Hi. I have a question. I am bipolar. Does your body get immune to meds. Because meds will great for a while then we relapse and have to start over. Do we gain a tolerance to meds.


Dear Clayton -- 
Getting symptoms again, while taking a dose of medication(s) that seemed to work well for a while -- how to explain?  Is this "tolerance", or is the illness itself "evolving" underneath those medications?  

Usually I'm afraid that when this happens it's more the "evolving" explanation, because if we taper off the medications and then try them again I would rarely expect that to work, although I'll admit we don't try that too often (usually we're starting something else to treat those emerging symptoms, and keeping the previous ones in the hopes that this will allow us to add only a low dose of the new one; then if there's a great response to the new one, we might slowly taper the old one(s), with our fingers crossed!).  

By comparison, when we use a medication that is known to cause "tolerance", e.g. Valium or one of its cousins like lorazepam or Klonopin, if we lower the dose slowly we don't expect anything more than the original symptoms to emerge; and after a short while starting the same medication again, or one of its cousins, will "work" again, at the same or even a lower dose than before -- that's "tolerance".  

However, I wouldn't rule out the "tolerance" theory, at least for some people.  Unfortunately, we just don't know enough about how the medications work, or what exactly we're trying to affect with them. 

Dr. Phelps

Published April, 2001