Anxiety and depression increased by 25% worldwide after the first year of the pandemic. Rates for those and other mental health conditions have remained at alarming levels ever since. Though many mental health problems can benefit from psychotherapy and drug therapy, an estimated that 30%-50% of people with depression inadequately respond to psychotherapy and drug therapies, resulting in treatment-resistant depression.
A standard definition of TRD doesn’t exist, but the U.S. Food and Drug Administration (FDA) defines treatment-resistant depression as a failure to respond to two or more antidepressants despite adequate dose and duration and adherence to treatment. Though multiple factors have been associated with TRD, including social determinants of health, life stress events and even physical comorbidities (such as diabetes, osteoporosis and metabolic syndrome), such factors aren’t necessarily predictive of TRD.
Multiple options are available for consideration in people experiencing TRD.
Ketamine belongs to a group of drugs, commonly known as psychedelics or hallucinogens, that can induce altered thoughts or sensory perceptions. While the exact mechanism of action is unclear, it’s likely that such substances alter the levels of chemicals associated with mood, such as serotonin and glutamate. This seems to “reset” brain processes, helping resolve symptoms related to depression.
Ketamine works quickly but typically lasts four to seven days, requiring repeat administration over four to six treatment cycles. Providing psychotherapy with the ketamine infusion can help keep the effects going. It’s been shown to be more effective than either one alone by making the patient aware of their feelings and learning from them. This is done by helping the patient process memories and emotions that come up while they are under the influence of ketamine with the help of a therapist.
Recently, the public has become more aware of this disease because of celebrities’ support and recent high-profile deaths. This has led to charges against doctors who prescribe it. This shows how important it is to learn about ketamine and get it through certified providers and infusion centers that provide all the help a patient needs.
TPAs (third-party administrators) such as Enthea, Meeko Health and TARA Mind provide networks of certified providers that help patients prepare for ketamine by setting expectations, extracting insights from their experiences and then monitoring progress post-treatment to improve outcomes.
Many campaigns, like the Healing Breakthrough and Heroic Projects, advocate for the approval of psychedelic-assisted therapy for post-traumatic stress disorder (PTSD) treatment in veterans. The Multidisciplinary Association for Psychedelic Studies (MAPS) is the largest U.S. non-profit organization dedicated to advancing research, policy reform and safe patient access to psychedelic therapies beyond ketamine. MAPS aims to bring these agents into mainstream medicine in a responsible way by teaching people how to use them safely and by making psychedelics less stigmatized. They are actively involved in the ongoing clinical trials of other products, such as MDMA, psilocybin and LSD to treat other mental health conditions, such as PTSD, suicidal behavior and even pain management.
In July 2023, Australia became the first country to allow psychiatrists to prescribe MDMA for PTSD and psilocybin for treatment-resistant depression. In the U.S., psychedelics are currently classified as Schedule I Controlled Substances, a designation indicating that they have no medically approved use and a high abuse potential. Some states are changing their rules about psychedelics. Colorado was the first state to make it legal to use psilocybin, and Oregon made it legal to use it in some medical centers.
MDMA was expected to be the newest psychedelic approved in the U.S. for PTSD, but an FDA advisory panel didn’t endorse approval in June 2024 due to potential biases in clinical trial evaluations overstating its effectiveness. If it had been approved, it would have been the first new treatment for PTSD in 25 years.
Recently, neuroimaging techniques like functional MRIs have shown promise in TRD alongside blood-based biomarkers by identifying the specific areas of the brain causing an individual’s symptoms to help inform treatment decisions.
TRD and other mental health conditions pose a significant economic and healthcare cost burden. Support for mental health conditions should go beyond employee assistance programs to include access to other therapies through high-quality, certified providers. Employers should also consider including travel benefits, paid time-off policies and guides to help members navigate the process.
It is important for employers to know about hard-to-treat mental health conditions like TRD and to make plans that help their employees improve. Personalized approaches such as pharmacogenomic testing can maximize drug efficacy. But for those continuing to experience difficulties, third-party networks can provide quality clinical support for psychedelic treatment that can provide therapeutic benefit.
Benefits are as important as ever when it comes to attraction and retention
