Mods: Please note that I’m not asking for medical advice. The person taking the medication in question is under a doctor’s care. I’m just trying to better understand the situation.
For pretty much the entire time I’ve known her, my wife has been on Wellbutrin. She is very conscientious about taking it, as she has no illusions about what she’s like when she’s not on it. But for a few weeks she’s been growing, well, distressed; for much of last week it was as if she was not taking it at all. So she went to the doctor and has gotten a scrip for a different drug.
I have no doubt that she’s taking her meds as scheduled. The Wellbutrin is simply no more effective than sugar pills or prayer now, even though, only a few months ago, it was quite effective in helping her be healthy. Why would this happen? What sort of chemical or neurological mechanism could have been tripped that would cause this?
I’m a psychiatrist. Sometimes this just happens, not all that uncommonly. It seems to happen more often when people are inconsistent with taking the meds, but it can certainly also happen with conscientious patients. The chemical and neurological mechanisms by which these medications work isn’t really fully understood, much less the mechanisms by which they stop working. I hope the new stuff works better.
Not a psychiatrist. I’ve known some folks paradoxically to need less Wellbutrin in the spring (presumably, when the light level goes back up). She might want to talk with her prescriber about trying a lower dose.
I’ve been taking Elavil for something like 20 years, for chronic depression and acute insomnia. (Other antidepressants interact badly with other meds I have to take.) The Elavil stopped working as an antidepressant many years ago, for no apparent reason … but I still take it for the insomnia, because without it I’m up literally all night, becoming a zombie the next day. So basically my depression is just something I deal with, but at least I can sleep.
Perhaps she stopped believing the drug would work. A 2002 study looked at data submitted to the FDA on the six most commonly prescribed antidepressants, and found little difference between the drugs and placebos:
I can’t believe that it was a reverse-placebo effect. She has, or had, an almost religious faith in the drug’s efficacy, and I think some of her distress is due to that faith being shattered.
IMHO, depression is a cyclical thing. It ebbs and flows. The time that people feel good enough to want to improve their situation and begin taking medication usually is when it is starting to improve on its own. So when the depression naturally starts returning, the drugs get blamed.
The neighbor kid is bipolar, and his mom was telling us how difficult it is to dial in the dosages. Everything will be just right, then BOOM, the kid hits a growth spurt and everything is out of whack again. I would think Menopause would have just the same type effects as a growth spurt.
I don’t know what you base this opinion upon. I finally went to a doctor and got a prescription when my depression was spiralling down so badly that I knew one way or the other it had to end. No way was it starting to improve on its own.
My academic background is in psychopharmacology and the correct answer is, indeed, nobody knows why that happens. The same phenomenon occurs with most psychiatric drugs. There are many drugs such as the SSRI’s that suggest that they would be largely interchangeable but yet they aren’t. Patients may respond to one strongly and not at all to a similar one and then stop responding to the first one. That is why drug makers keep inventing drugs with similar profiles to existing drugs.
And the side effects differ, too! That’s another crazy thing about my crazy-pills. You’d think if I have or don’t have a side-effect with one SSRI it’d be the same with others, but it’s **so ** not the case.
Firstly: I don’t have experience with Wellbutrin in depression (it isn’t licensed as an antidepressant here).
If your depression is relapsing, the medication you have been stable on (whatever that might be) may not be cutting the mustard. Sometimes switching to a different drug is better than upping the dose.
Some people with a purely biological depression aren’t lucky enough to have one episode (as opposed to people who have depression triggered by stressful life events, who may have only a single episode) . Many have a chronic relapsing condition. Some people’s meds, while enough to get them well, aren’t always superb at keeping them well permanently.
In psychiatry, unfortunately, it’s sometimes a case of “whatever gets you through the night”. SSRI/SNRI/TCA/Lithium/Antipsychotic/ MAOI or a combination of the above, if it works stick with it, if it doesn’t, think about a change.
Personal experience, just like you. At the depths of depression I was unable to bother to do things like answer the phone when it rang, and was so completely disgusted with life that I couldn’t even picture wanting to get better, much less actually taking steps towards achieving it. There was no way I could have got to the doc short of involuntary commitment, which I sometimes secretly prayed for.
It’d come on and off in pretty regular year long cycles since childhood- Freshman year was good, sophomore I was depressed, junior okay, etc. I have no doubts that with drugs I would have probably seen the same exact cycle, but would have attributed those ups and downs to the drugs instead of to the natural cycle of depression.
When people’s depression swings up, we always attribute it to the meds, but when it swings down, we have a million justifications for why the meds wouldn’t be working at that particular time (it takes a while to kick in, you gotta adjust dosage, you have to change drugs, etc.) Medications have saved many lives, including people I know and love. But they are not magic cure-alls and are not the only way to treat depression.