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Q: Why Are the Same Meds Not Working This Time?
Hello,
I m 20 years old male and I started my psychiatric treatment in 2002
for the 1st time because I was suffering from Bipolar Mania accompanied by
Obsessive Compulsive Disorder and my doctor prescribed me,
Risperdal half of 1mg at night
Prozac syrup one tsp at night and one tsp in morning
Klonopin 2mg half at night and other half in morning
Kemadrin half at night and other half in morning
These medicines had successfully treated my Bipolar Mania and OCD. after
determining my condition, doctor gradually dropped the dosage each med and
finally I was normal but in 2003 I got relapse and I consulted another
Psychiatrist not 1st one, he prescribed me,
Inj. Flaunxol 20mg
Kemadrin thrice a day
Tegratol 250mg in morning and at night
Soon I got EPS and discontinued because of severe Anxiety and Depression with
these meds.
After one month I consulted another psychiatrist but no improvement, finally I
have to go to the doctor who prescribed me Prozac, Risperdal etc but this time
these medicines was successful in bringing 76% improvement and could not show
the desirable results like before in 2002, now I m totally treatment resistant
patient, no medicine is helping me, I m just confused why those medicines not
working this time, now I m much disappointed myself plz tell me why it is
happening to me being on the same meds?
Dear A' --
Unfortunately, sometimes a particular set of medications will work at first,
then not work when tried a second time. This is not unusual. We think that in
most of these cases, the illness is worsening (perhaps during a period of time
of no medications, or a switch to medications that don't work). So when the
original medications, that worked well the first time, are tried again, they are
not treating the same illness: they are treating a worsened version of that
illness, and may not work as well.
Before you conclude that you are a "treatment resistant
patient", you'll have to try Risperdal with several different "mood stabilizers"
(lithium, valproate, perhaps carbamazepine (Tegretol) again, without
Prozac around. You may have "evolved" into a patient who cannot tolerate an
antidepressant. These other medications could fail to work when an
antidepressant is used at the same time. So make sure they got a "fair trial".
This is the most common reason for apparent "treatment resistance" in my
experience. Good luck with all that.
Dr. Phelps
Published August, 2005
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