Treatment Fatigue

Elizabeth Spencer

I’m a CBT therapist. I believe in CBT therapy – I know it works. Yet some of our clients can’t make use of the good work we can do with them without finding medicine to help them first. Several years ago, I had a client who had been on medicine for panic disorder, agoraphobia and depression for ten years with little success before he started working with me. One of his friends had seen me give a community talk and suggested he come see me. I was grateful to the friend for sending him, because this poor man had been mostly home-bound for all those years. He was seeing a psychiatrist who was also glad the client was starting therapy, because he didn’t have any other ideas about how to help with medicine. The client and psychiatrist had treatment fatigue.

I thought about him again recently, when my sister, psychiatrist Caroline DuPont, M.D., shared with me a question from one of her patients brought in for a friend who was struggling to find the next step in treatment:

“Dear Dr. DuPont, I have a quick question. Do you ever have patients who get treatment fatigue (I don’t know if this is a real term)? Do people ever get burned out from going to treatment for a long period of time and not seeing the results they expected? What do you do in that situation?”

Here is the note Dr. DuPont wrote for her patient to give to her friend:
“Great question. Not only do patients get this “treatment fatigue” but clinicians do too. It is frustrating for both sides to be trying and trying but not getting the hoped-for results. When this happens to me as a doctor I sit back and look at the person from different angles. It is often a useful strategy is to go back to basics. I review the core elements of health. Is the person getting enough sleep, at least 7 hours a night? Are they sleeping too much, more than 9 hours or napping during the day? Healthy eating is also important. I stress getting enough protein and limiting empty calories. (Food is fuel for a healthy brain.) Regular exercise is very important. Set a goal and a schedule. If the plan is to go to the gym don’t let a negative internal voice derail you. My rule is get fully dressed for the activity and go to the location of the activity. Usually after putting in that effort it is worth it to at least do a short time even if it is difficult. Make sure you are surrounding yourself with positive content: people, books, shows. It is hard to feel good when there is negativity all around you. And my last component is to get outside. Natural light is good for our brains. Spend some time noticing the changes in the seasons, and even the time of day. It is hard for anyone to feel good if they don’t follow these basic principles for a healthy life.

If my patient has been doing all of this, or is unable to follow these healthy living strategies because they are too ill, this is the point that I refer a patient for a second opinion. If I can, I send them to our regional hospital or to another psychiatrist who’s work I trust for an evaluation. The interesting thing is that rarely do these outside doctors have something dramatically different to say. But, the experience is often completely revitalizing for me and my patient. Sometimes they do have a different opinion about the diagnostic approach and that is very helpful, too. Occasionally people change to another doctor completely and that is totally fine with me. While doctor shopping is bad, trying a new perspective can be very good.

The same thing goes with therapists. Sometimes it is helpful to get that fresh perspective and to try another treatment modality.

But, this is a really important thing I tell my patients, even people who have struggled for a long time: DON’T GIVE UP! Whatever happens, don’t give up. I have seen people suffer for years, then some combination of factors occurs and they get better. I mean really better! And for a lot of those people they stay well. They come back once or twice a year for medicine checks and we reminisce about the dark days, but they are living in the light.”

I love this answer. It is so true – the client that I saw years ago with the debilitating panic, agoraphobia and depression went (with his psychiatrist’s blessing) for a second opinion about his medication, found a better combination of medicines and made amazing progress with CBT within six months of our first appointment.

If you or your client has “treatment fatigue,” I hope you will take Dr. DuPont’s great advice and find a new direction. We want all of our clients to live in the light of good mental health.

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