Tolerance – When Psychiatric Drugs Stop Working
There is an interesting, if perhaps disturbing, phenomenon in psychopharmacological drug treatment. It is the instance where a person initially has a satisfactory response to a medication, getting well, and perhaps staying well for years, only to have the illness come back at a random time in the future. The medication just “stopped” working. We have known about this for a long time with many drugs including antidepressants and anticonvulsants (mood stabilizers) and it’s sometimes referred to as antidepressant “poop-out” (I kid you not).
But this phenomenon goes against even the most basic understanding of medication, so why is it happening?
Tolerance to Medication
More scientifically, this is seen as tolerance to the medication. Tolerance induces a state where the same dosage of a given drug will no longer produce the desired effect and more of the drug, or a different drug, is needed. This is a physiological process and not necessarily indicative of addiction. This will happen with every substance you consume from sugar to coffee to fluoxetine (Prozac).
Tolerance happens because your body adjusts to the drug. Your body actually starts to produce more, or less, of chemicals in response to a drug in an attempt to keep your body at a neutral point (homeostasis). For example, one cup of coffee might have once given you energy, but now, you need two cups of coffee to feel any difference. This is tolerance thanks to the magic of your body. (The same thing can be said of tequila shooters.)
Tolerance is frequently seen to the side effects of medication. For example, when you start an antidepressant, you may get headaches, but after three weeks of being on the medication, that side effect goes away.
And this example with antidepressants and headaches makes sense. When you introduce the drug to your body, your body compensates, and you see tolerance gradually over time. But this is not the case when medications work for prolonged periods of time such as months, or years, and then spontaneously stop working. This prolonged wellness followed by spontaneous tolerance is something we just don’t understand.
No one knows exactly how many people suffer from spontaneous tolerance, but in my experience the number is quite high over long periods of time. It can happen to anyone and does not indicate anything is wrong with the patient or the medication.
What to Do About Tolerance
No one really knows what to do about tolerance either. Sometimes switching to another medication in the same class or another medication in a different class is successful. Sometimes it isn’t. Sometimes a dosage change helps. Sometimes augmentation with another medication is the way to go. Unfortunately it puts people in the position of grasping around in the dark for another medication or medication combination and this can take months to find, all the while the person is suffering from their illness.
The one thing I can say is that an interesting piece of research suggests that spending some time off the medication and then restarting the medication can make it effective again. Do not take this as a recommendation – I recommend you work with your doctor to find the right solution for you. But if you are suffering from spontaneous medication tolerance, I recommend you read or talk to your doctor about this article. (It’s probably too scientific for some, but that’s OK, that’s what doctors are for.)
Tracy, N. (2012, May 14). Tolerance – When Psychiatric Drugs Stop Working, HealthyPlace. Retrieved on 2019, September 21 from https://www.healthyplace.com/blogs/breakingbipolar/2012/05/tolerance-when-psychiatric-drugs-stop-working
Author: Natasha Tracy
I'm not suicidal or anything, but my brain is in a constant cycle of feeling nothing to feeling too much, which is so exhausting. I just want something that works.
Vs chemical depression that one would think that would need a prescription. But is there a way to change the brain chemistry if the medication is not working without medication. ..??
What is the root of the depression??
How, when and why did the depression start?
Is it thinking certain thoughts that fuel that depression?
I'm sure there is not a one size fits all solution but I def think medication is overused these days.
It seems like everyone is medicated these days and that's not the way it always was. It seems there are more side effects on a medication and problems then then initial first problem...that started one thinking about seeking medication.
There are def people who need medications and can't live without it and need medication to stay stable. (bi-polar,schizophrenia..others)
But if one is trying to coverbad feelings with a medication when there is a source that needs to be looked at and possibly dealt with the depression could be the side effect of not dealing with what is actually depressing you....
t live like this anymore. I hope every night I ho to bed, I don't wake up. I think about ending it so often now, it scares me. I even think about when would be a good time to do it and keep telling myself, I need to be here for my daughter's high school graduation. I use to think that people who killed themselves were selfish, but lately, my thought's are who are really the selfish ones here. Your loved ones should never want you to be in such pain 24-7, but they still call you selfish if you were to do it. I call it "ending your suffering" I love my family and I don't want to die. I want this back under control so I can enjoy the rest of my mom and dad's lives and embrace life with my children and husband. Is there anyone out there that can help"? maybe has heard of successful meds? I really don't know how much longer I can live with this. Every morning my thoughts tend to be pulling me towards the negative.
I'm so sorry you're in that situation. I've been there, more than once. There is hope and there is help. I would recommend you try a new doctor. The fact is, there are many options out there aside from lamotrigine, not to mention many cocktails.
I am very familiar with this as I wrote about all the evidence-based options in my book. I highly recommend you look it up. (It's not, in any way, affiliated with HealthyPlace.) It's here: https://www.amazon.com/Lost-Marbles-Insights-Depression-Bipolar/dp/1539409147/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1520698779&sr=1-2-ent (You'll find the medication options outlined in the appendix. Discuss those options with your doctor.)
Also, please know there is always help for your suicidal feelings. Reach out. There are many hotlines and numbers listed here: https://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-referral-resources/
I understand wanting not to wake up. I have felt that feeling for years at a time. But it _can_ get better.
- Natasha Tracy
Being able to talk about your feelings with someone could help.
The point here is that all these things are, as they state, "treatments". They are not cures. Through my amature studies I have drawn a very strong but humble opinion: there will not be a 'cure' for psychotropic issues (and other illnesses for that matter) until we find a way to safely and effectively understand and then rewire the individuals genetic makeup. It is in fact our genes that tell the CNS how much serotonin, dopamine, etc. to produce. Introducing an outside agent to modify it will last until the genetic programming readjusts the amounts to get everything back in back in balance.
Unfortunately I don't think the above hypothesis will be proven in my lifetime (I am 41 now, 42 on March 28th), but I can see no other way to permanently modify the neurochemicals that take away the depression-anxiety-OCD, etc. I am personally just happy we have some things that help us for a while before having to look elsewhere.
Please, please call your doctor immediately. I don't know what your doctor will do, of course, but I can tell you that mine wouldn't hospitalize me in that situation - but it's _important_ you deal with it now before you get to the point when you _really_ need the hospital.
Ignoring the problem will just let it get worse and not make it better.
- Natasha Tracy
I never really felt any improvement with medication, but I do feel worse after I stop?
I wasn't well while taking them, but I am worse without them, but that is not enough for me to convince me to keep taking them. I need to feel OK, not good, but at least OK.