Posted by SLS on May 1, 2001, at 21:58:08
In reply to Anyone's exp. on discontinued meds, posted by judy1 on May 1, 2001, at 10:33:13
> I read somewhere that people with bipolar disorder that start and stop meds (not just lithium) and continue to have multiple episodes eventually become treatment resistant to anything. Since I have stopped (again) because i'm pregnant- am i facing the same thing? and perhaps i already have gotten there. any thoughts?- thanks, judy
Dear Judy,I think we have both seen this happen plenty of times with antidepressants. However, I don't think this phenomenon can be extrapolated to anticonvulsants or neuroleptic antipsychotics.
You are obviously aware of the notion proposed by several doctors in the early to mid 1990s that starting and stopping lithium might cause a refractoriness to responding to it subsequently. This was based primarily on anecdotal reports. I know someone whose case provides a perfect example of this. She was maintained on lithium for over 8 years. Despite a gradual weaning process, she relapsed into severe depression within three months. Lithium was restarted immediately. She did not respond to it. She has been refractory to countless drug treatments for the 16 years since. Despite these occasional stories, I don't think that the idea of lithium causing its own refractoriness has gained acceptance.
Again, I currently have the impression that one is not likely to become resistant to periodic exposure to anticonvulsants and neuroleptic antipsychotics as has become very evident with antidepressants.
I get the impression that depression is not your primary problem. However, it might be comforting to know that pregnancy itself can ameliorate and prevent depression. I don't know if pregnancy can have the same prophylactic effect against psychosis or mania, but I can't find any indication on Medline that pregnancy can cause them either. It is during the time just before delivery and the postpartum period that both depression and psychosis can emerge. If you decide to discontinue medications for your pregnancy, I think it would be important to restart them immediately upon giving birth, and not breast-feed if you deem it prudent not to.
I hope this has been helpful. Whenever a woman proceeds with a pregnancy, I think the magnitude of any risks drugs pose to the fetus must be weighed against those posed by a protracted severe psychiatric episode of the mother. I wish it were an easy decision for you to make. I can't identify.
- Scott
poster:SLS
thread:61245
URL: http://www.dr-bob.org/babble/20010424/msgs/61313.html