It’s estimated that 25% of people develop tolerance to their antidepressant medications. This medication tolerance issue was first noticed in the early 1980’s when we were using Monoamine Oxidase Inhibitors, called MAOis. These were very effective drugs, but you had to adhere to a really strict diet of no cheese and other things or else you could have a dangerous hypertensive crisis. Meaning your blood pressure could shoot up dangerously high.
Then in 1988 we got Prozac or fluoxetine as the first selective serotonin reuptake inhibitor. This was innovative because now we had another option that promised to have less side effects. But it didn’t take long before we started to see the same problem. Then the term was called Prozac poop out.
The classic way this looks is that you take the medication and get a full remission of your symptoms, meaning your symptoms resolve and you’re back to where you were before you started taking the medication. Then somewhere around 4 months to a year, you start feeling bad again even though you made no change to the medication.
The medical term for this is antidepressant tachyphylaxis. Which is defined as a rapid development of tolerance or immunity to the effects of a drug
Why isn’t this talked about more? Because it’s complicated and for a while, we weren’t sure if this was a true tolerance build up or if your return of symptoms was due to other reasons. Here are 5 other reasons you can have a change in your response to your medication.
1. Changing generic medication.
2. Not being on enough drug.
3. Having another medical issue.
4. You could be put on another medication that interferes with your antidepressant or causes depression.
5. Dopamine depletion
Here are 4 solutions.
1. Increase the dose of the medication if you can.
2. Decrease the dose or take a drug holiday
3. Change to an antidepressant that works differently
4. Your doctor can you give you an add on medication like aripiprazole or lithium.
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References
Targum, S. Identification and Treatment of Antidepressant Tachyphylaxis. Innov Clin Neurosci. 2014;11(3-4):24-28
Scherrer JF, Salas J, Copeland LA, et al. Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations. Ann Fam Med. 2016;14(1):54-62.
Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain. 2011;12(9):964-973.
Upadhyay J, Maleki N, Potter J, et al. Alterations in brain structure and functional connectivity in prescription opioid-dependent patients. Brain. 2010;133(Pt 7):2098-2114.
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