#i am the only person who had that happen on a dose less than 40mg

[roetrolls]

:))))) hrgh

ok so not to get too venty on here but

i start my final quarter of college tomorrow w/ my senior film due in 2 months, and my neurologist just upped my steroid dosage which might result in new side effects (or maybe already has? the steroids have already been fucking with my vision but it seems a lil worse and now i think im having trouble falling asleep too) AND im gonna have to deal with infusions during this too :')

o(-< so hrghhhhhhh basically the next 10 weeks are about to be really stressful and i just wanna ask that everybody be patient/gentle with me

[translesbiantheo]

very long post about ADHD/medicalising my body cos a post by a friend a few days ago got me thinking about it

so like, i’ve been on amphetamines for a good few months now for ADHD. And it’s like... IDK. IDK how to feel about it. I’m definitely more productive. In some ways it feels like I have my mind back, things I lost when CFS/IBS/adventures with SSRIs/a literal 60 hour work week at uni broke every coping mechanism I used through my younger life. I’m also getting pretty ill from side effects. It might just be winter - the cold is definitely making things worse and I am usually pretty bad in winter, but it also seems pretty clear that the side effects are responsible for a good portion of it too.

It’s also like... not perfect on a brain-fixing front?

Years ago, I tried some of this same medication that a friend had, and it was like. unreal. It seemed to totally clear my CFS brain fog. In the week of meds that I had then, I not only got a lot of short term memory skills back, but started remembering things that had happened in time periods where I had had no memories (there are whole chunks of time in which i have like 1 vague memory per six months or so). This hasn���t been anything like that. I’m pretty sure that I get a particularly strong effect when I increase my dose (like, the first few days on 20mg were better than a non-transition-state day on 70mg)*. 

But overall, I’m getting a lot more shit done. Like. The house is usually pretty tidy for at least a portion of each day. We’re eating food on a regular basis without spending money we don’t have on takeout. Laundry is being done almost often enough. Baby is getting more outings and more fun when we’re at home. I’m even doing creative work some days. So like, that’s pretty undeniably a Good Thing, even if i spend like an hour a day extra on the loo and several extra hours in really intense pain. If I had gotten PIP or we could otherwise afford a PA, I would do that instead of taking the amphetamines, without hesitation. I’d also stop taking them if we had like, capital-C Community, or didn’t live under capitalism. But I don’t live in that world? So like... shit’s gotta get done, this is really the only available solution that’s come close to being good enough.

My doc said that 90% of ADHD patients eventually settle on a long term ADHD med. I wonder if that’s actually true and whether that means that I should be trying to seek out something better than what I have now? There’s a lot of reasons that I went for this particular amphetamine, and there are reasons for me to be wary of the non-amphetamine options, and in general I get pretty shitty side effects for any and all serious medications. But a drug with side effects that are basically just +3 to IBS is obviously not the best if you already have IBS. 

There’s also that changing over drugs takes *a lot* of effort. It takes months of dose titration, a minimum of half a dozen trips to the nearest ADHD clinic, and given I’d have to step down this one first, probably at least a month of ineffective ADHD med levels. And at the end of it all it might not be any better... I might be less reluctant if the ADHD clinic wasn’t a 20 minute cycle away and also somewhat preposterously disorganised**.

I’m tempted to wait for spring when my health gets that warmth bonus, then try something then? So long as my 1/3 month check ups don’t show me as having been too ill and they don’t crash me out of these in the middle of winter. I also know from once attempting to step from 40mg down to 30mg that I respond really awfully to stepping down. Though in theory it is  really supposed to not be so bad. 

I kind of wonder even, if this is just me like, back up to old bad habits. Running the old’ brain machine hotter than it should be run, using drugs to put mind over matter now that will power isn’t enough. I’m pretty sure that doing that (plus my medical misadventures) is a large part of what broke me in the first place. 

What if, 6 months from now, or a year from now, I just collapse, back to as bad as I was in my bad years? Not only is our home not wheelchair accessable, but our family is 1000% dependent on my being able to Get Shit Done. My partner is as seriously disabled as me and xe does all the serious money-earning. If I were in a state where I couldn’t even take care of myself, then who would take care of my family?

It’s all so fucked up and i wish that there were options for survival besides attempting to overclock my brain and body with drugs that I don’t massively trust.

* The doc said that’s not how it works and called it a placebo effect, but like, I don’t trust that even a little bit. Doctors are always pretending to be all sure about shit like that even when there’s either no evidence or even evidence counter to what they’re asserting. (I cannot count the number of times that a doctor has asserted that a side effect i/a person i’m advocating for is getting that is literally listed under “common” and perfectly correlated with the med could not possibly be the med, until i/they stop the med and the symptom goes away then the doc is all “well of course it was a side effect”). I have almost never had the “expected” effects from a drug, even drugs that are helpful to me it’s just like... bodies are complicated, shit’s gonna be different from person to person.

** While I’m referred out to them, my personal ADHD doctor is the only person in the freakin world who can perscribe me these things cos they’re controlled drugs, and she’s only around on Mondays, and she has solid appointments then leaves the office right after and just like, does not respond to messages left with her receptionist. At all. Twice I’ve come within a day of just totally running out of drugs after missing an appointment and then struggling to arrange something, anything, in time. Once I spent a week dissolving a 30mg pill in a cup of water then drinking 1/3rd of the cup along with another pill to make 40mg-ish. Side effects from the dose wobblyness were unpleasant to say the least.

[psychotherapyconsultants]

What Do I Do When My Antidepressant Stops Working?

Approximately 25 percent of patients with major depressive disorder (MDD) experience a recurrent depressive episode while on an adequate maintenance dose of antidepressant medications, according to a 2014 metanalysis published in Innovations in Clinical Neuroscience. The clinical term for this medication poop-out or antidepressant tolerance is antidepressant treatment (ADT) tachyphylaxis. While psychiatrists and neuroscientists don’t know exactly why this happens, it could be due to a tolerance effect from chronic exposure to a medication.

I address this topic because I have experienced antidepressant poop-outs myself, but also because I often hear this concern from persons in my depression communities: What do I do when my antidepressant stops working? 

The following strategies are a blend of clinical suggestions from the metanalysis mentioned above and other medical reports I’ve read, as well as my own insights on recovering from a relapse.

1. Consider all reasons for your relapse.

It’s logical to blame the return of your depressive symptoms on the ineffectiveness of a drug; however, I would also consider all other potential reasons for a relapse. Are you in the midst of any life changes? Are your hormones in flux (perimenopause or menopause)? Are you experiencing loss of any kind? Are you under increased stress?Did you just start therapy or any kind of introspective exercise? I say this because I experienced a relapse recently when I starting intensive psychotherapy. While I am confident it will lead to long-term emotional resiliency, our initial sessions triggered all kinds of anxiety and sadness. I was tempted initially to blame the crying and emotional outbursts on ineffective medication, but soon realized that my pills had nothing to do with the pain.

Watch out especially for increased levels of stress, which will commonly drive symptoms.

2. Rule out other medical conditions.

Another medical condition can complicate your response to medications or contribute to a worsening mood. Some conditions that are associated with depression include: vitamin D deficiency, hypothyroidism, low blood sugar, dehydration, diabetes, dementia, hypertension, low testosterone, sleep apnea, asthma, arthritis, Parkinson’s disease, heart disease, stroke, and multiple sclerosis. Get a thorough check up with a primary care physician to rule out any underlying condition.

Make sure to test for a MTHFR gene mutation, how you process folate, which can definitely affect antidepressant results. If you experience any elevation of mood with your symptoms of depression, be sure to discuss those with your doctor. More than half of people with bipolar disorder are misdiagnosed as clinically depressed and don’t receive the proper treatment they need, including a mood stabilizer.

3. Take your medication as prescribed.

Before I list some of the clinical suggestions, it’s worth mentioning that many people don’t take their medication as prescribed. I would like to plead innocent here, however, I acknowledge that there are too many evenings when I forget to take my pills.

ccording to a 2016 review in the World Journal of Psychiatry, about half of the patients diagnosed with bipolar disorder become non-adherent during long-term treatment, a rate similar to other chronic illnesses. Some psychiatrists assert that the real problem isn’t so much the effectiveness of medications as much as it is getting patients to take medications as prescribed. Before switching up your medication, ask yourself: Am I really taking my meds as prescribed?

4. Increase the current antidepressant dose.

Increasing the dose of an antidepressant is a logical next course of action if you and your doctor determine that your relapse has more to do with a medication poop-out than anything else. Many patients take too little medication for too short period of time to achieve a response that can last. In a 2002 review in Psychotherapy and Psychosomatic, doubling the dose of Prozac (fluoxetine) from 20 to 40mg daily was effective in 57 percent of patients, and doubling the 90mg from once weekly to twice weekly was effective in 72 percent of patients.

5. Experiment with a drug holiday or lowering the antidepressant dose.

Since some medication poop outs are a result of a tolerance built up from chronic exposure, the metanalysis recommends a drug holiday among its strategies for tachyphylaxis, however this needs to be done very carefully and under close observation. In some patients where the symptoms are severe, this is not a feasible option. The length is of a drug holiday varies, however the minimum interval required to restore receptor sensitivity is typically three to four weeks. This all seems counterintuitive, however, in some studies, like the one by Byrne and Rothschild published in Clinical Journal of Psychology, decreasing the dosage of an antidepressant led to positive results.

6. Change your drug.

Your doctor might want to switch medications, either to another drug in the same class or to another class. You may need to try several medications to find one that works for you, according to the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study, the largest and longest study ever conducted to evaluate depression funded by the National Institute of Mental Health (NIMH).

If the first choice of medication does not provide adequate symptom relief, switching to a new drug is effective about 25 percent of the time. It might make sense to introduce a drug that has an entirely different mechanism of action in order to regain the response blunted by the drug tolerance of the one you’re on.

The transition between meds needs to be handled carefully. Typically it’s better to introduce the new drug while tapering off the old, not to quit it abruptly.

7. Add an augmentation drug.

According to the STAR*D study, only one in three patients in the first sequence of monotherapy (that is, taking one drug) achieved remission. Meta-analyses of antidepressant trials of nonchronic patients with major depressive disorder report remission rates of 30 to 45 percent on monotherapy alone. Augmentation drugs considered include dopaminergic agonists (i.e. bupropion), tricyclic antidepressants, buspirone, mood stabilizers (lithium and lamotrigine), antipsychotic medications, SAMe or methylfolate, and thyroid supplementation. According to STAR*D, adding a new drug while continuing to take the first medication is effective in about one-third of people.

8. Try psychotherapy.

According to a 2013 Canadian Psychology Association report, mild to moderate depression can respond to psychotherapy alone, without medication. They found that psychotherapy is as effective as medication in treating some kinds of depression and is more effective than medication in preventing relapse in some cases.

Also, for some patients, the combination of psychotherapy and medication was more beneficial than either treatment on its own. According to a study published in the Archives of General Psychiatry, adding cognitive therapy to medication for bipolar disorder reduced relapse rates. This study examined 103 patients with bipolar 1 disorder who, despite taking a mood stabilizer, experienced frequent relapses. During a 12-month period, the group receiving cognitive therapy had significantly fewer bipolar episodes and reported less mood symptoms on the monthly mood questionnaires. They also had less fluctuation in manic symptoms.

It’s normal to panic in the days and weeks your symptoms return; however, as you can see, there are many options to pursue. If the first approach doesn’t work, try another. Persevere until you achieve full remission and feel like yourself again. It will happen. Trust me on that.

from World of Psychology https://psychcentral.com/blog/what-do-i-do-when-my-antidepressant-stops-working/