Teen Treatment Resistance

Most people recognize that teens who are suffering from mental health or substance use disorders need help. But for a variety of reasons, some teens don’t seem to respond to initial treatment efforts in the same way as others. Despite efforts to help bring them relief or teach them how to adapt, they continue to struggle and may even become worse. The term “teen treatment resistance” is used to describe this phenomena.

Teens who are resistant to treatment may fail to show improvement even after being prescribed medication (such as antidepressants). As they fail to see results, they become more and more frustrated, feeling they no longer have any hope of achieving relative normalcy and wellness. But treatment resistance is not treatment impossibility; a little bit of patience and commitment – from teens and treatment providers – goes a long way.

What Does Teen Treatment Resistance Look Like?

  • Treatment resistance doesn’t necessarily mean a teen is unwilling to seek treatment or that they won’t ever respond to any kind of treatment. It is far more common for teens to be resistant to a specific treatment, such as medication.
  • Researchers continue to investigate the reasons treatment resistance occurs. While we still don’t have the full picture, it is likely that genes, environmental influences, and a variety of other factors may increase a teen’s risk.
  • Teens with treatment resistance often continue to struggle and suffer for weeks after treatment is initiated. The fact that many mental health medications take up to six weeks to start working also makes it a difficult condition to diagnose.
  • Treatment resistance isn’t limited to mental health conditions. It can occur in virtually any physical or mental health illness, including anxiety, the common cold, the flu, and even serious diseases like cancer.
  • Treatment resistance may also be a sign that current treatments are inappropriate or that the patient has been misdiagnosed. For example, bipolar patients may become worse if given SSRI medications.

Signs of Treatment Resistance

Unorganized or messy

Symptoms persist after initial treatment

Chronic tardiness or “no-shows”

Teens continue to have symptoms long-term

Anxiety attacks

Symptoms worsen despite escalating treatment attempts

What Causes Treatment Resistance?

Researchers don’t yet fully understand why some teens  seem to develop treatment resistance, yet others seem to respond effectively in only days. Studying the disorder has been difficult because treatment resistance is not a discrete illness or condition; rather, it is in response to the treatment of another condition instead.

Genetics - It is highly likely that response to medication and/or treatment is modulated by the patient’s own genetics. For example, some patients have genetic markers that inhibit their ability to process certain drugs (like antidepressants), making treatment ineffective. This is most common in depression patients, who may fail to respond to SSRI treatment, yet respond perfectly fine to other drugs that affect dopamine instead of serotonin.

Misdiagnosis – Psychiatry isn’t an exact science. While psychiatrists do use guidelines, like the DSM-V, to diagnose their patients, it is possible for a patient to be misdiagnosed once or even multiple times before receiving an accurate diagnosis. This may be due to differences of opinion among medical professionals, outside influences, or even the teens own inability to express how they feel.

Wrong treatment - mental health treatment is incredibly individualized; patients rarely find the right treatment on the first try. Teens who seem like they aren’t responding to treatment may really still be in the process of finding the right treatment for their needs.

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Teen Anxiety Treatment | Paradigm San Francisco


of all depression patients don’t find SSRIs effective


fail to respond to any antidepressants period


eventually respond to antidepressants after 6-8 weeks

How Can I Help My Teen with Treatment Resistance?

Help them seek alternatives – Antidepressants and other medications may be the first-line treatment for depression, but that doesn’t mean they’re the only option. In fact, there is a whole world of alternative treatments available out there that may help teens finally make progress. These options include transcranial magnetic stimulation, psychotherapy, neuromodulation, and a long list of next-generation drugs.

However, it is important to note that you shouldn’t switch medications at random, nor should you add new medications to your teens regimen without approval from a doctor. Mixing medications can be very dangerous; your teen’s doctor can help you do it safely.

Work with professionals to find a path forward – just because your teen has a bad experience with one medical professional doesn’t mean they’ll have the same experience next time. Get a second opinion – or a third, if necessary, or even a fourth. In fact, a second opinion ensures two sets of eyes remain on your teen’s case at all times, and with the nature of treatment resistance, this may help to limit ineffective treatments. It also lowers the risk of misdiagnosis, errors, and inappropriate prescribing strategies.

Continue to support your teen throughout treatment – Remember that, while your teen may act out due to mental illness, they are not inherently bad or evil, nor are they “not trying hard enough to get well.” They’re just unwell. In the case of treatment resistance, teens can become hopeless, and your support, compassion, and patience may be their lifeline during their most trying times. Share optimism and your belief that they will get well, even if it seems to be taking a very long time to get there.

Your own mental and physical wellness is critically important. If you don’t take care of yourself, and maintain your own sanity, your teen may find your advice shallow or ill-informed. Furthermore, caring for a teen with treatment resistance can leave you struggling with compassion fatigue. Work with the therapist privately to address these feelings and ensure that you don’t slip further into depression yourself, limiting your ability to help.

What Type of Treatments Work?

Unfortunately, there is no one magic treatment for teen treatment resistance. Instead, what works best is often highly individualized to both the teen and the specific condition they’re dealing with. Psychiatrist and therapist often initiate treatment through process of elimination, identifying what hasn’t worked in the past. Then, they can identify and utilize rarer or more uncommon treatments that have shown benefit to resistant patients in the past.

Some of the most effective new treatments are still experimental, but several have been approved for use by the FDA. For example, patients with treatment resistant depression may benefit greatly from neuromodulation. Patients who suffer from chronic pain, on the other hand, sometimes respond very well to treatment with antidepressants, versus painkillers.

Identifying a treatment that works is often a matter of trial and error. The exact process will differ facility-to-facility depending on how the patient responded to first-line medications and whether or not there is an established protocol for care.

Helping Teens with Treatment Resistance at Paradigm San Francisco

Teen treatment resistance requires a very special approach. At Paradigm, we start the process by focusing on several very important factors. Every relationship starts with an initial evaluation that thoroughly reviews the patient’s history, medications, and experiences with treatment, including what works well and what doesn’t.

Diagnosing mental health issues isn’t easy, even for the world’s best experts, because these conditions can be pervasive and complex, especially in teens. It’s completely understandable that teens and their parents may feel frustrated, hopeless, or like giving up. Rest assured that we can – and do – help with a patient, compassionate approach.

A Personalized Approach

In teen treatment resistance, a personalized treatment plan isn’t just an option. Instead of simply prescribing more first-line treatments that may not work, we custom design the teens treatment strategy to acknowledge the influence of wholistic factors like co-occurring disorders, physical illnesses, family history, social sphere concerns, substance use disorders, and the teen’s genetic history.

Our experts are relentless and dedicated to helping your teen for as long as it takes, no matter how complex, multilayered, or convoluted their story. Often, we’ll combine treatment approaches and medication to help teens truly succeed. While we may prescribe medications to provide relief at first, the overall goal is to find a more integrative strategy for long-term success.

Time and Patience

Around half of all patients treated for depression failed to respond to first-line treatments. We recognize that it can be difficult, frustrating, and discouraging to sit on the sidelines and watch treatments repeatedly fail time and time again. Remember that, even among non-treatment-resistant people, few find the right option the first time around. This is normal and to be expected!

If your teen’s initial treatment plan at Paradigm doesn’t work, or if they continue to fail to respond, don’t worry – we are continuously working to adapt their strategy. There are a wide variety of options available both on and off-site to help us help your teen.

I don't know who will see this, but I just thought I'd put it out into the world that Paradigm Malibu changed my life forever. Long story short, I had nothing but anger inside me when I got there, and putting the rest of the world to the side for a while and being present with people I grew to love helped me gain my sense of self back. I'm forever grateful for the people of Paradigm.

– Olivia H.

Frequently Asked Questions About Treatment Resistance

If my teen is treatment resistant, does that mean their disorder is more serious?

It is impossible to know the answer to this question without knowing your teen and the details of their individual case. However, we can confidently tell you that treatment resistance does not necessarily mean your teen’s disorder is more severe.

Treatment resistance isn’t about the strength or frequency of treatment; instead, it’s about finding options with sufficient efficacy or effectiveness. To relate this topic to a physical illness, think about a patient who has a sprained ankle. They may be unable to walk and in pain. If they don’t respond to first-line treatments like acetaminophen and rest, they may need a different drug, like naproxen. This doesn’t mean they’re more severely ill – it just means they need a different treatment. The same is true for mental illness.

Is treatment resistance more common in some cases than others?

Yes, absolutely – but researchers don’t yet fully understand what contributes to the development of treatment resistance. Science does show a correlation between depression and treatment resistance, especially in women and the elderly. We also know that teens who have other physical illnesses, such as chronic pain, thyroid conditions, or endocrinological conditions (like Diabetes), they are much more likely to struggle to find the right medication. This is also the case for teens with disorders such as chronic fatigue or fibromyalgia. If you really consider these influences, resistance to treatment makes sense; patients are under a constant onslaught of physical pain, stress, and hardship while trying to get well.


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