Treatment Resistance as Misnomer
They're not resistant. We're just not using treatments that are effective.
When a patient does not respond to first-line antidepressants, we call them treatment-resistant. But resistance implies the problem lies with the patient. In practice, it often lies with the treatment: the limited pharmacological toolkit psychiatry has relied on for decades, the absence of psychotherapeutic support alongside medication, and the systemic barriers that prevent patients from accessing alternatives.
This talk reframes treatment resistance as a system-level failure rather than a patient-level diagnosis. I present data from our clinical practice showing that patients labelled treatment-resistant often respond well to ketamine-assisted psychotherapy, particularly when the pharmacological intervention is paired with structured therapeutic support.
The implications extend beyond ketamine. If we accept that the label is misleading, it changes how we design clinical pathways, how we allocate resources, and how we communicate with patients who have been told nothing more can be done.