Mental illnesses not commonly treated with drugs.

[robert_columbia]

I am seeking general medical information, not medical advice such as help making a diagnosis or selecting treatment options.

Many people are aware that many common mental heath/psychiatric illnesses are commonly treated with psychiatric drugs, either alone or in combination with some talking, group, or other non-pharmaceutical treatment. Examples include clinical depression, bipolar 1 and 2, schizophrenia, ADD, and anxiety disorder. For all of these, drug treatment (e.g. mood stabilizers for bipolar, antipsychotics for schizophrenia, or CNS stimulants for ADD) is considered a primary treatment option and may occur in a large number of cases of these illnesseses handled by physicians.

What mental disorders exist (use your favorite psychiatric work such as the DSM or your country's equivalent) for which drug treatment is contraindicated, considered a last-ditch effort when talking therapy or other treatments have failed, or rarely done in real life? If patients with a disorder are commonly sedated in order to make them docile but the sedative does not actually treat the symptoms in a meaningful way and just renders the person unable to function (or harm anyone) in real life, make a common-sense judgment call as to whether or not the sedatives constitute an attempt to treat the disorder or its symptoms or are just a way to get the person out of the way.

What treatments are available for these disorders? Are there any mental health conditions that are truly untreatable in any way (e.g., "His doctor diagnosed him with aosmpmolic disorder. There is no known treatment for this and so he will likely be kept in the hospital for life.")?

[SpoilerVirgin]

Anorexia nervosa is one mental illness for which there is no specific drug treatment because "they haven't been found to work very well." People with anorexia may also have other mental disorders, such as depression or anxiety, that can be treated with medication.

Treatment for anorexia generally involves assistance with physical symptoms -- using nutrition training and sometimes forced feeding to help the person gain weight. The psychological aspects are treated with various types of therapy, including Cognitive Behavioral Therapy. Anorexia is a difficult disease to treat. Some people are able to recover through therapy, but others are very resistant and cannot be cured.

[elfkin477]

What mental disorders exist (use your favorite psychiatric work such as the DSM or your country's equivalent) for which drug treatment is contraindicated, considered a last-ditch effort when talking therapy or other treatments have failed, or rarely done in real life?

Erotomania, as a independent singular delusion? (I mean when not part of bi-polar or schizophrenia disorders) That one isn't considered a serious problem, though.

[Zsofia]

My understanding is that there is no treatment for sociopathy (and of course sociopaths do not seek treatment on their own, as they don't think there's anything wrong with them.)

[Qadgop the Mercotan]

Most personality disorders don't respond well, if at all, to medications. A few folks with certain types of them can benefit from meds if they're also quite well-engaged in cognitive behavioral therapy.

The basic personality disorders:

Antisocial (a term often also encompassing most definitions of psychopath/sociopath)
Avoidant
Borderline
Dependent
Histrionic
Narcissistic
Obsessive-compulsive
Paranoid
Schizoid
Schizotypal

I should note that these disorders are often treated with drugs, but frankly the evidence that the drugs are effective in most cases is rather lacking.

[Corcaigh]

Originally Posted by Qadgop the Mercotan

Histrionic
Narcissistic
Obsessive-compulsive

My mother has these traits, and was put on lithium years ago by a doctor who mistook her histrionic behaviour for something else (not sure what, only know the name of the GP who prescribed the meds, and they are no longer at the practice). I'm 99% certain that it's had no effect whatsoever on her behaviour.


AFAIK there are types of Depression that can't (or shouldn't) be treated with drugs, Cognitive Behavioural Therapy works much better.

[Nava]

Originally Posted by Corcaigh

AFAIK there are types of Depression that can't (or shouldn't) be treated with drugs, Cognitive Behavioural Therapy works much better.

Spanish psychiatrists differentiate between "exogenous" and "endogenous" depression: the trigger for exogenous depression is external (a personal problem) and the best treatment is CBT, pills won't do squat and may cause other issues; the trigger for endogenous depression is internal (a biochemical problem) and while CBT is good for it, it is not enough, pills are needed.

[uglybeech]

Originally Posted by Qadgop the Mercotan

Most personality disorders don't respond well, if at all, to medications. A few folks with certain types of them can benefit from meds if they're also quite well-engaged in cognitive behavioral therapy.

The basic personality disorders:

Antisocial (a term often also encompassing most definitions of psychopath/sociopath)
Avoidant
Borderline
Dependent
Histrionic
Narcissistic
Obsessive-compulsive
Paranoid
Schizoid
Schizotypal

I should note that these disorders are often treated with drugs, but frankly the evidence that the drugs are effective in most cases is rather lacking.

I'd bracket avoidant personality and schizotypal personality. Avoidant is often considered more or less the same thing as generalized social anxiety, which is treated with drugs, and schizotypal is widely considered a mild form of schizophrenia.

[buddha_david]

There's no effective drug treatment for autism, AFAIK.

[Qadgop the Mercotan]

Originally Posted by buddha_david

There's no effective drug treatment for autism, AFAIK.

I'd call that more of a neurodevelopmental disorder than a mental illness, frankly.

[thelurkinghorror]

Originally Posted by uglybeech

I'd bracket avoidant personality and schizotypal personality. Avoidant is often considered more or less the same thing as generalized social anxiety, which is treated with drugs, and schizotypal is widely considered a mild form of schizophrenia.

IANAD but: Avoidant is not the same, it is a pervasive problem which is considered to be much less curable than anxiety. Which is why it is on Axis II. Although I wouldn't doubt that it's a more extreme version on the same continuum.

Similarly, schizotypal might be on the same continuum, but does it have the same etiology, genetically or neurally?

A search suggests that Obsessive-compulsive personality disorder benefits from meds in conjunction with psychotherapy. Keep in mind that this disorder has very little to do with obsessive-compulsive personality disorder. The latter is like Monk, but usually more toned down, the former is a person who expects everyone else to comply to their feelings about order. Also, Paranoid personality disorder may benefit from drugs.