Medications Whose Effects Change Markedly Over Time

I have wanted to post this for a long time. I have had the experience of having a number of my meidcations work very differently for me as time marches on. Usually, not as well. Sometimes, they start doing almost the opposite of their intended purpose. For example, some meds that used to make me manic occaisonally now, they will put me to sleep. Very reliably. Weird.

I don't know why this happens. Has my brain changed over time? Is my bipolar illness different now in some ways? I have no idea, but was wondering how others' experiences have been. I am sure I am not the only one. I suspect this is why I am always having to change my medication around or something.

Yes, it's known as "medication poop out."

Unfortunately, that has been my experience with possibly all psych meds I've been on, sooner or later. If we're fortunate the medication has room for an increased dose, which is one reason why many pdocs try to use the lowest dose possible to treat symptoms.

In my experience, sometimes the increase will work for awhile, but oftentimes not as well as the original prescription worked.

Many years ago it was standard for psychiatric patients to take "medication breaks." The hope was to reset the brain so that when the drug was reintroduced it would again be effective. The breaks were almost always done when patients were in long-term psychiatric hospitalization, however. Unfortunately, the med breaks usually did more harm than good and weren't as effective as hoped, which is why med breaks fell out of popularity.

I believe that the loss of medication effectiveness is due to the body building up a tolerance for the medication.

Also, it's possible for our minds build up a "tolerance" for medication. i.e., We feel like a med is no longer working because we've taken it for a long time. But that's debatable.

For people with BD it seems to me to be especially challenging. Most of us require a reassessment of our meds fairly often due to mood states; on top of that, there's the poop out effect, which requires even more med adjustment.

It all takes patience, that's for sure.

Almost 50% of BD patients are not med-compliant, which can lead to "kindling." Another potential medication issue.

Medication poop-out. I like it!!

Definitely,- pooped out, I have heard that and they have done that with me.

I've experienced medication poop out quite a bit usually pretty quickly. So far so good with Risperidone, although I have had my dose increased a bit.

How long hve you been on it, spikes?

Since October of last year

I relate to pretty much everything BethRags wrote, except that I wouldn't say that all medications I have been on in the past "pooped out" on me. But a number. Sometimes I was forced off of medications because of severe side effects. Just a few examples I have where the medication ceased being helpful because of either "poop out" or not being an adequate "moodstabilizer" for me are:

Depakote - Did a great job at finally squashing years of mania (along with Invega), but then didn't prevent the eventual crash into a pure depression, for me. I don't blame Invega for the crash.

Lamictal and Abilify - They certainly lifted my mood out of a brief period of depression, but then I kept going up, up, up, as my Lamictal dose went up to 300 mg, and then was in the hospital very manic and psychotic. That time really sparked the kindling effect and I had four hospitalizations in a short period of time for extremely severe episodes. Abilify's role? Well, it certainly didn't curb the mania. I do know that Lamictal is very activating for me. A few trials have shown this clearly. Lamictal is helpful for me, but only at low doses WITH at least a very powerful antimanic antipsychotic and moodstabilizer. I do not regard Lamictal as being helpful at all for curbing my bipolar mania, only being a possible catalyst for it.

Geodon - I was on this med very briefly maybe 12 years ago, but was taken off quickly. I don't remember why. Then it was added to Lithium and seemed fine as an antimanic for a brief time. Then it pooped out at its maximum recommended dose of 160 mg, so my psychiatrist added a second antipsychotic with it. I had also been put on Tegretol and the small dose of Lamictal by then. Actually, the second antipsychotic was added to prevent the hypomania I was starting to experience from the rise to 100 mg Lamictal addition.

Thanks, everyone!!!! So, do people think pretty much it's the meds that poop out, our our own brains that poop out? It could be either one, right?

I’ve had meds poop out. The risperal&haldol combo for
Psychosis seems to be good for now

I tend to think it is our brains. However I honestly can't say exactly why I feel that way, only that I know what my brain feels like when a med is working and when it has changed and isn't working anymore.

I never had an AD work for long until Emsam which my pdoc tells me rarely poops out. I don't know why but she just says that's been her experience and I'm nearing 11 years on it so it seems to be stable for me. Of course clozapine is also stable for me so maybe it's not my brain and is the drugs. I'll have to try to remember to ask her next time I have a chance.

I believe it is my brain, personally. I think it has changed. A lot. Very happy Emsam worked for you. I was told it would be my miracle drug, but all it did was nearly kill me with a hypertensive crisis. No mood affect whatever, sadly.

Tough question for me. I suppose it's the old every body is different...

There are plenty of meds that I didn't stay on due to side effects - or, more frequently, because they simply didn't help in any way. The meds I've stayed on for years...it seems to me that eventually they would stop being effective. I would have to switch to a different medication.

So. Brain? Med? Med combination? Diagnosis? Circumstances at the time?

I've always had a theory that "nothing is ever one thing." Keeping in line with that, I'd say that med poop out is all of the above. What would be interesting to figure out is the percentage of each cause that contributes to the effect of poop out.

Oddly enough, I had a dream last night that all my medication stopped working and I was horribly manic and psychotic. And nothing we tried would help. It was so awful. I really hope that doesn't happen to me. What would I do if it did?

Well if it happens it happens and then you can start fresh.. 7-8 Years ago I was on 6 meds a day, and after about 6 months of being unstable and adding meds here and there.... I didnt know if a couple were even doing something anyway and my Pdoc agreed.

So we weaned off them all taking into consideration half life and the time for my brain to go back to function sans meds.. It wasnt easy but I wasnt stable on the 6 meds anyway so what the Hey ????

Anyways I went on Invega and stayed on lamictal 300mg ER and it did level me out rather quickly and I found some damn calm waters..

One Plus of Invega was I had Zero dry mouth, I had to watch to make sure I wasnt going to drool.. and it was weight neutral honest to god.

I think often Pdoc's see a person in crisis and they add a med to try and level them out then before you know it your on numerous meds and still arent okay. Sometimes a person is over medicated and it needs to be addressed, All these meds swirl around our bodies and have there own interactions, that could cause us to have another problem and then Maybe another pill get added. Then its just a chemical mess.

Often time we need to wipe the slate clean and start again. start a med and dont add another for at least 3 weeks..

I know many people that do need 2 AP's one or more Mood stabilizers, a AD and then a need for a Benzo or add on for sleep etc..

I see alot of people that seem to have Pdocs that would rather have a patient tilted more towards a depression than work hard to get them at base line, some think its better to keep someone a bit snowed down , Not enough to the point they want to punch there ticket outta here , But low enough so there isnt a big worry that they flip hypo and climb right up the ladder to Mania and all the hell that can cause..

Thanks, Christina. yeah, i relate to a lot of this. Iam still just very confused about all my meds. I was blown away when BirdDancder said she thought Wellbutrin CAUSED depression in her. What? So, my antidpressant is making me worse?

We added depakote because I got manic and psychotic on lithium and ablifiy, which had worked well for years for me. Trilafon has helped, for sure, as has the depakote, but we did nto stop anything. We lowered the Abilify, which apparently has very different affects at different doses. Whatever.

Anyway, it is just very confusing for me. I know an awful lot about the pharmacology o fantideprssants, but not very much abot mood stabilizers or APs. Just not very knowledgable.

Right now, I am existing. I cannot write, cannot really keep the house up. Unable to work toward any life goals, few though they may be. I would sure prefer just a little but more functioning. That would be very nice.

Thanks for you rthoughts. I always appreciate your wisdom. I hope you have a day relatively free of misery and that you guys can breathe and sleep.

So imagine you're on Wellbutrin... It is a dopamine reuptake inhibitor. This means that the dopamine that is produced in your body is blocked from being recycled by the body as fast as it normally does so that it can help keep you happier longer. It would be like eating sugar and having the high last twice as long as usual. Over time, dopamine begins to build up which is meant to lift you out of depression...

So now your body realizes that it is not recycling the dopamine as quickly as it should and in response, your body generates more dopamine receptors to process the dopamine because it wants to balance and process normally as our bodies naturally seek homeostasis. Now you have more and more dopamine receptors processing the dopamine than before. If all you take is Wellbutrin this is what happens when you need more and more for the same effect over time.

Lets now assume at the same time you take Wellbutrin you are on a typical antipsychotic and it is a dopamine antagonist which means it keeps the body from producing as much dopamine as it did before. So now your body has more receptors for dopamine than it did and it wants more and more dopamine for the hightened feelings, but it no longer makes enough because you are blocking production with the AP.

This is kinda the perfect storm for depression. Decreased dopamine and increased demand for it. Your body cannot get the dopamine it expects, so you get depressed. So now what do you do? Lower the AP to allow for more dopamine, or increase the Wellbutrin?

It is like playing with one big chemistry set. The problem is the prescribers don't always factor in how the body changes to accommodate this stuff over time. There's no way for them to k ow how many receptors you have for any given neurotransmitter at any one time. It isn't always the chemicals that are imbalanced like they claim. Oftentimes it is the body's ability to use and effectively recycle the chemicals that is off.

So we talked about antipsychotic medication withdrawal the other day and how a withdrawal symptom is psychosis. The same imbalanced and body homeostasis response comes into play there as well. You take the AP for a long time and dopamine production is slowed and the body reduces the dopamine receptors to accommodate the decreased production rate. You then withdraw quickly without allowing the body to catch up by creating new receptors because the dopamine production is no longer blocked by the drug. There are many fewer receptors now and the brain gets flooded by dopamine and then BAM. Mania and psychosis return. A doctor sees this and puts you back on an AP to balance things back out when maybe this could have been avoided with a baby steps withdrawal process.

So... Hopefully that sheds a little light. Its all about supply and demand and how the body shifts to accommodate. Our bodies get out of whack all of the time, but our bodies shift to accommodate. Culturally, we are quick to medicate without allowing our minds and bodies time to rebalance. We do a lot of damage that way in my humble opinion. We get ourselves stuck in these med dependent teeter totter loops that are hard to get out of... Sometimes I think providers forget to take a step back and look at the big picture.

Thank you for the explanation, fern. In my opinoin, my brain seems permanently broken and unable to "rebalance" or whatever that is. I was just manic and psychotic for like, 8 months on all these meds. Maybe I should have stopped them all and then, would have gotten better? Dunno, rally. No idea. Way too hard for me to figrue all this out.

That said, if your general explanation is on the money, then, I foind this all incredibly depressing and hopeless for me and others like me. As I hvae said, even though we did it completely wrong, I have already stopped all my meds once before and the result was disaster. Maybe had it been done more gradually... But that is very frightening fo rme.

I have survived many things in life, inlcuding being tortured. There is virtually nothing that frightens me. Almost nothing. But one thing I do remain scared of is my own brain. That terrifies me.

Yeah, I can appreciate that. It is the abyss I was staring into every time a provider told me this is my new future. I am this for life and will be on the meds forever is what they said. It may still be true. Who knows, but I won't label myself as broken.

As for permanently broken... I don't believe that, but I can see how you'd get there.

As far as no meds... That doesn't need to be a goal. If anything, I think it could be used as proof that you are not broken. Your body is shifting over time which is what it is built to do.
So I think maybe you can just use that knowledge to study the meds you're on and and then figure out the possibilities of what could happen when you make a change. You can know how to implement a change in a way that works better for you whether that means you decide to add more meds or lower some. Arming yourself with the possibilities ahead of time helps you to figure out your next move when one of them comes to fruition.

There is a balance possibility with meds and without it. Being off meds isn't some golden ticket you need to chase. In fact, it cpuld be detrimental. Sometimes people have genetic factors that make it such that they thrive with meds. That is nothing to be sad about.

Balance is a moving target with or without meds. Our emotional responses and thought patterns just do more of the controlling without meds... I'm just suggesting that the whole picture be considered when your needs change. That includes your thoughts, your feelings, outside influences, current meds and how they might interact and also shifts your body may have taken on its own. I realize that may feel daunting, so you can always leave it up to the experts... But they indeed are just guessing a lot of the time.

And then I also consider that maybe you don't need to figure it all out. Sometimes something complex can just stay that way when breaking it all apart leaves us feeling worse than when we started. If knowing how things work helps you, then great. But... They say ignorance is bliss for a reason

And... I feel you on the fear. My own mind was my biggest fear. I watched it turn itself inside out. I hold no judgment. It can be one scary ride.

I don't know what it is.

I was stable for a couple of years. Last year unstable.

Right before the covid stuff I asked my doctor to put me back on Zoloft. Now I have been stable again for 3 1/2 months.

The problem I have with Zoloft is that it will work for 3-4 years and stop. Then I would have to switch to Prozac. It would work for 3-4 years. Then stop. Then back to Zoloft. And the cycle goes on.

We will see this time. 2013 was the last time I was on Prozac. Was on a bunch of other things. Now finally am back on Zoloft.

However I am also on Memantine, quitiapene, ativan, zolpidem, NAC suppliment, all for psych.

Am on a lot of other meds for medical conditions.

Am hoping I will stay stable for at least a couple of years before having to go through med changes all over again.

I have no idea why they just can't work once and for all.