Approaching Treatment-Resistant Anxiety

Roughly one out of three people is at risk for anxiety disorder at some point in their life. Anxiety disorders are the most common psychiatric conditions in the United States and have the highest risk for suicide attempts. Yet, these disorders are often poorly understood, underdiagnosed, and inadequately treated.1

According to a review of treatment-resistant anxiety published in the journal Molecular Psychiatry, only about 60% of patients with anxiety respond to front-line treatments. Up to 30% of patients may be treatment resistant.1

“If providers had a better understanding of anxiety, and patients were better educated about anxiety, I think we could reduce treatment resistance to about 10%,” says Alexander Bystritsky, MD, PhD, director of the Anxiety Disorders Program at the Semel Institute for Neuroscience and Human Behavior in Los Angeles, California.2 Bystritsky wrote the Molecular Psychiatry review.

Risk Factors for Treatment Resistance

“Treatment resistance in anxiety is less defined than in depression,” says Mary Beth Salcedo, MD, director of the Ross Center for Anxiety & Related Disorders in Washington, D.C.3 “Most psychiatrists would say that failure to respond to two rounds of front-line antidepressants and cognitive-behavioral therapy would qualify.”

“The two biggest risk factors for treatment resistance are inadequate treatment and failure of patients to comply with treatment. The other important risk factor is having a comorbid condition, such as depression, bipolar disorder, or substance abuse,” says Bystritsky.

“There is a big difference between not effective treatment and not tolerated treatment,” Salcedo notes. “In many cases, a patient will try an antidepressant, have some side effects after a few days, and stop taking it.

Bipolar disorder may present initially as anxiety, and it is hard to motivate a person with depression to work on anxiety in therapy,” she continues. “All of these contribute to treatment resistance.”