About 30% of people with schizophrenia continue to have psychotic symptoms even on medication. Treatment resistant is when you don’t have an adequate resolution of your symptoms after taking at least two antipsychotic medications that are not clozapine.
A 2019 study analyzed several research studies and found common factors that predicted that someone would like fall into the treatment resistant category. They are:
Early age of onset (most robust predictor)
Being born in the autumn or winter
Poor functioning before the diagnosis
Clozapine is the strongest medicine we have to treat schizophrenia. No other medicine has come close to the power it wields in knocking out symptoms. Why don’t we use it all the time? Because it has lots of side effect including the potential for massive weight gain. I talk about the negative effects of antipsychotic induced weight gain in this video on Metabolic syndrome. https://youtu.be/H__G0UxLCbQ
If you can’t tolerate clozapine or don’t want to deal with it, other treatments are electroconvulsive therapy, repetitive transcranial magnetic stimulation, called rTMS and deep brain stimulation. ECT has been around the longest and has the best track record of improving schizophrenia symptoms. rTMS is still new and experimental as is deep brain stimulation. Deep brain stimulation requires surgery and we need a lot of more information about its effectiveness before it becomes an accepted treatment recommendation.
Schizophrenia treatment requires medication to manage it. However supportive therapy is still very helpful. Online therapy is becoming the standard delivery method during the pandemic. IF YOU’RE LOOKING FOR A THERAPIST, BetterHelp offers affordable counseling from licensed therapists for $260/month which gets you once a week video or phone sessions and unlimited text/emails between sessions. Check them out at https://betterhelp.com/drmarks. This link gets you a 10% discount on your first month. I get a referral commission that goes toward supporting the costs of maintaining this channel with free mental health education for you.
Looking for a therapist?
Option 1 – Psychologytoday.com you can find a therapist or psychiatrist in your area
Option 2 – https://Betterhelp.com/drmarks
This is a virtual option with REAL therapists who do online therapy via messaging, phone and video. They also have webinars on various topics. The unlimited texting feature allows you to type out your concerns and get a well thought out response from the therapist. Some of them will help you set goals, give you worksheets, etc. If you use this link you will get a 10% discount on your first month. https://betterhelp.com/drmarks This is an option I’ve researched. I get a referral commission if you sign up.
Smart, S., Kępińska, A., Murray, R., & MacCabe, J. (2021). Predictors of treatment resistant schizophrenia: A systematic review of prospective observational studies. Psychological Medicine, 51(1), 44-53. doi:10.1017/S0033291719002083
Sinclair DJ, Zhao S, Qi F, Nyakyoma K, Kwong JS, Adams CE. Electroconvulsive therapy for treatment-resistant schizophrenia. Cochrane Database Syst Rev. 2019;3(3):CD011847. Published 2019 Mar 19. doi:10.1002/14651858.CD011847.pub2
Nucifora FC Jr, Woznica E, Lee BJ, Cascella N, Sawa A. Treatment resistant schizophrenia: Clinical, biological, and therapeutic perspectives. Neurobiol Dis. 2019;131:104257. doi:10.1016/j.nbd.2018.08.016
Want to know more about mental health and self-improvement? On this channel I discuss topics such as bipolar disorder, major depression, anxiety disorders, attention deficit disorder (ADHD), relationships and personal development/self-improvement. I upload weekly. If you don’t want to miss a video, click here to subscribe. https://goo.gl/DFfT33
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.