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Re: TX Resistance Mind or Body Or Both?

Posted by SLS on November 10, 2011, at 8:02:48

In reply to TX Resistance Mind or Body Or Both?, posted by Phillipa on November 9, 2011, at 20:47:50

> Seems treatment resistance could be related to a patients reluctance to get better. Treat Psychology Issues That Underlie the Medication not working. Is secondary gain involved? Phillipa
>
>
> http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1946385?pageNumber=1


I am sure that some people do have counterproductive psychodynamic relationships with their drug therapies. The questions are, though, how many treatment resistant people fall into this category and how are they identified. Just because a theory makes sense, this does not ensure its validity. The next steps for these doctors would be to produce statistics of associations, establish cause and effect, and suggest psychobiological mechanisms. I would be scared to death if this psychodynamic model for treatment resistance became the prevailing explanation such that treatment decisions would be based upon it.

When I was being treated by the research team at Columbia-Presbyterian in 1983, they concluded that my treatment resistance was possibly due to psychological factors. They required me to go for psychotherapy for six months before continuing to treat me biologically. I told them that I would go to any psychologist they chose for an evaluation, but I would not commit to psychotherapy without first demonstrating a need for it through the establishment of a relevant diagnosis. Afterall, I had already underwent several years of failed psychotherapy using different therapists.

The article cites "nocebo" as an example of treatment resistance. However, it explains that this applies to side-effects and makes no attempt to relate this to a lack of treatment response. Obviously, if a patient is not adherent to treatment due to nocebo expectations, this will affect treatment outcome. Is this what is meant by "treatment-resistance"? This certainly qualifies as being resistant to treatment. However, I don't believe that all cases of treatment-resistance are the products of resistance-to-treatment.

How many people posting on Psycho-Babble are reluctant to get better, despite searching unceasingly for treatments that will end their suffering? I don't know about everyone else, but I welcome the time I spend in remission of depression.


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw

 

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