12/27/2025
Why Treatment Resistance in Psychiatry May Be a Biological Signal — Not a Clinical Failure
One of the most persistent challenges in psychiatry is treatment resistance.
Despite adequate dosing, duration, and adherence, a substantial subset of patients with depression, schizophrenia, and OCD fail to respond meaningfully to standard treatments.
An expanding body of evidence suggests this is not simply a matter of “refractory illness,” but rather a biologically distinct subgroup characterized by:
• Elevated inflammatory markers (CRP, IL-6, TNF-α, IL-1β)
• Excessive oxidative stress and impaired antioxidant defenses
• Disrupted neuroplasticity and altered brain circuitry
• Reduced responsiveness to monoamine- and dopamine-focused therapies
Inflammation and oxidative stress can shift tryptophan metabolism, amplify glutamatergic signaling, activate microglia, and interfere with synaptic remodeling — creating a neurobiological environment where conventional treatments operate at a disadvantage.
This reframes treatment resistance not as noncompliance or therapeutic failure, but as a mismatch between biology and intervention.
The clinical implication is precision:
measure → stratify → target biology rather than repeating identical algorithms.
I discuss this framework in the accompanying video and will follow with practical discussions on biomarkers, phenotyping, and rational augmentation strategies for treatment-resistant patients.
📹 Video below