My anxiety medication is not working
Anxiety Disorders
When your medication is not working for anxiety
Anxiety disorders as a group are the most prevalent psychiatric conditions in the United States. 1 They can have a serious impact on a person’s quality of life. In fact, too many patients say their medication is not working well enough to alleviate or manage their symptoms.
An estimated 40% of patients with an anxiety disorder do not respond to first-line treatment (i.e., antidepressants, benzodiazepines, and cognitive-behavioral therapy.) Up to 30% are considered treatment resistant patients. 1
Untreated anxiety is a very real concern. Aside from its ability to cause debilitating mental anguish and the increased risk of suicide 1, anxiety that is not treated can lead to major depressive disorder. 2
Treatment resistant anxiety
There may be several reasons why anxiety medication is not working. A patient may have co-morbid conditions or they may not be taking the medication as prescribed. Or, anxiety symptoms may be due to an underlying and untreated biological cause, such as a bacterial or viral infection.
“Some infections start as a peripheral infection in the body and can cross the blood-brain barrier and come into the brain, and thereby cause damage and increase the risk of mental disorders.” 3
Common infections, which may be ‘subclinical’ and not producing outward physical symptoms, can trigger the immune system to produce antibodies to destroy harmful pathogens. But in some cases, these autoimmune antibodies mistakenly target healthy cells in a region of the brain known as the basal ganglia.
This autoimmune response causes inflammation in the brain and disrupts how cells (and receptors) function. This leads to the onset of various neuropsychiatric symptoms, including anxiety.
Identifying an underlying autoimmune process is important, since proper diagnosis and treatment can often lead to a complete resolution or substantial reduction in symptoms.
Could your anxiety be due to an immune dysfunction?
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Are you struggling with treatment-resistant anxiety? It may be due to an autoimmune response.
Immune system in overdrive
In some individuals, infections can trigger the immune system to produce antibodies that mistakenly attack healthy cells in a region of the brain known as the basal ganglia. This region controls movements and emotions, as well as other body functions. These autoimmune antibodies can disrupt how the cells function and cause brain inflammation, leading to the onset of psychiatric symptoms, such as anxiety.
These patients often report that their anxiety medication is not working or that it is making symptoms worse. It’s important to identify autoimmune-induced neuropsychiatric symptoms, since treatment often involves immune-modulating therapy in addition to antimicrobial and anti-inflammatory drugs, rather than just psychiatric medications. And, when treated properly, patients often report complete or substantial reduction in symptoms.
References
- Bystritsky, A. Treatment-resistant anxiety disorders. Molecular Psychiatry, volume 11, pages805–814 (2006) https://www.nature.com/articles/4001852
- Meier SM, Petersen L, Mattheisen M, Mors O, Mortensen PB, Laursen TM. Secondary depression in severe anxiety disorders: a population-based cohort study in Denmark. Lancet Psychiatry. 2015;2(6):515–523. doi:10.1016/S2215-0366(15)00092-9 https://www.ncbi.nlm.nih.gov/pubmed/26360447/
- Roy-Byrne P. Treatment-refractory anxiety; definition, risk factors, and treatment challenges. Dialogues Clin Neurosci. 2015;17(2):191-206. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518702/