who received TMS reached remission of their depression, with five times more people receiving active TMS finding remission from depression than those receiving “sham” TMS (Gaynes and colleagues, 2014).
Recent data has found that TMS may also be effective in treating certain symptoms of schizophrenia, including voices (and negative symptoms (Lorentzen and colleagues, 2022). Adjunctive treatments involving changes to diet, such as focusing on metabolic health, have also garnered the spotlight in recent years as emerging interventions. Psychotherapy is also effective in treating many aspects of both depression and schizophrenia.
Lastly, new treatments are under investigation for a variety of mental health conditions.
Recovery
It is important to remember that mental health recovery is more than adherence to medical treatment. Engaging improved quality of life over eradicating symptoms is a nuanced approach to mental health. Peer support and the creation of adaptive strategies can give a person new means to re-engage in life goals, even if they are still experiencing mental health symptoms.
Closing
In summary, there is hope. If you are not feeling relief from your current mental health treatment, please discuss this with your providers and support network. There are a spectrum of treatment options available and while it can sometimes take time to identify which is right for you, recovery is possible.