How To Tell If Your Anxiety Is Treatment Resistant

In this video, we're going to talk about what it means when you have treatment resistant anxiety. I’m also going to define four terms for you, treatment resistance, treatment refractory, medication intolerance, target symptoms. I also explain how to tell if your treatment is working.

References
Ansara E. D. (2020). Management of treatment-resistant generalized anxiety disorder. The mental health clinician, 10(6), 326–334.

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers in psychiatry, 11, 595584.

Roy-Byrne P. (2015). Treatment-refractory anxiety; definition, risk factors, and treatment challenges. Dialogues in clinical neuroscience, 17(2), 191–206.

WANT TO START IN THERAPY? Here’s a convenient and affordable option with my sponsor BetterHelp

For a monthly fee, you get a REAL licensed therapist with whom you can meet weekly by phone, video or chat. You can also send daily messages.

Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.

[pjsmith]

When I was suffering from depression at 15, nobody even discussed it. A taboo subject in every way. I just lived with it.
Then at 20, severe and constant anxiety began. Still no adequate treatment, except for an MAO inhibitor, Nardil, for Post Partum Psychosis at 28 and Anafranil - a tricyclic - for Post Partum Depression at 30.
At 39, I went to a therapist for a year. Cost a fortune and was a waste of time and I came out worse.
Then my GP sent me to a psychiatrist. He put me on an SSRI and Clonazepam at 40 years old.
It was such a shock - I thought “ Is this what normal people feel like? “
Changed my life completely. There are no words!!
Slow thinking - not in my case. Took two courses, one in my forties and got top mark, one at 50 - top marks.
I became a swimming teacher at age 48 and got my Lifeguard award at 49.
I could downhill ski, fly, swim in water over my head ( obviously ) eat in public, play piano in public ( lost a career there after 14 years of studying ) - I can’t name all the things that just disappeared almost instantly.
Depression was a bit trickier. Had to change meds about 5 times and am on 2 different ones now.
I did find out later in my life that I was sexually abused by a Doctor. Took years to recover any memories after my sister ( who was abused by the same Doctor - she remembered and told our Mom ) told me I went to see him before her. At first, I didn’t believe her because I had absolutely no memory of such a thing. But slowly, I started to remember over a 20 year period.
I am now 68 and am so grateful for being given a life. Even though it started at 40!!

[lofiiowa]

My doctor didn’t tell me that it was strange to be resistant to 4+ different medications, and he had me maxed out on those medications and my therapist wasn’t trained in CBT. I don’t even know how little I know about my own condition but I know I can’t afford to go through it again. Thank you for giving me hope that there’s real mental health professionals who can actually help, and also an education on understanding what I’m feeling. Unparalleled in my experience

[tayzonday]

I’m autistic — so a lot of peer-reviewed human subject studies have an implicit asterisk where I’m an exception.

[fussyfissy]

I had crippling anxiety as a teen. I suffered from racing intrusive thoughts and a visceral tightness that would sometimes be so overwhelming I thought I was having a heart attack or dying. I looked around at my peers in situations that caused my anxiety. They were all seemingly unaffected. I tried hard to mask and match others. I would tell myself, "Everyone goes through this and look at them! They are all doing well and getting through the day. If they can do it, you should be able to as well."

Slowly I forced myself into painful situations that I know now do not have to be painful. I worked retail and service industry jobs. I forced myself to demand others attention by greeting customers and patrons. Through the pain in my chest and the tears to decompress after tough exchanges, I began to grow and de-sensitize myself. The pain, discomfort, and intrusive thoughts were all still there. However, it had become much easier to overcome them to do what I needed. Until one day, a customer upset at other coworkers was passed off to me. I did the best I could for the man, but in his frustration, he lashed out verbally and shoved the very large, very heavy merchandise item I had retrieved for him back at me. I broke down and went to lunch to cool off. After my meal break, I approached my first customer since the incident. The pain in my chest was overwhelming. My mind began to over analyze the man's expression. Intrusive thoughts about the man judging me, wondering what's wrong with me, and looking down at my social incapableness began to flood my mind. I was a kid again - back at the beginning. Any progress I had made was gone. I stumbled over my words through the pain. In this moment, I knew I had to quit this job. I wish I had known that I also need to speak to a therapist and/or seek treatment for anxiety. It would take hitting rock bottom in my 30s to figure out.

I am on medication now and I am still me. I just don't feel like I am dying all the time. The medicine doesn't stop the thoughts but they no longer consume my life. Please reach out to your doctor or someone you can trust if your experiences are similar.

[amybarathStorminStormy]

Hi Dr Tracy love your videos. When I retired from a very dangerous job where I consistently saw a lot of horrible things combined with sleep deprivation let's just say I was an emotional and physical mess. I stopped taking medication and left the psychiatrist I was supposed to be working with. I got a puppy. And my whole world changed for the better without meds. I know it's not a standard mode of treatment, but it worked.

[DonnaSnyder]

I wish you could train all the psychiatrists and psychoanalysts in the world. This presentation is so fair and straightforward. I've heard so many mental health professionals blame the person they are "treating" for not wanting to take medicine with harmful side effects. Actually this is true for other doctors, too, for example those with clients suffering chronic respiratory trouble.

Thank you.

[NeverStopLearningThings]

Dr. Marks...you'll have to switch those video thumbnails around at the end of the video (at about 8:48)...you're pointing at the opposite ones. :-) Other than that...I've done a TON of research on anxiety lately and you sound like a mental health ninja! :-) Fantastic info. Thanks so much! It's so wonderful to hear professionals talk about CBT. The older doctors seem to still be stuck on medication and almost downplaying therapy or referring to it as a secondary solution. I HATE that! The info you share in this video alone was enough to get me to subscribe and start looking at your other videos. Thanks again for sharing your obvious depth and professional experience in this subject.

[philipp]

A few weeks ago I experienced a moment of moderate happiness and motivation. I think it lasted maybe 20-30 seconds. Glorious times.

[shaunakay]

You are so smart and so relatable. You make people feel comfortable. I somehow feel heard, and I’ve not spoken a word. So grateful for all you do. 💜

[kenbach]

I been in the mental health system for a long time, , and I've learned so much from your videos. Thank you.

[mobrownful]

As a new psychiatric nurse practitioner, I really really really do appreciate these videos.

[herculesrockefeller]

Decades ago, one of my heroes, Dr. Karen Horney said "The patient wants things to be different, but doesn't want to change."
This was the first reference to treatment resistence that I ever found, and it shocked me that I would actually resist feeling better.
Dr. David Burns has recently addressed this in his latest book, "Feeling Great", and points out some of the reasons resistence might actually be a positive thing to the patient.
As far as CBT, I have sought therapists who actually USE CBT techniques, but most just have a vague familiarity with them, or just pay lip service to them. When you get in therapy with them, you find they know little, if any, about CBT.
I am convinced that CBT works, but would like to find a therapist that USES it, and makes me do homework, etc. to get better.
Thank you, Dr. Marks, for yet another helpful video. I wish you wre my therapist!

[auradjmixes]

The way you put complex theories across is amazing

[lameduck]

CBT is indeed effective therapy. But as someone diagnosed with schizotypal disorder, the paranoia often sets in and I end up cancelling my therapy because I feel the therapist is digging through my brain and emotions in ways that cross my boundaries. I've tried a bunch of SSRI's, anti-psychotics, benzodiazepines and even got a beta-blocker prescribed because my anxiety would usually start with a physiological reaction, like increased heart rate beats, sweating, shaking etc. I don't think I'm inherently resistant to treatment but I do believe that my mind and condition plays a big role in how willing I am to receive treatment and believe in it.

[marissab]

Thank you so much - as a lifelong anxiety sufferer, it’s difficult to truly understand how to measure the effectiveness of my medication… the examples you provided are super helpful 🙂

[NeverStopLearningThings]

Thanks again Dr. Marks! Gotta give a sistah her flowers on this one! LOVE your content. First time listener.

[magafantastica]

Dr Marks, should I ever run into you anywhere in the world, I would hug you tightly and thank you for all that you do to help us educate ourselves on mental health. Thank you so much.

[eman-nfkl]

Your videos are very informative. You have a way to break down the medical jargon so it's easy to understand for us laymen. I told my shrink and my therapist about your YouTube channel and they agreed that it's good stuff.

[misseselise]

this video was incredibly helpful with how to explain my symptoms to my doctor in a way where she’ll be able to better understand me.

[cad]

Thank you for your well rounded perspectives. Thanks for addressing medication resistance. Therapies such as CBT and positive lifestyle habits make all the difference. I would love to see therapies offered as often as meds for real whole body healing. Have a blessed and empowered day❤️🙏✨