It took Rachel nearly six months to finally admit she was struggling — and then seek help from a mental health professional for her depression. But then it took another 14 months before she found a treatment regimen that finally restored her to what she terms, “somewhere near normal.”
“It was extremely frustrating,” Rachel says. “I just wanted to feel better. I tried one medication, it had terrible side effects. I mean, I didn’t think I could feel worse than I already did, but that medicine did it. So they put me on a different drug. That one didn’t really do much. The third time was the charm, as they say, but, honestly, I was about ready to give up.”
Rachel’s story is not uncommon. In 2006, a large-scale National Institute of Mental Health (NIMH) study, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D), found that the majority of patients experience two or three tries before they receive a treatment regimen that will actually work for them. Only about 30 percent will find recovery with the first drug selected. Success remains at approximately 30 percent with the second drug choice. That leaves a little more than half of the patients who will be returned to a normal clinical state after two treatment attempts.
While the numbers may vary from condition to condition, this phenomenon is not limited to depression. Patients struggling with other neuropsychiatric disorders ranging from attention deficit hyperactivity disorder (ADHD) to epilepsy to anxiety disorders also often experience this kind of trial-and-error approach to treatment selection as well. The reasons why vary. Some, like Rachel, may be particularly sensitive to certain side effects. Others may have co-morbid physical or mental health issues that make it tricky to find the right medication. And doctors also have to take into account lifestyle factors as they consider treatment — diet, exercise and sleep factors may also play a part in overall health and well-being.
For some, the process can literally take years — long enough that many patients start to wonder if they can be helped at all. But the field of neuropsychiatry, a subspecialty of psychiatry that focuses on the biological underpinnings of mental health disorders, may offer more relief than traditional psychiatric approaches.
Historically, the field of psychiatry focused on the mind — that inner sense of yourself that we all have. But more and more, researchers are understanding that there is no “mind” without the brain. It is the seat of all that makes you, well, you. As such, to effectively treat disorders like depression and anxiety, you must look to the brain for answers. Ranjit Chacko, MD, a neuropsychiatrist at Houston Methodist Hospital, says taking a comprehensive, interdisciplinary approach can help doctors better hone in on successful treatment options early on — and make the process less of a guessing game.
“This approach involves more of a thorough evaluation of neurological, neurocognitive, and neuropsychological findings, together with laboratory tests and brain imaging studies,” he says. “We look at all of those things together before we initiate treatment.”
And the treatment that is initiated may not just be a drug prescription — it may also include important cognitive therapies and lifestyle changes that can help you better manage your mental health condition — ultimately helping patients, no matter what their diagnosis, feel their best.
To learn more about the neuropsychiatric approach to mental health care and how it can help you or your loved ones, visit the Neuropsychiatric Center of Chicago at the Hartgrove Behavioral Health System.
Written by Kayt Sukel