I see so many posts about meds working and not working or causing nasty sfx, etc., that I thought it might help to run down the following info about the influencing factors I know of from both education and observation that are most commonly observed:
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Co-morbid abuse of or addiction to alcohol or street drugs. Far and away the most often-seen correlative.
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Lack of appropriate, functional support from family members, other intimates and the health-care providers.
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Inconsistent use of prescribed medications. The anti-Ps, anti-As and anti-Ds all have half-lifes. If they’re not taken on schedule, or suddenly discontinued, one may experience withdrawal and rebound effects.
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Over-medication. A very common problem, especially if the prescriber is not a more sophisticated, board-certified psychopharmacologist (regardless of whether he or she is an MD, and DO, an NP or a PA). I have seen a lot of pts do better on lower dose levels, but NOT everyone, by a long shot.
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Stress. Too little as well as too much. Some stress is useful; too much is not. If the autonomic nervous system is regularly in “fight or flight” (let alone “freeze, freak, flop or fry”), the meds may not only not be able to get the job done but make things worse (as with negative symptom pts).
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The principle anti-P is no longer effective owing to neuroplastic changes the med itself – or many other other factors – may have induced.
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Poly-pharmacy. A lot of sz pts (especially those with negative symptoms) are on "cocktails* used to try to balance the neurostimulant vs. neurodepressive effects of other meds, as well as mood levelers and minor tranqs. What may have worked well together before may not work well now.
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Abuse of PRN-used minor tranquilzers, especially benzodiazepines like Ativan lorazepam, Klonopin clonazepam, Valium diazepam and Xanax alprazolam.
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Over-dosing or overly long-term use of other anti-anxiety agents like BuSpar buspirone, Inderal propanolol or Catapres clonidine.
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Diet. Unfortunately, a lot of sz pts are drinking way too little water, drinking way too much coffee or other caffeinated beverages, eating junk food, eating way too much bread, eating way too much sugar, etc., etc., etc.
I think it’s a really good idea for pts – or those living with them – to keep a record of what the pt is taking (including street drugs), and how he or she is doing.