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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by inanimate peanut on December 29, 2009, at 21:34:01
I've been wondering about this. When our meds stop working, why is that? Is our brain no longer producing a certain chemical-- did we use it up? For example, is the reuptake now completely blocked but we just don't have enough serotonin period? Or is the drug just no longer effective in its role as an antagonist/agonist at a certain cite- the chemical is there but the drug is no longer acting as it should?
I wonder this because the difference between Geodon (which worked for me for 1.5 months wonderfully) and Seroquel (which does nothing but put me to sleep) is Geodon's antagonism at the 5-HT-2A cite. This is also one of the targets of Remeron, which my doc wants me to try. So, if Geodon just burnt my brain out then the Remeron would be useless, but if Geodon stopped working because the drug just didn't act appropriately as an antagonist anymore, maybe the Remeron would come in and help. I should just stop thinking about it until I try it.
Posted by RocketMan on December 29, 2009, at 21:53:30
In reply to Why do meds stop working?, posted by inanimate peanut on December 29, 2009, at 21:34:01
I can't explain why meds stop working, that is the million dollar question we all try to answer.
I may be out to lunch with my Remeron theory, but, I believe it is an excellent augmenting agent. I agree with my p/doc that on it's own, it has a poor track record all though some do fine with just it as their primary A/D.For me, it seems to work as a magic powder, boosting the primary A/D. I find it takes 4 - 6 weeks before I notice a remarkable lift in mood. I often look at Remeron as more of a mood stabilizer but whatever, or, however it works, I'll take it.
Rocket
Posted by Phillipa on December 30, 2009, at 0:27:37
In reply to Re: Why do meds stop working? » inanimate peanut, posted by RocketMan on December 29, 2009, at 21:53:30
As I took a shower was thinking about all classes of meds not just psychiatric meds and then added men and women and ages. I haven't heard of let's say thyroid pooping out needing adjustments yes, or does blood pressure medicine poop out or have to be raised and diabetes raise insulin but poop out? And to me seems the whole endocrine system is responsible for so many functions in the body. Seems women effected more than men but is that true? Thyroid also seems commom with psyciatric illnesses why? So many questions and lack of answers. There is a missing link. Phillipa
Posted by julie1977 on December 30, 2009, at 4:47:17
In reply to Re: Why do meds stop working?, posted by Phillipa on December 30, 2009, at 0:27:37
My theory is that our brains know homeostasis and are constantly striving to get back to their own personal natural state, albeit depressed. Medication is an external influence which may work for a while but sooner or later the 'natural' functioning of our diseased brain is going to be reestablished. In terms of neurotransmittors I believe the brain is working against them and its only a matter of time before the depressed state is reestablished. Not very scientific I know but just a hunch I have.
Posted by RocketMan on December 30, 2009, at 14:04:50
In reply to Re: Why do meds stop working?, posted by julie1977 on December 30, 2009, at 4:47:17
Meds are static in that their ability to deliver a given action is fixed. Our thoughts are dynamic in that they are a result of ever changing actions, whether internal or external. So, sooner or later, the once effective med just can't keep up with our bodies ongoing change...... hence, poop out?
Rocket
Posted by linkadge on December 30, 2009, at 16:33:31
In reply to Re: Why do meds stop working?, posted by RocketMan on December 30, 2009, at 14:04:50
Because they're not fixing the core issue. As such, long term administration only leads to futher imballences.
Linkadge
Posted by SLS on December 30, 2009, at 19:51:07
In reply to Re: Why do meds stop working?, posted by linkadge on December 30, 2009, at 16:33:31
> Because they're not fixing the core issue. As such, long term administration only leads to futher imballences.
Unfortunately, that sounds about right.
- Scott
Posted by Phillipa on December 30, 2009, at 19:54:37
In reply to Re: Why do meds stop working?, posted by SLS on December 30, 2009, at 19:51:07
So what is the core issue? And does this mean a person is born to either be depressed or anxious in some cases? Why do people I see in real life take an ad and then stop them and they are fine? What about post partum depression? The moms take a med and then don't need it anymore, or PTSD? Some take no meds like my Son? Some take for alchohol and then go off also? Phillipa
Posted by janejane on December 30, 2009, at 20:19:06
In reply to Re: Why do meds stop working?, posted by linkadge on December 30, 2009, at 16:33:31
Yeah, what Phillipa said. What do you guys think are possible core issues? Lately I've been wondering a lot about the kind of stuff that bleauberry talks about.
Posted by SLS on December 30, 2009, at 20:28:06
In reply to Re: Why do meds stop working? » linkadge , SLS, posted by janejane on December 30, 2009, at 20:19:06
> Yeah, what Phillipa said. What do you guys think are possible core issues? Lately I've been wondering a lot about the kind of stuff that bleauberry talks about.
Perhaps I misunderstood Linkadge, but I interpreted his statement to mean that the core issue represented the primary biological pathology that produces dysregulation. I don't think he was speaking of psychological issues. I could be wrong.
What kind of stuff does Bleauberry talk about that you are now wondering about?
- Scott
Posted by Phillipa on December 30, 2009, at 21:33:35
In reply to Re: Why do meds stop working? » janejane, posted by SLS on December 30, 2009, at 20:28:06
My take on BB is the infectious component, allergies, low doses of meds, diet. Next//// Phillipa
Posted by hyperfocus on December 30, 2009, at 22:23:00
In reply to Re: Why do meds stop working?, posted by Phillipa on December 30, 2009, at 0:27:37
You're right. Imagine if our diabetes or heart disease meds or any other meds we rely on behaved in our body the way ADs behave. Half of us wouldn't be here.
Posted by RocketMan on December 30, 2009, at 22:24:25
In reply to Re: Why do meds stop working? » SLS, posted by Phillipa on December 30, 2009, at 21:33:35
Globally, I believe meds do a pretty darn good job. Of the millions that are treated daily, only a small percentage show up at Boards such as this. I would venture to guess that a large percentage of the population lead a productive lifestyle with the help of psychiatric medicine. It is unfortunate that some become treatment resistant, but that could be said for numerous chronic illness's/diseases. We have to look at the larger picture and be thankful for what little choices we may, or may not have.
Rocket
Posted by hyperfocus on December 30, 2009, at 22:31:33
In reply to Why do meds stop working?, posted by inanimate peanut on December 29, 2009, at 21:34:01
That's why the advice I never get tired of giving is, if you're feeling better stay on your meds. Do not adjust, flip, swap, reduce, remove. No matter how logical it is or how trivial it is. If you have serious side-effects consider treating them with other meds if possible. If you stop a med there is a very high probability it will not work for you when you come back to it.
I don't know why this is but as others have said there is probably some systemic process that is hidden under pharmacological scientists playing whack-a-mole with neurotransmitters. Maybe we don't have the theoretical tools as yet to understand this since it is occurring at the brain/mind boundary. Maybe in the future we'll look at SSRIs the same way we look at cold baths and lobotomies now.
Posted by inanimate peanut on December 30, 2009, at 22:45:48
In reply to Re: Why do meds stop working?, posted by hyperfocus on December 30, 2009, at 22:31:33
hyperfocus, why weren't you in my life 1.5 years ago when I decided to go off lithium because "I didn't think it was really helping" (even though it was the first drug I ever got partial benefit from) and "it upsets my tummy". As I've said on this board before... if I could change any single decision in my entire life, that would be it!
Almost every time I go off a med, I turn out to mess up something, and then "just putting the med back" doesn't work. This is the way I have burnt out Effexor, Lithium, Celexa, Lamictal, Lexapro, and now probably Pristiq and Wellbutrin. Why oh why can't I leave S*&( alone!!!
Posted by willey on December 31, 2009, at 2:36:02
In reply to Re: Why do meds stop working?, posted by hyperfocus on December 30, 2009, at 22:31:33
"Maybe in the future we'll look at SSRIs the same way we look at cold baths and lobotomies now"
This is a outstanding statement,one i believe will be the case,especialy since no scieance at all is used when even choosing these toxic drugs....oops mean meds.
One thing i read,wish i had it,was a study concluded that even after one year of stopping prozac the patients brain had a enormous amount of the drugs residue still in the brain.
Also with prozac to be the scapre goat,have read from very reputable source that tons and tons of toxic data,as well as data showing no effectivness
and so on was and is kept from the public by eli lilly.Joke i heard goes,one man asks another
"are you bipolar?"
man answers "no"
man replies
"well once u take ur first psych drug,u will be"
Bipolar since the introduction of ssris has blasted in numbers,so much that we now of course have to actualy label then by numbers,i.e bipolar 1,bipolar 2,and in additon now we have combos,bioplar 2 pscotic etc
Hell seems like pretty soon everyone in treatment will be bi polar.......oh you are taking the drug but now are hyper,hmmm i believe ur bipolar.
Where were all these specifics terms prior to ssri use.
Personaly parnate or another maoi will be the only anti depressant i will touch until significant advances are made.
thanks for ur post!
Posted by janejane on December 31, 2009, at 5:56:41
In reply to Re: Why do meds stop working? » janejane, posted by SLS on December 30, 2009, at 20:28:06
> What kind of stuff does Bleauberry talk about that you are now wondering about?
>
>
> - Scott
>Infection, mercury from amalgam, dietary factors, etc.
For me, personally, I doubt Lyme is involved (grew up in a non-tick area and my depression preceded my moving to one), but candida seems like a possibility.
I also had a really bad sugar habit which led to a lot of silver fillings over the years. (Of course candida thrives on sugar too.) Despite what the ADA says, I think that in susceptible people (who have bodies that aren't good at detoxifying themselves perhaps), having all that mercury in one's mouth can't be good.
I do wonder about possible food allergies, and have been trying to put less junk in my body. I suppose what I really should do is try an elimination diet, but I haven't had the guts to do it.
Though I'm not sure Bleauberry has talked about it much, I also see hypoglycemia as a possible factor for me as I almost always wake up hungry and irritable and often feel at least a little better after eating. I get cranky during the day if I don't eat every few hours too, or if I eat sweets without having a large meal first.
Posted by janejane on December 31, 2009, at 6:14:23
In reply to Re: Why do meds stop working? » SLS, posted by janejane on December 31, 2009, at 5:56:41
Oh yeah, I forgot to mention... like Phillipa noted in another recent post, hormones might play a role too.
Posted by SLS on December 31, 2009, at 6:49:03
In reply to Re: Why do meds stop working? » SLS, posted by janejane on December 31, 2009, at 5:56:41
> > What kind of stuff does Bleauberry talk about that you are now wondering about?
> >
> >
> > - Scott
> >
>
> Infection, mercury from amalgam, dietary factors, etc.
>
> For me, personally, I doubt Lyme is involved (grew up in a non-tick area and my depression preceded my moving to one), but candida seems like a possibility.
>
> I also had a really bad sugar habit which led to a lot of silver fillings over the years. (Of course candida thrives on sugar too.) Despite what the ADA says, I think that in susceptible people (who have bodies that aren't good at detoxifying themselves perhaps), having all that mercury in one's mouth can't be good.
>
> I do wonder about possible food allergies, and have been trying to put less junk in my body. I suppose what I really should do is try an elimination diet, but I haven't had the guts to do it.
>
> Though I'm not sure Bleauberry has talked about it much, I also see hypoglycemia as a possible factor for me as I almost always wake up hungry and irritable and often feel at least a little better after eating. I get cranky during the day if I don't eat every few hours too, or if I eat sweets without having a large meal first.
I looked at those things with the exception of amalgam tooth fillings and testosterone level. I did the rotation diet. It is very inconvenient, but might be worth the effort. I tested positive for hypoglycemia as a teenager, and I adjusted my diet accordingly. I tried doxycyline and Nystatin therapy. None of these things helped me.Many people use the expression that depression has many faces. This is true. However, I think it is equally true that many depressions have the same face. There are conditions other than the affective disorders that present depression as a symptom.
I doubt that such statistics exist, but I am willing to bet that the overwhelming majority of people who present with a symptom cluster that matches a diagnosis of major depression or bipolar disorder are indeed suffering from those illnesses. It is for the sake of the minority that more extensive diagnostic algorithms should exist.
- Scott
Posted by janejane on December 31, 2009, at 10:33:54
In reply to Re: Why do meds stop working? » janejane, posted by SLS on December 31, 2009, at 6:49:03
> Many people use the expression that depression has many faces. This is true. However, I think it is equally true that many depressions have the same face. There are conditions other than the affective disorders that present depression as a symptom.
>
> I doubt that such statistics exist, but I am willing to bet that the overwhelming majority of people who present with a symptom cluster that matches a diagnosis of major depression or bipolar disorder are indeed suffering from those illnesses. It is for the sake of the minority that more extensive diagnostic algorithms should exist.
>
>
> - ScottFair enough.
You said in another post: "Perhaps I misunderstood Linkadge, but I interpreted his statement to mean that the core issue represented the primary biological pathology that produces dysregulation." -- Is this something that can even be addressed, or are we just not there yet? Do meds just treat symptoms? Do you believe as linkadge earlier suggested, that long-term administration just leads to further imbalances?
By the way... Peanut, this is a great thread you started!
Posted by bleauberry on December 31, 2009, at 11:26:42
In reply to Re: Why do meds stop working? » janejane, posted by SLS on December 31, 2009, at 6:49:03
To followup on janejane and SLS discussion, I think it deserves mention that psychiatric medications can, and sometimes do, completely ameliorate the symptoms of other diseases such as Lyme or amalgam illness and MS. A lady at a med review site with MS had all of her pains and fatigue disappear on Parnate, for example. Some doctors find Modafinil is the most common med they prescribe to help Lyme patients for energy and brain fog.
Depression in Lyme disease is treated the same way as any other kind of depression. Depression from amalgam illness, hormones, food intolerances, etc, are all treated with the same psych drugs. Sometimes very well, maybe I'm guessing 25% remissions, 50% improvements, my own rough estimates. If nothing else, they can lessen symptoms and make life more manageable. Maybe things can't always be restored 100%, but the potential to improve quality of life is real.
We never know how much permanent organic damage has been done, but psych drugs can still help quality of life.
Picture someone walking into a Las Vegas hotel, sitting down at the gambling table, and placing everything they own on one huge bet. I think that is the mistake that many psychiatric patients make. Disease is complicated and requires comprehensive strategies. Once in a while we see someone completely cured in days with the right magical meds. Those cases are far too rare to place big bets on.
Posted by SLS on December 31, 2009, at 13:04:08
In reply to Re: Why do meds stop working? » SLS, posted by janejane on December 31, 2009, at 10:33:54
> > Many people use the expression that depression has many faces. This is true. However, I think it is equally true that many depressions have the same face. There are conditions other than the affective disorders that present depression as a symptom.
> >
> > I doubt that such statistics exist, but I am willing to bet that the overwhelming majority of people who present with a symptom cluster that matches a diagnosis of major depression or bipolar disorder are indeed suffering from those illnesses. It is for the sake of the minority that more extensive diagnostic algorithms should exist.
> >
> >
> > - Scott
>
> Fair enough.
>
> You said in another post: "Perhaps I misunderstood Linkadge, but I interpreted his statement to mean that the core issue represented the primary biological pathology that produces dysregulation." -- Is this something that can even be addressed, or are we just not there yet?We are not there yet.
Scientists find so many biological anomalies associated with depression, I don't think they know where to focus their attention anymore.
> Do meds just treat symptoms?
I am probably in the minority, but I believe that antidepressants do indeed treat the illness as a global phenomenon rather than act as palliative care for individual symptoms. I think that these drugs are acting upstream of the primary pathologies, creating a cascade of events that leads to an improvement in neuronal dynamics and entire symptom clusters. In anxious depression for example, it seems to me that benzodiazepines treat the outward symptom of anxiety while antidepressants produce improvements in the core pathology that produces the entire symptom constellation, including the anxiety.
> Do you believe as linkadge earlier suggested, that long-term administration just leads to further imbalances?
I don't think I would extend that statement to all cases, but it certainly looks like there are changes that these drugs produce that are persist. Clues of this are the observations that one can experience antidepressanat poop-out or wind up resistant to a discontinued drug the second time it is employed. Something is made different by a drug between the time that the nervous system is initially exposed to it and when treatment resistance emerges. For me, I have seen persistent changes emerge from antidepressant use that involve autonomic function. I believe that tricyclic antidepressants have increased sympathetic tone and/or reduced parasympathetic tone.
One of my doctors recommended that I stay as "clean" as possible between trying new things. In other words, I should not play with old drugs that don't work very well while waiting for new drugs to become available. Unfortunately, new drugs were not coming out fast enough for me that I should risk wasting the rest of my life waiting and suffering.
- Scott
Posted by Phillipa on December 31, 2009, at 19:20:04
In reply to Re: Why do meds stop working? » janejane, posted by SLS on December 31, 2009, at 13:04:08
I do believe that hormones play a huge role as I was fine til menopause began. And with that the hasimotos thyroiditis emerged. Which then created high anxiety levels which eventurally led to vertigo and antivert and then crash bam first ad paxil l0mg. Three months for brain to tolerate it. Say tolerate as it was something not natural to my body. So for me personally I wish I'd never taken the first one. Gad has always been my diagnosis and tiny doses of benzos did fine and when thyroid med started on day l0 at work nursing my mind seemed to just open up, the anxiety lessened and down went the benzos? Betting that vertigo was a thyroid switch also since happened three months later. This is just my thoughts on me. Phillipa
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