In 2023, important comparisons gave patients more evidence about what to consider when depression treatment had not helped enough. Family-intervention research and national health reporting also made the picture more detailed. The challenge was not simply obtaining more treatment. It was understanding which result applied to which person, how long it lasted, and what happened beyond the clinical setting.
Key findings
27.1% versus 17.6%: eight-week remission in the ESCAPE-TRD comparison of esketamine and quetiapine strategies, each alongside an antidepressant. [1]
55.4% versus 41.2%: response in a separate three-week ketamine-versus-ECT trial. Response and remission are not interchangeable. [2]
18% versus 15%: medium or high psychological distress in Switzerland’s 2022 and 2017 surveys, reported in 2023. [3]
One session: average participation in a small family-involved alcohol intervention designed as three sessions. The delivery gap matters alongside its preliminary outcomes. [5]
2023 is the review year, not the publication date of this report. Prepared in October 2026, the retrospective labels later evidence separately and reports no original THE BALANCE patient outcomes.
The year’s lesson: a better comparison beats a bigger promise
Families facing persistent symptoms can encounter several plausible next steps. A direct trial comparing specified alternatives provides information that cannot be obtained by placing promotional success rates beside each other.
The question remains individual: does the study population resemble the person seeking care, and does its endpoint address the goal that matters? A numerical advantage is important, but it does not make the other clinical details optional.
For people with substantial resources, access can widen faster than certainty. More choices increase the value of a coordinated assessment and a transparent explanation of the evidence. The same requirement applies whether treatment is public, privately funded, local, or overseas.
Depression: one trial found a remission advantage
ESCAPE-TRD randomized 336 participants to esketamine and 340 to quetiapine extended release, each added to an antidepressant. Eight-week remission occurred in 91 and 60 participants, respectively. The study was open-label with blinded raters and funded by Janssen EMEA. [1]
The difference between the rounded percentages is 9.5 percentage points. It concerns the defined strategies, not every treatment using a related medicine. [1]
The result also leaves a substantial group without remission at that assessment. A responsible care discussion includes what happens after partial or insufficient improvement rather than presenting the favorable comparison as a guarantee.
A second trial measured response, not the same endpoint
ELEKT-D randomized 403 people with nonpsychotic treatment-resistant major depression to intravenous ketamine or electroconvulsive therapy. After withdrawals before treatment, 195 and 170 received their assigned intervention. The primary comparison supported noninferiority under its specified design. [2]
The reported difference was 14.2 percentage points, with a 95% confidence interval from 3.9 to 24.2. The population boundary excludes an automatic conclusion about psychotic depression. [2]
| Feature | ESCAPE-TRD | ELEKT-D |
|---|---|---|
| Headline outcome | Remission | Response |
| Primary period | Eight weeks | Three-week treatment phase |
| Comparison | Two augmentation strategies | Intravenous ketamine versus ECT |
| Essential limit | Not every ketamine-related intervention | Not every depression or ECT population |
For a family choosing care, comparing the largest percentages across these trials would be less informative than understanding which question each trial answers.
Switzerland: prosperity did not mean distress disappeared
The 2023 Swiss Health Survey release described observations collected in 2022. Medium or high psychological distress increased from 15% in 2017 to 18% in 2022. These repeated surveys do not follow the same individuals into illness or recovery. [3]
The difference is three percentage points, not three percent. The country’s prosperity does not identify the personal wealth of respondents or explain the change by itself. [3]
For affluent families, this supports a careful question rather than a stereotype: what does the person actually need? National reputation cannot serve as an individual health assessment, and private treatment requires its own clinical justification.
Family involvement had evidence, with specific boundaries
A behavioral couples therapy review published in 2023 included twelve studies comprising nineteen randomized trials in alcohol or drug-use disorders. It reported benefits on substance-use and relationship measures, but the effect sizes differed by outcome and period. [4]
| Outcome | After treatment | Twelve months |
|---|---|---|
| Relationship satisfaction | Hedges’ g = 0.45 | g = 0.31 |
| Substance-use frequency | g = 0.17 | g = 0.32 |
| Substance-use consequences | g = -0.28 | g = -0.34 |
These are standardized effects, not percentages recovered. Negative consequence values favor fewer harmful consequences under the review’s coding. They cannot be added into one success score. [4]
The evidence concerns structured interventions, not every conversation involving relatives. A family update can be useful without inheriting the result of a tested therapy.
For family-funded care, define participation, goals, and information sharing before treatment. A patient’s experience and a relative’s reassurance can differ. Neither should silently replace the other as the outcome.
The intervention offered and the intervention received differed
A small 2023 alcohol-treatment pilot enrolled 35 patient-family pairs and adapted an intervention into three planned sessions. The average received was one, while six pairs received none because of scheduling conflicts or discharge. Four-month outcomes were preliminary and did not move uniformly across drinking and family measures. [5]
The delivery gap does not prove that the intervention is ineffective. It shows why a brochure’s schedule and actual care should be reported separately. [5]
A family with substantial resources can still face timing, preference, and relationship barriers. Support should be workable and consent-based, not simply extensive on paper.
Later evidence about 2023 must keep its later date
Some useful information about 2023 was not available during that year. A retrospective can include it if the distinction is explicit.
Qatar’s primary-care study, published online in November 2025, reported 1,119,006 anxiety screenings and 1,107,551 depression screenings during 2023. These categories overlap and do not count unique new diagnoses. Its first-appointment attendance figures were engagement measures rather than recovery rates. [6]
The chart is later evidence about the reporting year, not a claim that these findings were published in 2023. [6]
That rule applies across the library. A data-collection year, source release, journal issue, and THE BALANCE publication date are distinct. Moving the date without explaining the source can turn a careful retrospective into misleading current news.
What the regional evidence does and does not establish
For UK and US readers, the direct treatment comparisons illustrate the value of an appropriate comparator. They do not measure every national service or establish a superior destination for treatment.
Germany, Switzerland, and the Netherlands are also relevant to families comparing European care. The same clinical question should lead the choice: what fits the patient’s needs and what evidence applies to the actual program?
For Saudi Arabia, older citizen-survey findings remain historical context, not current prevalence. The 2020 treatment analysis reported 13.7% past-year treatment use among respondents with a disorder. It is not a 2023 or HNW-specific recovery measure. [7]
The UAE, Kuwait, Bahrain, and Oman should not be assigned that percentage or another country’s outcomes merely to complete a regional table. An evidence gap in this selected review is not proof of no care, no need, or poor quality.
The practical regional comparison is between defined pathways and comparable populations. Citizens, residents, expatriate groups, clinic patients, and high-net-worth households are different denominators.
The client-group question is what resources change
Financial resources can make additional assessments, travel, or time away possible. They cannot identify a diagnosis or convert an average trial result into a personal prediction.
A senior role may make continuity and discretion especially important to the person. It does not justify assuming that executives are uniquely ill or respond differently to treatment.
Ask whether additional spending addresses an assessed need. More clinicians may improve access to expertise, but the plan should identify who reconciles their recommendations. More sessions should come with a purpose and review points rather than being treated as evidence of effectiveness.
The same distinction protects the patient from a false choice between expensive and legitimate care. Price alone neither validates nor discredits treatment. The relevant evidence concerns the proposed intervention and the people it is intended to help.
Recovery needs more than a favorable discharge assessment
An early endpoint can provide useful evidence while leaving later functioning unresolved. A person may return to work, family responsibilities, or another country after the primary trial period.
A longitudinal outcome report should state what care continued, which measures were used, and how many eligible people could be assessed. Missing information should remain visible rather than become an assumed success.
It should also distinguish symptom improvement, remission, recurrence, functioning, satisfaction, and personal goals. Those measures can move in different directions without making any one of them useless.
Continuing-care research provides relevant context for substance-use treatment, with varied interventions and effects. It supports examining the pathway beyond an initial program, not an undefined promise that every form of aftercare ensures recovery. [8]
A family office can organize logistics without replacing clinical responsibility
Appointments, travel, accommodation, and information requests can require careful coordination. A family office or adviser may help with these tasks while qualified clinicians retain the clinical role.
The patient should understand who is involved, what information is shared, and how consent is handled. The person funding treatment should not automatically become the only person defining success.
Where care crosses borders, confirm that a receiving clinician has accepted responsibility and that the proposed arrangement fits the applicable requirements. A referral list and an accepted handover are different things.
These are practical standards for evaluating a plan, not findings that every international family experiences fragmentation. Original research would be needed to quantify that experience in a defined client group.
The evidence questions a provider should answer
| Question | Useful disclosure |
|---|---|
| Who was treated? | Eligibility, diagnosis, severity, and previous care |
| What was delivered? | Actual intervention and clinical responsibilities |
| What improved? | Defined measures and relevant patient goals |
| Compared with what? | A defensible comparator, where a comparative claim is made |
| For how long? | Observation period and subsequent treatment |
| Who was missing? | Departures, follow-up coverage, and handling of unknown outcomes |
These questions apply to THE BALANCE too. A testimonial, comfortable setting, or high satisfaction rate cannot substitute for a clearly defined clinical outcome.
What changed, and what remained unanswered
The year’s treatment trials added meaningful comparative evidence. The Swiss release and family-intervention research added context about need, relationships, and actual delivery.
They did not establish a universal treatment hierarchy or an HNW-specific recovery rate. Nor did they show that the most intensive, novel, or expensive pathway is always the right one.
The valuable next step is to make those distinctions usable. An admissions conversation should translate evidence into the person’s clinical situation and explain how the plan changes if the initial approach is insufficient.
For journalists, the tension is not simply new treatment versus old treatment. It is the difference between a clear, tested comparison and a broad commercial promise. That remains an important question even when a trial’s result is positive.
The bottom line
2023 offered new options and better comparisons without eliminating uncertainty. For affluent and internationally mobile families, the strongest decision is not necessarily the one involving the most care. It is the one with a defensible rationale, understandable evidence, patient-defined goals, and continuity beyond the initial treatment setting.
For journalists
Reporting year: 2023. This is an October 2026 retrospective, not a contemporaneous publication.
Key distinction: eight-week remission in ESCAPE-TRD and three-week response in ELEKT-D cannot be ranked as the same outcome.
Later evidence: Qatar’s 2023 screening counts were published in 2025 and are explicitly labeled as such.
Suggested attribution: THE BALANCE retrospective analysis of published treatment and population research. No original clinical or HNW survey findings are claimed.
Methodology and sources
This selective narrative report distinguishes 2023 developments, older context, and later evidence about the reporting period. It preserves source populations, outcome definitions, and timing rather than pooling incompatible figures. Charts reproduce reported results and simple arithmetic; no provider ranking, individualized prediction, or causal national explanation was calculated.
The clinical comparisons describe specific research strategies, not instructions to change treatment. Patient decisions require appropriate assessment. Original survey and program-outcome claims would require their own data and methods.
- Reif and colleagues. Esketamine nasal spray versus quetiapine for treatment-resistant depression. 2023.
- Anand and colleagues. Ketamine versus ECT for nonpsychotic treatment-resistant depression. 2023.
- Federal Statistical Office. Swiss Health Survey 2022, reported in 2023.
- Song and colleagues. Behavioral couples therapy for alcohol and drug-use disorders. 2023.
- McCrady and colleagues. Brief family-involved alcohol treatment pilot. 2023.
- Al Abdulla and colleagues. Qatar PHCC integration and screening, including 2023 observations. Published November 29, 2025.
- Al-Habeeb and colleagues. Historical treatment use in the Saudi National Mental Health Survey. 2020.
- McKay. Impact of Continuing Care on Recovery From Substance Use Disorder. 2021.
