Why Are the Same Meds Not Working This Time?
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Q:  Why Are the Same Meds Not Working This Time?


         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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