A Psychiatrist Explains How You Can Tell if Your Anxiety Is 'Treatment Resistant'
In a new video on her YouTube channel, psychiatrist and mental health educator Dr. Tracey Marks breaks down the different methods that are used to treat anxiety, and how to determine whether a treatment is working, or if the condition is "treatment resistant."
She starts off by explaining that the term treatment resistant is used in the psychiatric community to refer to conditions such as depression and schizophrenia which have not responded adequately to two different types of medication. In the case of anxiety, a patient's illness is considered treatment resistant if it has failed two rounds of medication and a course of cognitive behavioral therapy (CBT).
While it is more common for a patient to be prescribed meds such as Prozac or Lexapro by a primary care doctor as a time and cost-saving measure, Marks states that CBT is actually the most effective form of treatment for anxiety in the majority of instances.
"CBT approaches your anxiety from three angles," she says. "One is your physical response to anxiety, like chest tightness or nausea. You learn exercises to reduce those symptoms such as deep breathing from your diaphragm or progressive muscle relaxation. A second component is correcting faulty thinking that keeps your anxiety going, like de-catastrophizing your expectations or challenging inaccurate assumptions. Then a third component is changing the things that you do to cope with anxiety, like avoiding things... Exposure therapy teaches you how to allow yourself to face the feared object or situation and manage your anxious feelings."
Marks adds that the efficacy of CBT relies on both the skill of the therapist, and the ability of the patient to put into practice the tools they have learned. "If you don't do well with therapy, it's more like you have a pseudo-resistance, because other factors kept you from benefiting," she says. "It's not that you're such a difficult case that you can't be helped."
When it comes to medication, Marks explains that it's important to keep track of "target symptoms" in order to gage whether the course of treatment is working–and that if it's not, it is worth trying increasing your dosage (within safe, advised levels). However, she also notes that what can sometimes happen is a treatment plan will fail because people have to stop taking their medication due to side effects.
"If you've taken six different medications that all caused problems for you that made you stop them, you're not treatment resistant," she says. "We call this medication intolerance, when you can't reap the benefits of a medication because the side effects get in the way."
A best-case scenario, Marks says, is to use medication to bring down the severity of your symptoms so that they become less of a disruption to your daily life, and to then use CBT techniques to manage the remaining symptoms.
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