Ideally, entering therapy or mental health treatment would always mean finding what works for you right away and moving forward. Many people do have this experience, but it’s not the outcome for everyone.
For many adults, mental health conditions and their symptoms can persist for years, even after accessing treatment. This can create new fears around whether or not anything will ever work, causing a sense of hopelessness and dread. Understanding what to do when treatment fails is the first step toward finding new approaches that could make a difference.
This article will cover:
Not improving during or after mental health treatment doesn’t mean you’re beyond help, or that you haven’t tried hard enough.
Persistent mental illness in adults is a clinical reality and not a personal failure. For example, depression and anxiety that are considered to be treatment-resistant, which is a way of saying they have not responded to initial attempts, are well-recognized throughout the field.
Somewhere between 30 and 67% of people with major depressive disorder don’t achieve full remission of their symptoms after one course of treatment, with a meaningful portion not responding to several more attempts.[1]
The term treatment-resistant is used in clinical-based literature to describe a specific pattern: a person who has tried two or more courses of medication without experiencing noticeable improvement. While the term technically refers to medication, clinicians also apply the same concept to participation in therapy.
Many people who might think they’ve exhausted their options haven’t had access to the full range of treatments available or completed enough treatment yet.
A few months of therapy or antidepressant medication, many of which take six weeks or more to build up to therapeutic levels, may not be enough to qualify for treatment resistance in the clinical sense.
The reasons that some mental health symptoms do not seem to respond initially are varied and complex.
Resistant psychiatric conditions in adults often involve a combination of:
Any situation in which symptoms aren’t improving can be painful and isolating. But it’s important to remember that the path forward usually involves taking a fresh look at what’s already been tried, and which additional options are still available to you.
This reassessment process is often the first step to getting effective help for chronic mental health symptoms.
The path through mental health treatment may seem straightforward: attend therapy, add medication if needed, and adjust as you go. This standard, outpatient-based care works for many people, but this is not always the case. There are a few reasons why standard treatment approaches may not work as effectively for you.
Conditions like depression and anxiety aren’t uniform and contain enormous variations. Two people who meet the same criteria for major depression could have totally different:[2]
Anxiety not improving with treatment often follows along similar lines. Standard, first-line medications target the serotonin and norepinephrine systems, which aren’t always involved equally in everyone’s presentation of anxiety.[3]
Approaches like cognitive behavioral therapy (CBT), one of the most well-researched modalities, have proven helpful for a wide array of conditions. But research also supports that CBT is not guaranteed to be effective.[4]
A condition like depression can impair your focus, motivation, concentration, and capacity for self-reflection, all of which are required for CBT-based work.[4]
No single treatment approach is effective for every individual. That’s why options after “failed” therapy exist, as people are far more diverse in their needs and experiences than any single treatment could accommodate.
Unresolved trauma can be both a cause of mental health conditions and a complicating factor. Conditions such as post-traumatic stress disorder (PTSD) require personalized, comprehensive care.
Someone being treated for depression who is also carrying unresolved trauma might improve a bit, but still have complex needs underlying their mood symptoms, which cause ongoing mental health challenges.[5]
Mental health treatment models haven’t always accounted for how much stress, instability, or isolation can work against recovery. A harmful relationship, unsafe housing, or financial strain can undermine otherwise effective treatments.
Managing persistent anxiety and depression is also a structural challenge. Treatment doesn’t always account for what’s happening outside of the therapy room, but quality providers can help you or your loved one take a fresh approach.
AMFM is here to help you or your loved one take the next steps towards an improved mental well-being.
For those who haven’t found relief from first-line treatments, alternative treatments for mental health in adults have expanded substantially in the past few decades.
A useful starting point is to consider what’s already been tried. A psychiatrist specializing in treatment-resistant conditions can help you to find potential gaps, such as a class of medications that hasn’t been tried or a new diagnosis that should be explored.
When long-term depression is not getting better despite multiple attempts, this kind of comprehensive review becomes essential.
Treatment-resistant anxiety solutions and depression approaches can respond well to medication combinations or augmentation strategies, such as adding a second medication to an existing one. Lithium augmentation, low-dose atypical antipsychotics, and thyroid testing all have evidence for those who haven’t responded to SSRIs and SNRIs alone.[6][7]
Different levels of care also exist to help you explore new approaches with more structure and support. Stepping up the frequency and intensity of your treatment sometimes helps to get things moving when nothing else has. Options include:
There have been several new innovations in recent years for severe depression. These advanced depression therapies represent significant options for those who haven’t responded to standard approaches.
Transcranial magnetic stimulation, or TMS, utilizes targeted magnetic pulses to stimulate areas of the brain associated with depression. It’s non-invasive and doesn’t require any anesthesia, with around 50 to 60% of people who haven’t responded to medication showing at least partial improvement.[8]
Ketamine and esketamine have emerged as promising new treatments. Esketamine (a nasal spray sold under the brand name Spravato) is FDA-approved for treatment-resistant depression, acting on glutamate pathways and potentially producing rapid effects.[9]
Electroconvulsive therapy (ECT) sometimes suffers from an outdated reputation and representation in past media, but it’s still practiced today. It can be one of the most effective interventions for treatment-resistant depression, with response rates that often exceed other options.[10]
Modern ECT is administered under general anesthesia, and the field has refined techniques to minimize cognitive side effects.
Planning for long-term mental health care needs to adapt to new circumstances and be able to change as things evolve. A treatment plan that accounts for this tends to have several considerations:[11]
Sometimes, outpatient treatment isn’t enough. Recognizing this should always be a clinical decision made in collaboration with your providers. An increased level of care may be necessary when:
AMFM (A Mission For Michael) Mental Health Treatment builds our treatment programs around the mental health needs of adults with chronic depression, treatment-resistant anxiety, trauma, and other complex psychiatric conditions.
We draw on a range of evidence-based and specialized treatment modalities to build effective, long-term mental health care plans. Each of our facility locations is designed to provide a safe and supportive environment.
AMFM Mental Health Treatment accepts insurance and is in-network with most major providers. If you’d like to check your insurance coverage for mental health care, simply complete our confidential online verification form.
If you’ve spent years trying to get better without results, our admissions team can help you figure out the best step to take. Call us today at 866-478-4383 and find out more about the treatment and support options available to you.
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It isn’t always clear, so it’s definitely worth talking about with a professional. Clinically, non-responder depression is usually defined as an inadequate response to two or more adequate medication trials. That means taking the right dose for the prescribed amount of time.
Many adults who feel they’ve exhausted options haven’t had access to everything available. Working with a clinician or team like AMFM Mental Health Treatment can provide new insights and a plan for what comes next.
It can, and the reverse is true as well. Medication and psychotherapy work in different ways, and they’re ideally used together. Not responding to one category of treatment doesn’t predict your response to another.
It’s both common and understandable. Years of treatment efforts without relief would make anyone feel frustrated and worried, but chronic mental health symptoms that haven’t responded to treatment can respond to new approaches and different levels of care.
Remember that the length of someone’s experiences doesn’t determine the outcome. Contact AMFM today to find out how we can help you figure things out.
At AMFM, we strive to provide the most up-to-date and accurate medical information based on current best practices, evolving information, and our team’s approach to care. Our aim is that our readers can make informed decisions about their healthcare.
Our reviewers are credentialed medical providers specializing and practicing behavioral healthcare. We follow strict guidelines when fact-checking information and only use credible sources when citing statistics and medical information. Look for the medically reviewed badge on our articles for the most up-to-date and accurate information.
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