How does "resistance to [psychiatric] medication" develop?

November 1, 2014 11:16 AM

Today is the first day of National Novel Writing Month, and I've been kicking around a setting in which the regular use of all kinds of mood- and cognition-enhancing drugs is widely accepted in society and tacitly endorsed by the government (though this is neither utopic nor dystopic). I'd like my protagonist to be dealing with the fallout of developing a resistance to these mind-enhancing medications, but before I spend 50,000 words on it, I'd like to check my premises.

I've been warned by psychiatric professionals in my own life that developing a resistance to medication for the brain in general is a danger of too many med changes, among other things. How does that work? I'd like to be specific about the mechanism by which such an immunity develops, and how widely it can apply. Or, is it a boogeyman tale, and if it is, am I better off inventing a more plausible sci-fi premise?

I do NaNoWriMo for fun and know that my draft will not be a serious product, but I do harbor aspirations of revising enough after that I would eventually want to share my story with readers.

posted by dee lee to Science & Nature (3 answers total)

Here's a reference for you, with a short excerpt:

Now let’s turn to a 1996 paper by Steve Hyman titled “Initiation and Adaptation: A Paradigm for Understanding Psychotropic Drug Action.” A neuroscientist, Hyman was director of the NIMH when he authored that paper. He told of how psychotropic drugs perturb neurotransmitter function, and how in response to that perturbation, the brain goes through a series of compensatory adaptations in order to maintain its normal functioning. However, after a time these compensatory adaptations break down, and the “chronic administration” of the drugs causes “substantial and long-lasting alterations in neural function,” Hyman wrote. As part of this adaptive process, there are changes in intracellular pathways and “gene expression.”

You might also look up information about homeostasis, homeostatic compensation, receptor upregulation / downregulation, tolerance, and withdrawal. Much of the information you find is relevant to your question.

OP: "developing a resistance to medication for the brain in general is a danger of too many med changes". Not sure if the changes are really relevant. It's more about chronic administration of any given drug.
posted by alex1965 at 12:46 PM on November 1, 2014

I've gone through lots of ADs. A lot of them I build up a tolerance to. I'm back on one of those which pooped out on me. So for me, it is chronic dosing not changing meds.
posted by kathrynm at 3:05 PM on November 1, 2014

There are some psychotropic drugs that do not attenuate, but for the most part, our endocrine pathways are highly regulated both positively and negatively. Thus, to grossly oversimplify the matter, any force generated to push your neurological state in one direction will generate an equal and opposite force, which bides its time. This is colloquially referred to as the crash, or coming down.

You may await the inevitable crash, or attempt to chase the dragon, with ever increasing doses.

It's all very Zen if you think about it.
posted by hobo gitano de queretaro at 9:05 PM on November 1, 2014