585414 tn?1288941302

What Happens When an Antipsychotic "Kicks Out" or Stops Working?

I know that when I was on standard antipsychotics (before my recovery with the Phase II glutamate antagonist in FDA study glycine) I had one antipsychotic after another "kick out" or suddenly stop working even when the dosage wasn't lowered. What they are identifying in me as a criteria "tardive psychosis" is done within standard psychiatric research and they believe it to be the reason. I just can't put the specific names in the post. But what are other more clinically known reasons that can occur? Since it happens to other people? What are some other known reasons that an antipsychotic at a therapeutic dose would stop working? And if it occurs in multiple antipsychotics? I know there are people with "treatment refractory schizophrenia" which just means they are a non responder to current treatments. But when people stabilize on current treatments and then they don't work after a while what is going on?
  I ask this because this continually happens to a friend of mine with schizoaffective disorder and its of concern. But I can't assume an unknown diagnosis I am under study for applies to other people. What are some known reasons this could happen? Unfortunately he hasn't tolerated Clozaril either. But everything for him worked at first. And he is always monitored to see he takes his medications. What might be going on?
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604266 tn?1236358985

  Has he been on the drugs for more than three years? Or is this an instance of the drugs working for a year or so and then the effects stop?

No one know's for certain what happens after three years on these types of medications. If it has been over three years then this may be a side effects of having these medications in the system for that amount of time and they may at some point lose effectiveness.

Unfortunitly with Clozaril out, which is usually the back up when no other meds are working properly you're friend may have to be hospitalized in order to find a new medication combo or to try other options if any are available.
If these medications worked successfully at first then it's not a matter of how his body intakes the medication as they must be blocking the receptors suffuciantly until something happens or gets in the way. Or it's been over three years and this is a side effect of being on these meds for that long.

Many have carried treatment on past three years but because it's effects after that time are unknown for sure it's a decision between the doctor and patient.

So maybe start with trying to find any research that's been done on the meds past the three year mark and see if anyone else has experienced the same thing happening.
And if it hasn't been three years, maybe start to look for possible causes for dopamine that was at one point blocked by the meds actions to somehow over ride the meds and make them less effective or ineffective.
(of course I wouldn't know if it is that the meds suddenly stops which allows for the dopamine to pick up where it left off, it's only an uneducated guess knowing some about antipsychotics and how they work).

I wonder if the Mental Health expert would know better. I don't believe he's a psychiatrist but PhD's often know alot about how psychotropics work in the body and why they sometimes don't.

I hope this helpped you a bit. I'm afraid there is no easy answer to your question which i gather is why you haven't found one yourself since you know just as much it seems as some who prescribe.

I'll see if I can find anything on the web also.
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585414 tn?1288941302
Why did you post that? I read the information and I had to speak to my friend more and think about the circumstances. I wanted to look into what you said in the light of what's going on with him. I would rather post a follow up with some information than a simple response. That's why I was waiting.
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585414 tn?1288941302
My friend has an issue of substance abuse and alcohol abuse as well. He often stops taking medications and they have to give him injectables. That much I know. I was going to ask him exactly when his medications stop working but I've noticed its a few months after he starts a new one and he is monitored for taking them at those times. Injectables keep him stable to an extent but he still is psychotic. The reason I didn't want to post a hasty response is I wanted to speak my psychopharmocologist and see if there was some up to date research on what you said about the issue of anti-psychotics not being as effective often after three years. That's important for me to know but he might be able to get me in touch with up to date research. Once they publish the results of the study on me then they will have one confirmed case (in their terms) of tardive psychosis but I didn't want to generalize what happenned in me to other people until the condition is further studied and researched.
   However, I know that Prozac often "kicks out" after a number of years from what I've read (the term the "Prozac poop out") and the SSRI's do not cause tardive dyskinesia so that's definitely not what's going on there. As to why certain medications lose their effectiveness I would think they have information by now but I'll ask him why 3 years might be a specific timeline and if he has information I would post it but if he looks up a study it may take a while. I do thank you for your information but I wanted to follow up with a fully informed response but here's what I can give you for now.
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ssri's are antodopaminergic therefore most certainly can and will (in high dosages etc) cause both akathisia, tremor as well as tardive dyskinesia (anything that indicates a compromised dopaminergic system in essence). please stop misinforming people

As for neuroleptics, often their damage overweight any benefit to the patient in a many fold problematic result. that said, the dopaminergi hypothesis of schizophrenia is what the name states, a hypothesis, some indications in some cases may have preented themselves (as evidence) through out the years, yet as much as such 'evidence' exists, the same or more has been found for excess glutamate release as well as under-dopaminergic function (!) mean. the opposite of the mainstream theory pushed along with the pills!! these said;  there are as you said gaba agonists +/or glutamate antagonists (or substances like topiramate which affect both and/or pregabalin) + of course milder forms of brain electrotherapy (no need for anesthesia etc).

= please stop pushing wrong  info
604266 tn?1236358985

guess just going off the fact that we had a misunderstanding I saw it as your not wanting to speak to me even though I thouht we had worked it out. That's why I said I was starting to wonder though...becuase I felt confused why you haden't replied and really didn't know why. I actually felt a bit hurt for some reason. So, that's my answer.

Sorry for the misunderstanding.

I'm having a terrible night tonight but I do want to read your other post as I'll do that wheb I can give it my full attention.
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604266 tn?1236358985
Okay, read it. I really do want to give it my full attention later but wanted to def ask you to post any research you find on the 3 year issue that's up to date. I'd be interested to know more.

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585414 tn?1288941302
Thanks very much. And my psychopharmocologist is not just helping me and coordinating with the movement disorders specialist he's actually going through a lot of research studies on the whole subject and finding which ones are clinically valid and of use but I'll post where to find it when he lets me know.
Thanks again.
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585414 tn?1288941302
And my update for you is that my psychopharmocologist says psychiatry has not pinned down a specific cause unfortunately although as I had said correctly like SSRI's (the "Prozac poop out") the original psychiatric disability in the brain can over ride the functioning of the antipsychotic. In other cases, the schizophrenia worsens on its own. And of course there are many people who recover (although not to the extent I have on the glycine) on standard antipsychotics and don't have their schizophrenia or schizoaffective or other psychotic disorders worsen. That much I'm sure you knew. I will cut and paste the other information from the other thread which is groundbreaking.
   This information that is new to medical science but is clinically confirmed. My psychopharmocologist spoke to a provider agency, a well known one although I cannot state their name for confidentiality purposes. It confirmed that I had recovered with glycine as a primary antipsychotic although in studies it is still used as an adjunct. More importantly this agency stated that among their discussions would be to add glycine as a suggested adjunct for providers. Therefore, people should continue with standard treatment and in no cases obtain it on their own but it will be public knowledge that glycine in pure powdered format can be added to a primary antipsychotic.
  As for the research all the provider agencies indicated they would like to see research done on only new modalities of treatment, including glutamate antagonists but that is the perogative of the pharmaceutical industry. I personally believe that in a business sense as the study on myself confirms a clear recovery and the Eli Lilly drug LY2140023 advances ahead that other companies will want to start research on a glutamate antagonist as when they are approved they will certainly be an advance in treatment.
  The study on myself will not be finalized for publication until the remaining neurological disability is specifically diagnosed. They have not ruled out "tardive psychosis" as a criteria in me and they have ruled out all common neurological disabilities but they have to go through the rest. It is indeed rare for tardive dyskinesia to get this advanced and the fact that as a child I had abnormal movements (although a normal CT scan) and nystagmus may have made me more suspectable. Tardive dyskinesia occurs at the rate of 5% per person per year with the typicals and with the atypicals, as studies show it actually varies from 1% to 2.5% per person per year. I will be provided with specific studies to cite next time. Trazadone is relatively low risk but can cause it. There have been reports of temporary movement disorders such as akathesia from SSRI's and this is relatively common but no reports of tardive dyskinesia. There was one confirmed report of Lamictal induced temporary movement disorders online and I did experience extra pyramidal side effects from it which was reported to the FDA but it is a statistical rarity. This information is what my psychopharmocologist obtained from psychiatric journals that may not be easily accessible to someone who is not a provider online but I will be able to cite them next time.
   We well understand that the remaining psychosis I have is neurological in origin and being mitigated by anti-Parkinsonian agents (Zofran, Tenex, rhodiola) but the movement disorders specialist has to continue some more tests. The final case study of which I will be a co-author will contain my recovery from glycine as a novel antipsychotic and should it be found the confirmation in myself of the hypothetical criteria of tardive psychosis to understand how to identify and treat it and when it is published I will make it available as for people to read as I stated.
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604266 tn?1236358985
Thanks for the update. I'm glad you told me that.
So it has nothing to do nessisarily with the medication itself or the origional symptoms only that the disability has worsened over riding the medication. That makes alot of sense at it happens with many conditions.

Is there any way to get your friend into a study after yours?
I can't imagine what your friend must be going through waiting for the meds to build up only to override them a few months later. It can't be easy to keep going through that rollar coaster effect.

Is your friend doing all of this out patient or has he gone into a more stable enviorment with more consistant care? I hate to be so nosey but can imagine just how frustrated he must be and feeling a little defeated(I hope not) because they haven't been able to find a medicine to keep it's effectiveness past a few months.
I know I'd feel very frustrated at this point and maybe a little fed up with going through option sfter option to only end up at the start point again.

I wish I had some more suggestions but I haven't had alot of experience with antipsychotics on a consistant basis.
I do hope your friend is doing okay and has the support he needs to help keep him motivated and hopefull to hang in there until he can find something that works for him. I have all the faith that there is an effective option in something.

I'll be looking forward to your study being published. I may not work right now because of the IC and my own issues I'm taking care of but psychiatry remains my passion and I would feel incomplete if I wasn't keeping up with the latest up to date research in advancements. This study is certainly an advancement if it works as effectivly in others as it has in you.

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