When your medication is not working for anxiety
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 an 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
For example, common childhood infections, such as strep, mycoplasma pneumoniae, Epstein Barr virus, influenza, sinusitis, herpes viruses and Lyme disease are known to trigger pediatric autoimmune neuropsychiatric syndromes which can manifest with severe anxiety, separation anxiety, and irrational fears.
These patients may be misdiagnosed with an anxiety disorder, when they could have an autoimmune condition. How does this happen? Common infections, often hidden or without obvious symptoms, can trigger the immune system to produce antibodies to kill and remove the invading germs, and in some patients, the antibodies they make may cross react with certain parts of their brain.
“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)Click to tweet
Immune system in overdrive
In certain types of autoimmune conditions the immune system kicks into overdrive and mistakenly attacks healthy cells in the region of the brain that controls movements and emotions, as well as other body functions. This attack may also cause brain inflammation and the onset of psychiatric symptoms and behavioral changes.
These patients often report that their medication is not working or that it is making symptoms worse.
Be sure to consult your doctor because individuals with an infection-triggered autoimmune encephalopathy often require treatment with immune-modulating therapy in addition to antimicrobial and anti-inflammatory medications, rather than just psychiatric medications. When treated properly, patients often report complete or substantial reduction in symptoms.
- 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/
- Witthauer C, Gloster AT, Meyer AH, Goodwin RD, Lieb R. Comorbidity of infectious diseases and anxiety disorders in adults and its association with quality of life: a community study. Front Public Health. 2014;2:80. Published 2014 Jul 14. doi:10.3389/fpubh.2014.00080 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095564/
- Infections may raise the risk of mental illness in children. NPR. Health Shots. 2018. https://www.npr.org/sections/health-shots/2018/12/05/673700889/infections-may-raise-the-risk-of-mental-illness-in-children
- Köhler-Forsberg O, Petersen L, Gasse C, et al. A Nationwide Study in Denmark of the Association Between Treated Infections and the Subsequent Risk of Treated Mental Disorders in Children and Adolescents. JAMA Psychiatry. 2019;76(3):271–279. doi:10.1001/jamapsychiatry.2018.3428 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2716981
- Jennifer Frankovich, Susan Swedo, Tanya Murphy, Russell C. Dale, Dritan Agalliu, Kyle Williams, Michael Daines, Mady Hornig, Harry Chugani, Terence Sanger, Eyal Muscal, Mark Pasternack, Michael Cooperstock, Hayley Gans, Yujuan Zhang, Madeleine Cunningham, Gail Bernstein, Reuven Bromberg, Theresa Willett, Kayla Brown, Bahare Farhadian, Kiki Chang, Daniel Geller, Joseph Hernandez, Janell Sherr, Richard Shaw, Elizabeth Latimer, James Leckman, Margo Thienemann, and PANS/PANDAS Consortium. Journal of Child and Adolescent Psychopharmacology. Sep 2017.574-593.http://doi.org/10.1089/cap.2016.0148 https://www.liebertpub.com/doi/full/10.1089/cap.2016.0148
An estimated 40% of patients with an anxiety disorder do not respond to first-line treatment.
Learn more about how infections can trigger neuropsychiatric symptoms
Cunningham Panel™ helps identify an autoimmune disorder in child initially diagnosed with schizophrenia
Researchers describe a complex case involving a 15-year-old girl, who abruptly developed multiple neurologic and psychiatric symptoms.
Autoimmune diseases and severe infections as risk factors for mood disorders: a nationwide study
This nationwide, population-based, prospective cohort study examines the link between mood disorders, infections, and autoimmune disease.
Childhood infections can increase risk of mental illness in kids
Nationwide study finds both mild and severe infections can increase risk of mental disorders in children and adolescents.