Posted by SLS on December 3, 2006, at 10:50:08
In reply to Re: Maybe all drugs are like this » linkadge, posted by Squiggles on December 3, 2006, at 10:02:02
In the mid 1990s, there were several reports similar to the abstract I included here regarding lithium. There was some debate on the matter at the time, but there has been little interest in follow up.
A friend of mine had been maintained on lithium monotherapy for eight years before her doctor allowed her to discontinue it. She relapsed into depression within a few months. Restarting lithium therapy was ineffective in recapturing the antidepressant effect.
It is my thought that antidepressants produce long-term changes in the brain. Afterall, that is how they work. They do not produce remission upon acute administration. I can imagine that some changes in the system persist beyond the discontinuation of a drug. There might even be a rebound effect once the drug is removed. The net effect of these persistent changes might be to leave the system less "vulnerable" to the antidepressant reaction that needs to take place in order for remission to occur.
It has long been counseled by psychopharmacologists to avoid "pulsing" antidepressants so as to prevent non-response. This recommendation has been given since the age of the tricyclics. If one were to take at face value the reports of people posting on psychobabble, this phenomenon of non-response upon re-exposure to a previously effective drug is fairly common.
- Scott
------------------------------------1: Am J Psychiatry. 1992 Dec;149(12):1727-9. Links
Comment in:
Am J Psychiatry. 1993 Nov;150(11):1756.
Am J Psychiatry. 1994 Oct;151(10):1522.Lithium-discontinuation-induced refractoriness: preliminary observations.
* Post RM,
* Leverich GS,
* Altshuler L,
* Mikalauskas K.Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892.
The authors used a systematic life-chart methodology to observe four patients with bipolar disorder in whom long periods (6-15 years) of effective lithium prophylaxis were followed by relapses on lithium discontinuation. Once the drug was reinstituted, it was no longer effective. The incidence, predictors, and mechanisms underlying this phenomenon all require further systematic study. The current preliminary observations suggest an additional reason for caution when lithium discontinuation in the well-maintained patient is considered.
PMID: 1443252 [PubMed - indexed for MEDLINE]
------------------------------------
poster:SLS
thread:708634
URL: http://www.dr-bob.org/babble/20061129/msgs/709897.html