Why is my psychiatric treatment not working?
The path to mental well-being can be complex and multifaceted.
Achieving an accurate and comprehensive diagnosis is the first step towards personalized and effective treatment: there are no one-size-fits-all solutions when it comes to psychiatric care.
"Why aren't my psychiatric treatments working?"
Seeking answers
When faced with psychiatric treatments that seem ineffective, it's essential to first understand that the path to mental health can be complex and multifaceted.
Various factors can lead to the ineffectiveness of Pharmacological or Stimulation Therapies:
Inaccurate or incomplete diagnosis: In a significant percentage of cases, the received diagnosis may be imprecise or partial, significantly complicating the treatment process.
Lack of treatment personalization: Even with an accurate diagnosis, therapy may not work if it is not personalized taking into account the patient's specific metabolism or stimulation needs.
Treatment resistance: In some cases, the body develops resistance to therapies if they are not administered adequately.
In cases of disorders for which guidelines do not yet exist, it may be necessary to consider using "Off-Label" Cures, i.e., therapies that go beyond the official guidelines and based on the knowledge of the most cutting-edge scientific research data.
Precision Diagnosis ― The foundation of effective treatment
A Precision Diagnosis is characterized by a high level of accuracy and comprehensiveness. It serves as the first step toward personalized and effective care. In the mental health field, universal solutions simply do not exist: there are no medications or treatments that suit everyone. Therefore, gaining a clear and comprehensive understanding of an individual's health status is crucial to comprehend each patient's specific needs.
Unfortunately, a significant percentage of individuals seeking help receive inaccurate, partial, or completely wrong diagnoses, creating an unstable foundation for effective treatment.
Effective treatment absolutely must be individualized based on a person's specific need. Thus, diagnosis is just the starting point of the journey and may evolve or become more specific over time. This is because symptoms do not constitute the diagnosis itself but serve as clues that guide the therapeutic path. Therefore, an accurate diagnosis cannot be missed at all; only with this it becomes possible to plan person-centered care.
Treatment Personalization ― The key to successful care
Once an accurate diagnosis is obtained, the next step is establishing the treatment, which must be tailored to each individual's specific needs because clinical diagnosis does not determine the cure, but only provide a direction.
Unfortunately, many psychiatric therapies are still established following standardized protocols based on diagnostic labels. However, modern psychiatric research is gradually shifting its focus from studying traditionally diagnosed disorders to understanding the specific circuits and mechanisms underlying individual maladaptive behaviors (Cuthbert & Insel, 2013; Insel et al., 2010). This shift is due to the fact that the same symptom reported by different patients can represent the expression of different mechanisms.
It's crucial to understand that any form of psychiatric treatment ― whether it's pharmacological or stimulation-based ― may lead to limited results if executed in a standard manner, following a rigid protocol without considering the patient's uniqueness. This point is clearly demonstrated by the renowned STAR*D study (Sequenced Treatment Alternatives to Relieve Depression) on Depression, which unequivocally demonstrated that if therapy is carried out according to a standard algorithm, only 36 percent of patients with depression respond adequately to treatment with Selective Serotonin Reuptake Inhibitors (SSRIs), which are typically used in the treatment of Major Depressive Disorder and Anxiety Disorders.
Hence, the pivotal element for achieving significant positive outcomes lies in customizing therapies. Each person is unique and reacts differently to any type of medication or therapy. Therefore, effective therapy must take into account the specific needs of the patient.
Cutting-edge therapies based on neuroscience
Transcranial Magnetic Stimulation (TMS)
The different types of Transcranial Magnetic Stimulation (TMS) represent non-invasive and non-pharmacological therapies that use magnetic field to stimulate or inhibit specific brain areas, proving to be highly effective for the treatment of many disorders, including Resistant Depression and Obsessive-Compulsive Disorder (OCD).
Photo-Bio-Modulation (PBM)
The latest technology for treating the Central Nervous System and particularly suitable for children, which uses increased cerebral blood flow to stimulate brain metabolism and promote neuroplasticity processes.
The latest technology for treating the Central Nervous System and particularly suitable for children, which uses increased cerebral blood flow to stimulate brain metabolism and promote neuroplasticity processes.
Pharmacotherapy
It is not medications (or machines) that cure. Along with the right choice of medications, it is crucial to individualise the treatment through the choice of a minimum therapeutic dose defined specifically for each person. Learn more about the pharmacological therapies offered by the Istituto di Neuroscienze.
Ketamine Clinic
Due to their high efficacy toward the management of Treatment-Resistant Depression, Ketamine and Esketamine are considered a lifesaver for people suffering from this condition. These are drugs that can achieve with great speed a significant reduction in symptoms of depression and suicidal ideation.
Diet and Nutrition
In recent years, the in-depth study of the gut microbiota has revealed its involvement in the translation of what we eat into the messenger-molecules for our brains, highlighting the strong correlation between diet and our state of well-being.
Find out what the Istituto di Neuroscienze can offer.
Phytotherapy
Dr. Stefano Pallanti is a founding member of the italian Academy of Natural Therapy in Psychiatry and Neurology and promotes in an innovative way the use of natural remedies in psychiatry to offer alternative ― but scientifically proven ― treatments for the management of Depression, Insomnia and Anxiety.
Planning long-term care
The need to monitor and adjust treatment over time even if symptoms decrease
It is important to emphasize that the mere reduction or disappearance of symptoms does not necessarily mean that the disease has disappeared! In fact, even after initial improvement, the brain mechanisms underlying the disorder may persist.
For this reason, it's essential to adapt the treatment every two months, planning regular check-ups and therapy recall sessions to prevent relapses. Prematurely discontinuing treatments or their prolonged use without continuous monitoring and adjustment can significantly increase the risk of symptom relapse, which often presents in different forms than the initial symptoms. In such cases, regaining a state of well-being can be more complex and take longer.
Therefore, to avoid the possibility of relapse, it is crucial to schedule regular follow-up visits and treatment recall sessions.
