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Hope for the treatment resistant
Depression and anxiety rates have increased by 25% in the past year, and many who suffer from mental health challenges don’t respond to initial treatments.
This is known as treatment resistance, an increasingly urgent issue for the mental health industry to solve.
It’s a particularly pressing issue for depression, which is the leading cause of disability in the U.S. among people ages 15-44. Of that group, up to 46% don’t respond fully to antidepressant treatments.
There’s hope for those people. New research around emerging treatment modalities could potentially address the needs of individuals who are treatment resistant or make current treatments more efficacious.
HR and people leaders are a big part of the solution to breaking down mental health barriers for employees. Providing access to new treatment modalities for people whose mental health conditions have not responded to current treatment efforts is one area where that’s possible.
Here’s what you need to know about three of the most promising— pharmacogenomics, psychedelics, and transcranial magnetic stimulation.
3 promising new treatment tools
Pharmacogenomics, an emerging tool in the precision medicine field, involves looking at an individual's genes to figure out which medications might work best for them. Differences in these genes from person to person can impact how our bodies use each medication.
If we know ahead of time how each person’s body will respond, we might be able to select a medication more likely to help using this genetic information rather than making an educated guess. There is evidence that this approach can be helpful.
This is generally less beneficial at the beginning of treatment, and is normally only used after the first prescribed medication isn’t effective. For many people, the first choice of medication will be helpful. This type of test helps best when the provider is trying to decide which medication is the next best choice to try.
There is also excitement about new areas for treatment with ketamine and psychedelics for mental health conditions that do not respond to initial efforts—giving new hope for those who suffer from unrelenting illness.
There’s emerging evidence that psychedelics, like psilocybin and others, may be useful in treating certain mental health conditions as an added piece to structured psychotherapy, particularly for PTSD and treatment-resistant depression.
Definitive evidence of how psychedelics help is not clear, but it appears their use may help many change how someone relates to their memories. For example, with PTSD, a memory that previously triggered physical and emotional responses may still be present. After treatment, the memory does not create the same flood of emotions each time the memory is activated.
Ketamine has been particularly helpful in providing relief for those with chronic suicidal ideation. However, the effects tend to wear off in a few weeks for many people.
To be clear, there’s a lot to still learn about the effectiveness and best method to use psychedelics. This is truly a field of study that’s in the early stages.
Health insurance plans currently don’t cover many of these treatments while they wait for more research results. Some of these approaches are only available through research studies right now.
Transcranial magnetic stimulation (TMS)
TMS is a non-invasive, targeted form of brain stimulation. During a TMS session, a special magnetic coil is placed on the patient’s head, which creates an electrical current across the scalp and bone and into the surface of the brain. Usually the current moves to a depth of about 1-2 centimeters into the brain but can vary.
Providers are able to target very specific areas of the brain responsible for conditions like treatment resistant depression, without the negative side effects of electric shock therapy to the whole brain. No anesthesia is required and it is usually very well tolerated, with few side effects.
Another upside of TMS is that sessions can now be completed in as little as 10 minutes. As the technology progresses and becomes more precise, outcomes have also greatly improved. Researchers are experimenting with how much and how often brain stimulation can be given to find ways to speed up recovery.
There are other conditions researchers are using TMS to treat, such as treatment resistant OCD, PTSD, and bipolar disorder, to see where it’s most effective. Currently, the FDA has approved specific TMS machines only for depression, OCD, smoking cessation, and migraines.
There’s enough research literature showing the effectiveness of TMS for treatment resistant depression that most health plans will cover it as an alternative treatment. Health plans may be less likely to cover TMS for treating other conditions.
The future of emerging treatments
We always want to be thinking about how to break down barriers to mental health, when considering emerging treatment modalities—and how many people will actually be able to access those treatments once they’re approved.
We will keep exploring how to either build capability ourselves or partner with the best high-quality providers to ensure access to care for all our members across the country.
As I think about the upcoming year and where mental healthcare is headed, I believe that precision mental health will become the new standard of care. It helps employees feel better faster, helps providers understand what treatments are working best, and it helps us drive better economic value for health plans.
Here are six mental health treatment trends that will become increasingly important in 2023, to ensure quality of care and both clinical and financial outcomes.