Reasons For Dosage Increase Or Medication Change, Your Thoughts, Please?

[2quilt]

I had always thought that my depression and PTSD meds had to be changed or the dosage had to be adjusted because *the meds themselves* were not doing the job. I thought that the psych meds stopped working because I had heard that pain medication can become ineffective over time, and people will need a higher dose to releive the same amount of pain than before. The people on pain meds just keep increasing the dose until they are on morphine or die. I thought that psych drugs were similar to that.

Maybe not so!

I had a discussion with a M.D. about my beliefs and he said that no, a person with PTSD or depression gets a med dose adjustment (increase) or med change when their trauma triggers or life in general gets too overwhelming, either short-term or long-term. He said that antidepressants don't just stop working, like I had believed for almost my whole life.

What has been your experience?

 

[Grama-Herc]

Well, all I have to offfer is my meds have been the same for many years, I am on the max dosage allowed. My Xanax has been adjusted up and down depending on how I am doing and my doctor has finally given me semi free control. I only get so many per month based on 3 per day. Sometimes I need 3 and other times I don't, thank god I trust myself with this.

When I was first in hospital my physc meds were adjusted what seemed like daily, until they got me stablalized. The beginning is trial and error but once stable unless things just get really BAD I don't think they need ajustment very often, if at all, depending on how you are doing.

But then, this is just MHO based on experience. Plus, as we all know, every one is different in how they respond to treatment and meds.

 

[anni]

I thiink it also depends on the med? The SSRI's ( the Zolofts, etc.) I think act on the seratonin levels, and from what I understand isn't a matter of one's chemistry getting tolerant of them, like it does a narcotic.My T was trying to explain things to an art major ( me) hence a little dense with this stuff and said basically they trick your brain into producing the correct amount of seratonin. I don't know if that is right, but it made sense to me! :) I'm pretty sure the ones which help alter chemistry just pretty much continue to do that. The Lorazapams, etc. are a different class, and act on other things. I know you can get addicted to them, but not if one becomes tolerant. I had always assumed, like you, that THOSE kinds of meds one would become tolerant, too. I didn't seem to, in point of fact, when on them. I do think people's chemistrys are rather wildly different, and may react an awful lot differently than docs even think-just from having been on meds for so long. My Zoloft dose which works for me just plain should NOT-it's very low. My son has an anxiety disorder and his experience is the same.

I know one becomes tolerant of narcotics and some other meds, however. Now must go Google on the Xanax and Lorazapam!

 

[2quilt]

thanks! I appreciate hearing from others, as I dont trust completely my own beliefs. I am sometimes skewed.

 

[anni]

I get skewed, too, mostly by just going ahead and absolutely believing whatever it is someone tells me- then someone else tells you something ELSE, then another... sigh. Meds were making me so icky feeling years ago-took awhile to figure out perhaps once in awhile I was capable of forming a thought of my own. Still tend towards being a marshmallow- but a tougher one slowly these days. OH! that would be stale! Not a good analogy, is it?

 

[This Ends Now]

Variables

There are too many variables when talking about psych medication to pin this issue down to just one thing. I can try to cover some of the reasons and results from my experience and the experiences of my family members. The most important reasons to change medication are that they stopped working, never worked to begin with, cause too many side effects, or you are starting to develop an addiction.

There could be many reasons a medication can stop working. The most obvious one is tolerance as is frequently the case with sedatives and sleep medication. Your medication could also stop working if it interacts poorly with another substance you are using, for example birth control pills do not work when they are mixed with antibiotics. A much less talked about possibility is the fact that generic medication is not the same as name brand medication. Generics are required by law to be relatively close to the original but even the smallest difference can have a huge impact. They are also not manufactured or tested in the same way as a new name brand drug. Generics reverse engineer an existing drug and only have to prove that is is within a "reasonable" margin of error. If you want to check on this try calling your local pharmacist and asking about the difference between name brand and generic. Odds are you will notice a decent amount of squirming around the issue (especially if you start to list problems you are having).

I can think of many examples of this with antidepressants such as SSRIs. When generic Prozac first came out I was thrilled at the reduced cost. Unfortunately once I started taking it I found that it just did not produce the same effect. No matter how much my doctors increased the dose the stuff just did not work like the old name brand Prozac had. I was completely confused by this until I talked with my mother. It turned out that she had been equally baffled by the same problem and had gotten no explanation from her doctor.

Luvox was an even bigger shock when my husband was switched to generic. The name brand Luvox had been like a miracle but the generic completely backfired! :mad: He went from being calm and relaxed to having even worse symptoms than before. He was also unable to sleep for several days on the generic which resulted in him having hallucinations.

Now both of us ask our doctors to wright "name brand medically necessary" on our antidepressants and they work just fine. Sometimes we have to wait for the pharmacy to special order the good stuff and we always pay triple the price but it is more than worth it. I am not suggesting that this is always the culprit or that you should never buy generic. Many generics work just fine and saving money is great. Just be aware that if your medication suddenly stops working a short time after trying generic you might have to go back to the original.