Can a medication start working again?

[Paperback Writer]

Hi guys,

I've been on Pregabalin for GAD for the last four years, gradually increasing it up to 300mg which worked well for a couple of years. I felt anxiety creeping back in over Christmas (a mini relapse) and so upped the dose to 400mg as agreed with the psychiatrist. This helped to level things out until last week where it just seems to have stopped working. I probably am still feeling some of it's affects but it almost feels like I've gone back to square one which is pretty terrifying!

My question is can a medication start to work again, can it just have a period of ineffectiveness or is it a question of when it stops working than that's it? I'm unsure of whether to ask to go up to 600mg which is the maximum dose for anxiety or whether I need to accept that it's no longer working for me and to try something else? Thank you

[RadioGaGa]

Paperback Writer

You're describing classic "tolerance" - that is, a larger dose (400mg) is required to produce the same effects a smaller dose (300mg) once did. The problem with tolerance is that it will continue to climb, especially if the drug in question is taken every day at the same dosage.

When the benzos came out, they were seen to be "superior" to the barbiturates (certainly they are in respect of overdosages etc) but they were no better for creating tolerance and addiction. Then we ended up with the "valium crisis" where people simply couldn't come off them.

A tolerance break is sometimes used in this case, where you'll go off the drug for a dictated period, say one month. But the problem is, when you start again, "yes" the tolerance may have gone down, but it will go back to where you were beforehand quicker than it did the first time.

A great analogy is riding a bike. I remember it took me a while to finally "master" it without stabilizers when I was a child. Then if I stopped riding the bike for a while, when I started again I'd be a bit wobbly at first, but in no time it was like I had never stopped riding the bike! It's really the same way tolerance works - your brain never seems to "forget" it.

It's why so many drug addicts end up dying from an overdose - they keep upping their dosage until eventually they go into OD territory and don't make it. Pregabalin is a "drug of choice" for many, and thankfully it was recently made a "CD" (controlled drug). (Of course, usually they mix with other drugs to "synergise" the effect, not to mention the crap the dealers use to "cut" the drugs, yada yada)

Obviously, your psychiatrist knows you and is far better placed to decide which drug you are on - but at the same time, you're his patient not his "slave", so you should have a choice in how you're treated.

With regards trying "something else", it depends what you mean by that? Certainly, switching to a "benzo a day" would not, IMHO, be the best course of action because tolerance will develop there as well and you'll end up with the same situation. However again your psychiatrist is best to advise you on this.

The only real way to slow down (or prevent) tolerance from developing to these drugs is:
* Don't take them every day
* Only take prescribed dose - if you notice not effective, do not take an extra dose and mention this to your prescriber - then consider "drug holiday"
* Drug holidays

Even then, some people who do the above still continue to develop tolerance. This is why these drugs are best used only "when needed" and after other avenues have been exhausted.

Good luck and don't be afraid to question your treatment when you're being reviewed if you feel unhappy with it

[Paperback Writer]

Hi RadioGaga,

Thank you very much for your reply

Everything you've said makes complete sense, I kind of had an idea that would be the case but to see it written down in such a way is massively helpful.

I saw the psychiatrist yesterday who said to go up to 600mg of pregabalin for now to see if it helps to level things out again. However, I know from experience that this could just be a short term fix and have also spoken to him about having a plan B. He's suggested introducing an SSRI such as Sertraline to work alongside the pregabalin which I'm not opposed to at this point. He did also mention a benzo such as diazepam if the pregabalin didn't work but as you say, these can be very addictive and not something I would wish to entertain considering the tolerance issues and addictive nature of being on them for a prolonged period of time.

I have my fingers crossed that the pregabalin will start working again soon and I'm glad to have a plan in place in case (or rather when) the tolerance issues arise again. Thank you again for your advice, it's very much appreciated!

[KK77]

With regards trying "something else", it depends what you mean by that? Certainly, switching to a "benzo a day" would not, IMHO, be the best course of action because tolerance will develop there as well and you'll end up with the same situation. However again your psychiatrist is best to advise you on this.

The only real way to slow down (or prevent) tolerance from developing to these drugs is:
* Don't take them every day
* Only take prescribed dose - if you notice not effective, do not take an extra dose and mention this to your prescriber - then consider "drug holiday"
* Drug holidays

Even then, some people who do the above still continue to develop tolerance. This is why these drugs are best used only "when needed" and after other avenues have been exhausted.

Git

I totally understand tolerance issues with opiates, benzos, alcohol and other "addictive" drugs, but what about antidepressant meds which do not produce immediate "reward pathway" effects?