Treatment Resistant Anxietyby Eileen Bailey Health Writer
If you are receiving treatment for an anxiety disorder and feel like you are spinning your wheels, that the anxiety is still there and you aren't getting any better, you are not alone. Around 40 percent of those treated for anxiety have what is called "treatment resistant" anxiety, which means the first-line treatments don't take away your symptoms.[Coplan and Reddy, 2006] Treatment resistant is often used to indicate that someone has tried two treatment methods, for 6 weeks each and is still symptomatic.
Anxiety disorders are the most common mental illness in the United States, according to the Anxiety and Depression Association of America, with more than 40 million adults having at least one anxiety disorder at some time in their life. For the majority of people, anxiety disorders are easily treatable. Lifestyle changes, medication (if needed) and cognitive behavioral therapy all contribute to managing anxiety and allowing those affected by it to live happy and fulfilling lives. But for those who find treatments don't work, there can be constant struggles, such as not being able to work, loss of self-esteem, loneliness and health problems.
While it isn't fully understood why some people with anxiety are resistant to treatment, some of the factors that can contribute are:
Wrong or incomplete diagnosis
Treatment plan is not comprehensive
Patient doesn't adhere to treatment plan
Dosage for medication is not adequate
Comorbid conditions (medical or psychiatric)
Continued severe stressors or unresolved childhood stressors
Steps You Can Take
Ask for a complete psychiatric evaluation. Because symptoms of mood disorders and other conditions, such as ADHD, can share symptoms with anxiety disorders, it can be difficult to diagnose. This is even more true if you have more than one diagnosis. For example, those with autism can show signs of obsessive compulsive disorder; those with depression or ADHD can have trouble focusing, as can those with anxiety. Requesting a complete psychiatric evaluation will help determine the correct diagnosis and help identify and comorbid conditions which might have gone unnoticed and untreated. Having an accurate diagnosis is essential to creating an effective treatment plan.
Anxiety disorders, and other mental illnesses, are often treated with a combination of medication, therapy (cognitive behavioral therapy) and lifestyle changes. All three are important components of treatment and your doctor should talk to you about all three. While medication is important and does help, it is not a cure for anxiety and it is important to learn coping strategies and ways to combat negative and unhelpful thoughts; CBT addresses these issues. In addition, daily exercise and other lifestyle changes, such as avoiding caffeine and alcohol, eating right and getting enough sleep, all help you better manage your anxiety. It is important to include these aspects in your treatment plan.
Follow your treatment plan. Part of managing your anxiety is following your treatment plan. That means making sure you attend therapy sessions, taking medication on a daily basis (if prescribed) and making the lifestyle changes you and your doctor discussed. There are many reasons someone might not follow the treatment plan, such as:
Side-effects of medication are intolerable
Can't afford medication or therapy
Inability to get to therapy sessions
Other medical conditions stop you from taking medication or getting to therapy
Not willing to make lifestyle changes
Not willing to take medication
You should work with your doctor in finding ways to overcome any obstacles to treatment. He (or she) might be able to provide you with resources to help you afford your medication or community resources that can provide transportation.
Keep communication open with your doctor. You might not feel your medication or CBT is working, however, unless you tell your doctor how you are feeling, he isn't going to know. kTry keeping a daily log of your anxiety symptoms and include what medication you took, what lifestyle changes you made and when you attended therapy. You and youer doctor should routinely review this information to determine if your treatment is working and whether something needs to change, such as adjusting your medication dosage.
Sometimes other medical conditions can interfere with treatment. These can be othe psychiatric problems, such as bipolar disorder, or physical conditions, such as a thyroid condition. If you are finding treatment for anxiety isn't working, besides a complete psychiatric evaluation, you might want to schedule a complete physical to check for underlying physical conditions that could be stopping you from improving.
Work at stress mangement or finding ways to lower daily stressors. If you are combatting stressors on a daily basis, such as high-levels of stress at work or living in a stressful family situation, talk to your therapist about stress-reducing strategies. It can be difficult to manage anxiety symptoms with a constant barrage of stressors that aggravate the anxiety disorder.
While treatment resistant anxiety can be difficult to deal with, there are ways you can be proactive and look for solutions. Work closely with your doctor and therapist to overcome the obstacles to your recovery.
"Therapeutic Strategies for the Patient with Treatment-Resistant Anxiety," 1993, May, J.D. Coplan, L. Tiffon, J.M. Gorman, Journal of Clinical Psychiatry
"Treatment-resistant Anxiety Disorders," 2006, July 18, A. Bystritsky, Molecular Psychiatry, doi: 10.1038/sj.mp.4001852
"Treatment-Resistant Anxiety Disorders: Neurotrophic Perspecties," 2006, Oct. 31, Jeremy D. Coplan, Dorothy P. Reddy, Psychiatric Times
"Treatment Resistant Generalized Anxiety Disorder, Different Views of Anxiety Disorders" 2011, Nesrin Dilbaz, Sercin Yalcin Cavus, Asli Enez Darcin, Intechopen.com