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Child Psychiatrist /Adult Psychiatrist

The Failed Concept of Treatment Resistance


According to some estimates, about 20% to 60% of psychiatric diagnoses eventually become labeled “treatment resistant,” yet psychiatry seems to lack a consensus on what “treatment resistance” means, including clear criteria, H. Paul Putman III, MD, told Psychiatric Times in an exclusive interview.

Treatment Resistance

Putman, a Distinguished Life Fellow of the American Psychiatric Association and a Fellow and former Laughlin Fellow of the American College of Psychiatrists (ACP), led the session “Encountering Treatment Resistance and Finding Solutions” at the 2024 American Psychiatric Association Annual Meeting in New York City, May 3-8, 2024.1 In his presentation, he explored the concept of treatment resistance and how these cases may actually be a result of treatment failure. The goal, he noted, is to help patients, including those whose initial outcomes are disappointing.

Putnam said the field needs to shift its focus. Part of that, he told Psychiatric Times, is remembering that clinicians are humans who make mistakes. Before leveraging the term treatment resistant, Putnam, it is important to examine and rethink the facts. “We have innate biases that distort our clinical reasoning,” he explained. “We are not as aware of them all the time as we need to be, and I include myself.”

He explained clinicians need to use metacognition to avoid being on autopilot, which should result in less treatment failures for patients. Metacognition should help clinicians consider if the tools they are using as part of the treatment strategy are the most appropriate tools for each particular case. Similarly, it should allow clinicians to learn more tools and find new ways to apply those tools during diagnosis and treatment planning. Moreover, this approach encourages clinicians to go back and reexamine the problem from the beginning when there is a treatment failure, so they can better understand what data is missing and how to obtain that data. “This creative iteration needs to go on over and over again until you get satisfactory results for your patients,” he explained.

Note: This article originally appeared on Psychiatric Times

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