Typically, when teens experience a mental illness, there are clear forms of treatment that have shown to work in psychological study and research. However, there are some cases in which treatment doesn’t seem to be effective. Some teens with bipolar disorder or major depression do not respond to the typical treatment that works well for others. This is referred to as treatment resistance.
For instance, with teen depression, when medication is used to treat depression, there is a 50% reduction in symptoms within 8 to 12 weeks. Approximately 60% of teens show a significant clinical response by 12 weeks and remission by 24 weeks. However, 40% of teens who receive evidence-based treatment for their depression are considered to be treatment resistant.
Evidence based practices are those that are based on research studies that are quantitative in nature and have a narrow set of criteria, which lead to clear evidence of the effectiveness of the practice. The use of evidence-based practices was introduced in 1992 in the field of medicine and has spread to other disciplines including psychology.
For instance, with depression, treatment that is considered to be evidence based includes the use of medication and therapy. Specifically, medication such as selective serotonin re-uptake inhibitors, also known as SSRI’s increase the levels of serotonin, which can ease depressive symptoms and they have fewer and milder symptoms than other anti-depressants. In addition to medication is the use of psychotherapy, particularly Cognitive Behavioral Therapy (CBT), which identifies negative and distorted thinking patterns. Another evidenced based therapy for depression is Interpersonal Therapy (IPT). When used with medication, this therapy has shown a faster rate of response than medication used with CBT. Interpersonal Therapy is a form of therapy that invites teens to regain control of their mood and functioning by exploring in more detail the nature of his or her relationships. IPT is based upon the ideas that regardless of genetics, depression develops within the context of relationships.
There are also evidenced based treatment methods for bipolar disorder. For instance, effective forms of medication include Depakote, Lithium, and atypical antipsychotics for a manic episode, and for mixed episodes, atypical antipsychotics are also effective.
In general, teens who are actively experiencing symptoms and whose symptoms to not improve after two trial and error periods of medication are considered to be treatment resistant. Sadly, when a teen does not respond to these evidenced based treatments, depression and bipolar disorder can become chronic. As treatment continues to be ineffective, this can worsen symptoms and undermine any hope that a teen has. There are some factors that seem to consistently contribute to chronic depression and treatment resistance. They are:
- Severity of depression
- Co-occurring disorders, especially substance use
- Non-adherence to treatment
- Low blood concentration of the antidepressant
- History of abuse
- Parental depression
- Bullying at school
Yet, there is hope for teens who do not respond to treatment right away. It is known within the mental health field that teens with treatment resistant can eventually find remission from symptoms. Those who have not responded to traditional forms of treatment can use a different type of antidepressant (such as SSNRI, TCA’s or MAOI’s) and/or a different form of therapy.
Although it is easy to lose hope when prognosis for treatment does not look good, as caregivers, you should know that depression is treatable even when at first treatment appears to be ineffective.
Tracy, N. (2013). Some Ideas for Handling Treatment-Resistant Bipolar Disorder. Psych Central. Retrieved on August 6, 2014, from http://psychcentral.com/lib/some-ideas-for-handling-treatment-resistant-bipolar-disorder/00016779