By the time Jonah Tran reached a specialist clinic he was on his fourth escalation in three years. Each step had added a drug. None had added a question.
Nobody involved describes this as solved. It is managed, and managed is a job you do every day, indefinitely, with better or worse information.
The other half of the programme was a twenty-minute call every two weeks with the same practitioner. Not a different person each time reading notes. The same person, who remembered.
Roughly half of what arrives as treatment-resistant is delivery, adherence or diagnosis. We check those first now.
Illustrative composite
The fix, when it came, was unglamorous. One dose moved. One meal moved earlier. That was most of it, and it had been available the whole time.
“Ten years,” he says. “Ten years of maybe half the dose, because somebody was in a hurry once.”
