The Complexity of Mental Health Treatment

Mental health treatment is inherently complex: a web of challenging puzzles, overlapping symptoms, and varying perspectives on treatment. Unlike physical manifestations of illness such as high cholesterol, there is no specific prescribed treatment for mental illness. Rather, there are a host of treatments, many of which work for some people, many of which do not. There are also a range of psychotherapies and modalities used. Many find relief through counseling, support groups, various physical and creative therapies, or neuromodulation treatments. Others seek prescription medication such as antidepressants, although even within psychotropics, drug selection is often contingent on symptoms, treatment history, co-occurring conditions, and more.

The Idea Behind Transdiagnostic Care

Transdiagnostic care, in the context of psychiatry, refers to the emerging consensus that a “transdiagnostic approach” – one that cuts across traditional diagnostic boundaries – can provide us better insight into understanding and treating mental health conditions. This perspective lends itself to newer, more novel ways of considering clinical treatment for and recovery from disabling mental distress. A recent article in The Seattle Times speaks to this growing movement, stating that the National Institute of Mental Health has “made a push to drop the diagnostic labels we’ve used for decades, and instead, has prioritized studies that focus on individuals’ traits or symptoms.” It’s this transdiagnostic framework that recognizes how many people have characteristics of several diagnoses, since symptoms often overlap between conditions – and it’s this approach that allows people to better receive individualized treatment for their mental health conditions.

The Need to Destigmatize Medication

Beyond the need to understand the ways in which mental health treatment is complex is the equally important recognition that medications – specifically psychotropics – are often stigmatized. While mental health treatment has unquestionably made enormous progress in the public sphere, false beliefs still run rampant. More than half of people with mental health conditions don’t receive help; many avoid seeking treatment due to prejudice and discrimination, and a fear of losing livelihood. While many accept that mental health conditions have a medical or genetic component, there is still a perceived negative view of generalized mental illness.

Coupled with public and institutional stigmas is the very real stigma surrounding medication. While we rarely (if ever) experience stigma surrounding blood pressure medication, mood stabilizers – or other prescribed mental health treatments – prevent people from adhering to their medication regimens. A survey from the Centers for Disease Control and Prevention indicates that, in general, adults with mental illness symptoms do not believe that people are caring or sympathetic to those with mental illness and that this bias feeds into systemic stigmas. But when we treat psychiatric medication differently from blood pressure medication, it separates and silos mental health into its own category, thus preserving misconceptions. When mental health is stigmatized, so too are mental health medications.

New and Emerging Treatments

While stigma exists, so too does very promising research on new ways to support individuals with mental health conditions, even those who have not responded to a host of other treatments. A spate of new and innovative neuropsychiatric treatments are increasingly being used for mood and anxiety conditions, including neuromodulation and ketamine treatment. As clinical research and evidence grows, and patients continue to need and demand better treatment options, new tools are increasingly being used for treatment-resistant patients.

Electroconvulsive therapy (ECT) is a form of neuromodulation that uses an electrical stimulus to the brain to induce a seizure under anesthesia, whereas transcranial magnetic stimulation (TMS) involves the induction of a current in the brain (electromagnetic coil). Unlike ECT, TMS is an office-based procedure that does not require anesthesia. Both ECT and TMS have demonstrated significant efficacy rates among patients with treatment-resistant depression.

Ketamine is likewise gaining recognition as a promising treatment for cases of major depression, which is the leading cause of disability worldwide. Unlike other therapies or approaches, ketamine has a rapid action and can take effect very quickly. There are two main types of ketamine used to treat treatment-resistant depression: racemic ketamine (an infusion into the bloodstream) and nasal ketamine. Within the past 2 years, the nasal spray esketamine (Spravato) was approved by the FDA.

A recent article in the New Yorker specifically speaks to ketamine’s efficacy with chronic, treatment-resistant depression. “Zachary Rice, a twenty-eight-year-old TV writer, has seen a therapist since he was ten. At sixteen, he was diagnosed with clinical depression, and in his early twenties he was diagnosed with acute post-traumatic stress disorder and obsessive-compulsive disorder. He began taking antidepressants at eighteen; since then, he has been prescribed thirteen different medications and has attempted suicide. In March 2020, as the pandemic started to spread, he became suicidal again. He spoke with his therapist and psychiatrist on the phone. Concerned that more medication wouldn’t help him quickly enough, they gave him two options: hospitalization or ketamine.”

Where Are We Today?

The world in which we live changes each day based on new discoveries, new research, and new realizations. While our society does in many ways continue to stigmatize mental health conditions, there are new, exciting, innovative treatments specifically designed to help patients who have struggled to find relief. And while mental health treatment is complex by nature, these new medications, treatments, and psychotherapies continue to add to our growing psychiatric toolbox, giving us additional, new ways to support individuals with mental health conditions.