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Re: Atypical OCD - URGENT med suggestions needed NOW!!

Posted by Questionmark on March 12, 2003, at 18:49:17

In reply to Re: Atypical OCD - URGENT med suggestions needed NOW!! » Questionmark, posted by ace on March 12, 2003, at 0:28:54

> > Also, i wanted to mention something to you. Not to be condescending, anxiety-provoking, or discouraging at all, but... i'm convinced that psychiatric drugs can VERY often lose their efficacy after awhile (though it varies widely of course).
>
> I disagree with this statement. I do not really believe psychiatric medications poop-out much at all. Most MDs I have spoke to never even have heard of it! I believe poop-out represents many variant things but not the actual medication ceasing to act in a therapeutic way. Of course I'm not sure, but it seems as if this phenomenon is specific to people. For example, ANY drug will 'apparently cease' to work with them. But others can take any drug for a life time with no probs. Are these specific poop-out people just getting used to the phenomenological change in themselves and seeing it as 'now' normal, and then (as all humans do) wishing to reach a greater level of happiness? Does poop-out represent latent/undiagnosed Bipolar D/O.
> Is poop-out the result of the ceasing of an initial placebo response?
>
> I'm not sure, but I can tell you I'm not worried about any med pooping-out on me, and I am sceptical of the whole phenomenon.
>
> Ace.
>
>

Ace, you brought up some really good points and questions. Made me think. But i am still a firm believer in poop-out (at least for most people, for most drugs). i'd like to try to explain why, below. You or anyone else, please tell me what you think so we can get try to get a better understanding of this-- because i think this is an extremely important matter and has a lot of ramifications to treatment and what not.

First i just wanted to comment on your one statement. You said "Most MDs i have spoke to never even have heard of it!"
True, but most MDs are ignorant about many things and too arrogant or overconfident to realize or admit it.

Secondly, again i thought your other points were really good and, after thinking about it, do think that they (the reasons you gave for why you thought poop-out occurs) can be the actual causes in a good number of cases. But i still think that poop-out does often occur, and can occur with any psychoactive drug or substance. i have experienced tolerance with every single psychoative substance (legal or illegal) that i have used, i believe. And tolerance is just the process of poop-out, right? So it seems that every drug can eventually, gradually, lose its effectiveness, at least to some extent especially. Plus on a neurophysiological (woah) level, it would seem to make sense, too. The receptors and what not eventually adapt to the change in neurotransmitter (and whatever else) functioning (e.g., with recptor up- or down- regulation). This might take awhile and might not return to completely normal functioning, but still.
Fortunately from what ive heard/read it does seem that MAOIs can take years and years for full tolerance (poop-out) to occur. But it's still something to think about.
So sorry this was so freaking long. My brain doesnt work anymore.


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