Daily Archives: April 5, 2012

Some Things to Consider About Side Effects

I really get a kick when I’m prescribed two different medications with opposite side effects (just by chance) and the effects wind up canceling each other out.

Dry mouth? How annoying.

Overproduction of saliva? That sounds like a social catastrophe waiting to happen…

But when you put the two together, magic happens.

Side effects for the spectrum of psychiatric medications can range anywhere from minute, subtle annoyances to life-threatening emergencies, and that is part of the reason finding the right combination of medications becomes so tricky. Potentially, a number of things could work, but if the side effects are so severe that they damage one’s ability for daily living, what’s the point?

Finding out what the side effects are for each patient (since each person is different) means a series of attempts through trial and error. If the side effects are too severe, something else is tried instead. If the side effects seem to be tolerable, the dose is increased to a level that is most likely to effect the bipolar (or other disorder’s) symptoms.

Some side effects are short term, meaning they will last a few days or weeks until the body becomes acclimatized to the medication. Short term side effects might return briefly if the dose is raised, or may not make an appearance at all until a certain dosage is reached.

Other side effects are long term. Some side effects, like weight gain, might not be noticeable immediately, but will become a problem over time. Other side effects, like tremors associated with lithium, for example, might come and go, or remain after a certain dosage is reached. Again, the result is different for everyone, so it is possible that if two people are taking a drug, one might experience hair loss while the other does not experience that side effect at all.

Given the fact that some side effects are short term and some are long term, it is likely your doctor will want you to continue taking a medication (even if it has unpleasant side effects) for long enough that he or she can discern if those side effects short term effects or not.

Personally, I have a very hard time “waiting it out” because my side effects have often been so severe at the lowest possible dose, but I also have many very unusual responses to traditional medications. If it is possible to wait three or four days (or even a week), I would suggest giving it a try -because by that time it is possible that you may see a significant reduction in your side effects.

But where does one draw the line? At what point should you give up on a particular medication (after consulting with your doctor)?

Every person is different, so each person should really decide for themselves what side effects are deal-breakers.

To give you some idea, here are some of the more common side effects I’ve seen listed on psychiatric medications.

  • agitation/restlessness/anxiety
  • vision problems/dizziness/fainting/headache
  • seizure/tremor/uncontrolled muscle movements
  • dry mouth/increased saliva/nausea/increased appetite/decreased appetite
  • vomiting/diarrhea/constipation/stomach pain/heartburn
  • dry skin/rashes/skin discoloration/acne breakouts
  • hair loss/hair brittleness/nail brittleness
  • trouble getting to sleep/trouble staying asleep /drowsiness/ increased dreaming
  • increased sexual interest/decreased sexual interest/decreased sexual ability
  • weight loss/weight gain

Again, this is a general list that covers a spectrum of medications and side effects, but I wanted to show that there are side effects that can be associated with many different parts of the body, from skin to digestion to sleep patterns and beyond.

For long-term side effects you know for sure you want to avoid, like weight-gain, for example, you may want to bring this to the attention of your prescribing doctor as early as possible in the process of trying medications. Hopefully having that information early on can allow your doctor to avoid prescribing medications that might cause whatever side effect you’re trying to avoid.

When it comes to other things you may want to consider speaking with your doctor about, you may want to contemplate the sorts of functions you consider pivotal to your sense of well-being. Do you operate heavy machinery at work? You may want to discuss this with your doctor to re-iterate that alertness is something you value very highly. Do you do creative work that requires a steady hand? This is another thing you should bring to your doctor’s attention. Taking a moment to figure out what qualities you value in your daily life can really help in discerning what side effects you can live with and which ones you can’t.

So let’s say you’ve been taking a medication for a long period of time, and for the most part it has been working well for you -psychologically speaking, but there have also been one or two moderate to severe side effects. The questions I hear the most often from people about medications is if they should stick with the medication that is working (and making them somewhat miserable physically at the same time) or begin working with a doctor again to try new medications to see if they have better luck with something else.

It is not unusual for a doctor to prescribe medication to counteract the side effects of another medication, and to some extent this can be helpful. There are some doctors, however, who can get a little out of control prescribing medication to counteract side effects from another medication that is counteracting side effects for yet another medication. Because of this, I would suggest discussing with your doctor how many medications you are willing to take (or even able to afford).

Making the decision to try something new after having taken a medication that has been helpful psychologically comes with a lot of challenges. Again, each person has to decide for themselves where they draw the line, in terms of when side effects are doing more damage than the amount of good a medication is providing psychologically. I would suggest, however, asking yourself a couple questions before making any final decision.

1) Are the side effects of your medication hindering your daily functioning?

2) Are your side effects keeping you from enjoying many of the things you love most in life?

3) Are you emotionally and financially able to begin trying new medications again?

There are side effects that are an annoyance, and there are side effects that can keep us from functioning or enjoying the activities we love. In my opinion, if your side effects are an annoyance but you are still able to enjoy your life, I think it would probably be a good idea to try to work around the annoyances. If your side effects are keeping you from enjoying your life, either because they inhibit your functioning or ability to do the things you enjoy, it seems like a perfectly reasonable conclusion to try something else. Medications are supposed to help improve our functioning, they aren’t there to “make us happy.” We have to make ourselves happy, and if our side effects are keeping us from doing that, you may want to consider talking with your doctor.

As I made mention of in question number 3, it is also important to consider whether or not you feel up to the task of changing things up, as doing so can be a very challenging and scary thing to do. It isn’t a move to consider lightly.

In any case, most side effects are not permanent (and those that could become permanent will usually be pointed out to you by both your prescribing doctor and pharmacist) and though they can make the process of finding the right medication (or combination) a little maddening I would not suggest avoiding trying the medication route because of them. As long as you are clear with your prescribing doctor about what side effects are important for you to avoid, what abilities you value on a daily basis, and what side effects you experience (in the event that you do), you can help make the process as painless as possible.