[DechanDawa]

I was talking to my oldest friend in the world today.

She mentioned that the lexapro she has been taking for 20 years is no longer effective even at the highest dose.

Has anyone else had this happen...and were you put on something else that was effective?

My friend doesn't really have much experience. Her primary care doctor put her on this med and she has never seen a psychiatrist for more information on medication.

[handheart]

You never should watch on a statistics ,if your friend dont feel good with this meds that not means you will not feel good .Every organism its so diferent ,for example some diets works at some people but at others not work the same it is with mes i think

[*Laurie*]

Hi DD, SSRI's used to help me tremendously. I'm talking 15-20 years ago. I'm now in my 50's and on Zoloft (I've been through all the SSRI's). I'm on the max dose of Zoloft and it doesn't help my depression or anxiety much at all. Frankly, I'm not quite sure why I even take it. I also take Latuda, which IS helpful. It is entirely possible that your friend's SSRI has 'pooped out'. A very frustrating and frightening situation for someone who suffers from depression.

My hope is that your friend will see a pdoc. Maybe there's no miracle for her/him, but possibly a pdoc would be able to offer more options that a GP does.

[DechanDawa]

Originally Posted by LauraBeth

Hi DD, SSRI's used to help me tremendously. I'm talking 15-20 years ago. I'm now in my 50's and on Zoloft (I've been through all the SSRI's). I'm on the max dose of Zoloft and it doesn't help my depression or anxiety much at all. Frankly, I'm not quite sure why I even take it. I also take Latuda, which IS helpful. It is entirely possible that your friend's SSRI has 'pooped out'. A very frustrating and frightening situation for someone who suffers from depression.

My hope is that your friend will see a pdoc. Maybe there's no miracle for her/him, but possibly a pdoc would be able to offer more options that a GP does.

Yes, it has definitely pooped out. I also think she has been taking it for a few years just to avoid withdrawal side effects. I know she has tried to come off a few times but never makes it. This really is a friend...and she is very sensitive to medication. She is also under a lot of stress because a family member is gravely ill. So I offered to see if I could gather some information. I think she really needs a psychiatric evaluation to determine the best medication combination.

[Cyllya]

The technical terms are "drug tolerance" and "tachyphylaxis." (Wikipedia and NIH.gov both describe the latter as acute sudden-onset tolerance, after a few doses, but I see it used more generally when I'm searching for info on PubMed. Maybe other counties define it differently? "Tolerance" is more general and includes the possibility of environmental factors. This paper summarizes some research about the phenomenon, but just the first page has an overview of the concept and terminology.)

This problem can theoretically happen with any drug. (It's a big problem with pain medications, and I also hear a lot of anecdotes about the problem with ADHD meds.) Different drugs have more or less of a problem with it, but a different drug's susceptibility for tolerance can vary from person to person as well. You can theoretically get continued therapy by switching to another drug, but that only works if there is another drug that would be effective. Also, there is a such thing as "cross tolerance" where different drugs can create tolerance to each other, but I'm not sure whether any antidepressants have that problem.

In many cases, tolerance reverses or decreases after abstaining from the medication for a while. So even if there's not another med that works very well, there might be one that's adequate temporarily (if only to treat the Lexapro withdrawal effects) so she can restart the Lexapro later.

She is also under a lot of stress because a family member is gravely ill.

Did her meds seem to be working fine prior to this situation? If her misery is proportionate to the situation, it might be they are still working fine.

If possible, it's probably a good idea for her to wait until her situation improves before making med changes.

[DechanDawa]

Originally Posted by Cyllya

The technical terms are "drug tolerance" and "tachyphylaxis." (Wikipedia and NIH.gov both describe the latter as acute sudden-onset tolerance, after a few doses, but I see it used more generally when I'm searching for info on PubMed. Maybe other counties define it differently? "Tolerance" is more general and includes the possibility of environmental factors. This paper summarizes some research about the phenomenon, but just the first page has an overview of the concept and terminology.)

This problem can theoretically happen with any drug. (It's a big problem with pain medications, and I also hear a lot of anecdotes about the problem with ADHD meds.) Different drugs have more or less of a problem with it, but a different drug's susceptibility for tolerance can vary from person to person as well. You can theoretically get continued therapy by switching to another drug, but that only works if there is another drug that would be effective. Also, there is a such thing as "cross tolerance" where different drugs can create tolerance to each other, but I'm not sure whether any antidepressants have that problem.

In many cases, tolerance reverses or decreases after abstaining from the medication for a while. So even if there's not another med that works very well, there might be one that's adequate temporarily (if only to treat the Lexapro withdrawal effects) so she can restart the Lexapro later.


Did her meds seem to be working fine prior to this situation? If her misery is proportionate to the situation, it might be they are still working fine.

If possible, it's probably a good idea for her to wait until her situation improves before making med changes.

I think the lexapro was becoming less effective with passing time but because she is intensely afraid of the withdrawal she probably stayed on it for that reason. You see, all psych meds were given to her by her general practitioner. She has never seen a psychiatrist. This may seem odd but I know several middle aged women where this is the case.

I imagine her stress level increased due to the family member's illness. Also, her mother died in the past six months. She wears herself out helping others but also gets a feeling of being needed that is a positive for her self esteem.

Maybe now would not be the best time to mess with her medication???

What I told her is that recently I had an evaluation by a a psychiatrist who is also a psych medication specialist. I connected with him through my health care provider. She has a new health care provider and I told her to research what they have available in their Mental Health Department.

Thank you for your comments. This is my best friend since childhood. We don't live near one another but we are like sisters and always try to help one another, or at the very least, be a support. I would say she is under a lot of stress and I would like to see her get evaluated by a psychiatrist, and not keep accepting psych medication from her primary care doctors.

[NUKEDANGEL]

lots of people carry on a med that has pooped out , because they dont want to go through start up of another, STRAIGHT TAPERING MAKES IT EASY IF STAYING ON A SSRI believe me i had done it many times

[DechanDawa]

Originally Posted by NUKEDANGEL

lots of people carry on a med that has pooped out , because they dont want to go through start up of another, STRAIGHT TAPERING MAKES IT EASY IF STAYING ON A SSRI believe me i had done it many times

I guess this person left this comment before their account was suspended?

[joshuas-mommy]

Well, antidepressants cause damage to your nuerotranmitters. But, I haven't really noticed me building up a tolerance to my antidepressant, but I haven't taken them consistantly because of the cost and lack of transportation. My cousin who was majoring for her PhD wouldn't even help me stay on my meds.

[DechanDawa]

Originally Posted by joshuas-mommy

Well, antidepressants cause damage to your nuerotranmitters. But, I haven't really noticed me building up a tolerance to my antidepressant, but I haven't taken them consistantly because of the cost and lack of transportation. My cousin who was majoring for her PhD wouldn't even help me stay on my meds.

Permanent damage to neurotransmitters?

[DechanDawa]

Originally Posted by LauraBeth

Hi DD, SSRI's used to help me tremendously. I'm talking 15-20 years ago. I'm now in my 50's and on Zoloft (I've been through all the SSRI's). I'm on the max dose of Zoloft and it doesn't help my depression or anxiety much at all. Frankly, I'm not quite sure why I even take it. I also take Latuda, which IS helpful. It is entirely possible that your friend's SSRI has 'pooped out'. A very frustrating and frightening situation for someone who suffers from depression.

My hope is that your friend will see a pdoc. Maybe there's no miracle for her/him, but possibly a pdoc would be able to offer more options that a GP does.

Oh, I think my friend metioned Latuda? Is that advertised on television as she mentioned seeing a television commercial. I don't have or watch TV so I wouldn't be familiar with it.

[88Butterfly88]

I think pretty much any med isn't going to be effective after 20 years. I have found good meds only work for me for about 5 years.

[DechanDawa]

Thanks everyone for your input. I have not been on psych medication so don't know. I guess my friend mentioned not wanting to come off it because of the side effects. I really wonder how many people are on ineffective medication because they are afraid to come off of it.