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Is there an explanation for why I'm so treatment resistant to psych meds?


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I would say that 70-80% of the time I take a psych med nothing happens, good or bad. This applies to ADs, AAPs and mood stabilizers. Most troubling is I even feel nothing from benzos. I've taken 2mgs of klonopin and been given an injection of ativan and felt nothing. I've also had the phenomenon where a psych med works the first time but but does nothing the second time. What is wrong with my body?

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On 3/13/2021 at 5:55 PM, CeremonyNewOrder said:

I would say that 70-80% of the time I take a psych med nothing happens, good or bad. This applies to ADs, AAPs and mood stabilizers. Most troubling is I even feel nothing from benzos. I've taken 2mgs of klonopin and been given an injection of ativan and felt nothing. I've also had the phenomenon where a psych med works the first time but but does nothing the second time. What is wrong with my body?

I hear you....I have a similiar problem......I do seem to be able to get some sleep due to combo of trazodone and klonopin, but there is no med that has really touched my depression and OCD......It sucks.

I have tried many meds, too, with the exception of MAOIs....I have an excellent therapist.....My current pdoc even mentioned brain surgery as a treatment option for my OCD.....I told him that sounded way too invasive and risky.

I have no real advice for you, but just wanted to let you know you are certainly not alone.

Edited by CrazyRedhead
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9 hours ago, CeremonyNewOrder said:

Things are getting so bad that I am seriously considering ECT even though the idea scared the shit out of me in the past.

In my opinion, ECT doesn’t deserve the stigma it has. Yes it’s invasive, but if you go to a good program they will have the process perfected to minimize your (mental and physical) discomfort. I had some memory loss but only after they switched me to the more aggressive type (bilateral). The logistics are a major pain in the ass, and I could see it being tougher for someone not good with needle/IV/sedation stuff but I felt that hearing all the scary word of mouth stories leading up to the procedure were more intimidating than the procedure itself

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There are two things to keep in mind:

1) Human beings are, to quote the crystalline life forms of the planet Velara III, "ugly bags of mostly water." Specifically, the adult human body consists of up to 60% H2O, with its various parts being more or less watery. Even your bones are 31% water. Your brain, pudding-like as it is, will be about 73% water, that is, a fairly diluted bag of soup. In this soup, a great many highly complex processes happen that are all dependent upon chemistry. Have you taken much chemistry? It can be gobsmacking how much can go wrong just by placing the wrong molecules next to one another in a watery soup.

2) The science of psychiatric pharmacology in this, the third decade of the 21st Century, is as it has always been, dependent upon our scientific understanding of the intricate inner workings of the brain itself. Therefore, it's still mostly educated guesswork. If medical science knew how to fix our noggins, our noggins would be fixed. They actually, really... don't. They've got some pretty keen hypotheses, and on the basis of these they've made some complicated rocks that they give us to swallow in the hope that they will even out the chemical whoopsie-daisy-hell we each call daily life with MI. Sometimes the rocks even kinda-sorta work. But they're basically throwing goo at the wall to see what sticks. That's why we sometimes have to go through a dozen meds before anything registers.

Combine 1 and 2. Your personal chemical soup is unique to you. Science can make generalizations about how your brain ought to be composed and function, but there are myriad factors, genetic not the least, that affect your body chemistry and thus your brain chemistry. Outside influences further shape that brain chemistry. The whole business is so complicated that in the current climate of, let's face it, medical ignorance about the true nature and function of the human brain, it's impossible to craft a one-size-fits-all treatment that will reliably be safe and effective, let alone one that can be tailored to individual needs.

I, also, am treatment-resistant. Refractive, they call it, because it's so frustrating it needs its own special word. I've been this way for over 30 years, waiting-waiting-waiting-waiting for some medical breakthrough. Hasn't happened. Yet. Someone will probably say "Eureka!" just in time for them to inscribe it on my headstone. But they will, in time.

Anyway, you're treatment-resistant to psych meds because your brain chemistry is probably unusually or atypically complex in ways not anticipated by the meds formulations... all because your brain is made of soup, and because we're all ugly bags of mostly water.

Well. Ugly on Velara III, anyway.

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On 3/15/2021 at 11:50 AM, CeremonyNewOrder said:

Things are getting so bad that I am seriously considering ECT even though the idea scared the shit out of me in the past.

Just my two cents, but ... please don't be afraid of ECT. If your psychiatrist or another medical professional recommends you for it, please consider it seriously.

For the last eleven years I've worked full time at a very well known, free-standing psych facility in the United States which easily performs at least 10,000 treatments a year and I've seen numerous treatments from start to finish with my own eyes and helped countless others both before and after the treatments. Yes, it doesn't help everyone, or doesn't help them as robustly as we'd like, but I've also seen it work miracles for some and can confidently say they wouldn't be alive without it. 

And personally, if my psychiatrist (a doctor who performs ECT at the same hospital I work at) recommended it, I'd do ECT. I'd be anxious about going under general anesthesia because I've never been put under before, you know, but the treatment itself wouldn't worry me. 

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  • 3 weeks later...

@CeremonyNewOrder Have you tried DNA testing your CYP450? The science is in it's infancy, but really interesting. I did the test, and now I can FINALLY have science based reason's why I can take 30mg of oxycodone and 30mg of diazepam (migraines) and not die. Unfortunately, the majority of doctors are not up to date with this new science, and I don't fit into any government declared box, so in the real world it's not that helpful for me.  Also a lot of data for the myriad crazymeds I've taken, and had every goddamn side effect with almost every one I've taken. There is a young pharmacist working next door to my GP, and as he's just finished Uni, he knows about it, and has actually made a note on my file to look out for future possible ill effects.

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On 4/4/2021 at 7:41 PM, KJ said:

@CeremonyNewOrder Have you tried DNA testing your CYP450? The science is in it's infancy, but really interesting. I did the test, and now I can FINALLY have science based reason's why I can take 30mg of oxycodone and 30mg of diazepam (migraines) and not die. Unfortunately, the majority of doctors are not up to date with this new science, and I don't fit into any government declared box, so in the real world it's not that helpful for me.  Also a lot of data for the myriad crazymeds I've taken, and had every goddamn side effect with almost every one I've taken. There is a young pharmacist working next door to my GP, and as he's just finished Uni, he knows about it, and has actually made a note on my file to look out for future possible ill effects.

After a lot of research I think I finally found an answer to my  question. Evidently there are like 3 or 4 different genetic phenotypes for how one metabolizes drugs. It goes from one extreme (poor metabolizers) who are super sensitive to drugs and usually get all the side effects of a med to the other extreme (rapid or ultra rapid  metabolizers) who metabolize a drug so fast that they get little or no effect whatsoever, which is my experience. I then googled for articles about ultra rapid metabolizers in the psychiatric literature and it turns out that psychiatry is starting to speculate that ultra rapid metabolizer is the cause of treatment resistance! When I read the case studies in the articles I almost cried because I was like this is the story of my life. I really want to take the test to determine whether or not I have this. I don't know if my HMO does these tests or I'd have to do private pay. It's scary though because it means most psych meds won't work on me and I'll have to rely on things like ECT or TMS to treat my depression. I'll post a few articles below about the phenomenon if anyone is interested. 

 

https://www.mdedge.com/psychiatry/article/65119/depression/suicide-depression-and-cyp2d6-how-are-they-linked

https://academic.oup.com/ijnp/article/11/5/727/968967

https://www.psychiatrictimes.com/view/overcoming-treatment-resistance-can-pharmacogenetics-help

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i have not undergone ect, but i do want to also let you know along with crazyredhead that you are certainly not alone. i have very refractory variants of a number of anxiety-spectrum disorders as well as major depressive disorder. i really cannot function at all without medication and need to be medicated at all times. it seems that i need very high doses in order for me to respond and perhaps that's your problem? i dunno, but 300mg of pregabalin, for instance which is the standard dose for gad/panic disorder does absolutely nothing, but 900mg does do something - not enough, but in combination with other drugs, it does. it's a juggling act for me with multiple medications which improve as well as deteriorate my quality of life simultaneously and i have to weigh the benefits against the adverse effects of the drugs that i'm taking.

 

anyhow, know that you are certainly not alone. that may not be of any solace to you, but your suffering is understood by others out there for sure.

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  • 2 weeks later...
18 minutes ago, Gearhead said:

Interesting article. I definitely think it makes sense that a particular person's manifestation of MI is a complicated biological process. I like the idea that there may be biological subtypes of a particular diagnosis. It rings true for me. It makes me hopeful that my upcoming TMS treatment may work.

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