Thoughts on taking medications

What You Need to Know About Taking Medicine Every year, more than 100,000 people die in this country related to toxic reactions to prescribed or miss-prescribed medications. Another 200,000 people have severe reactions to their medicines, going up or down on the dose. Medications are powerful agents for good, but medications are also powerful agents for harm and should not be taken or stopped lightly. This information is provided to increase your chances that the medication you are being recommended to take (or come off of) will provide you with more benefits than harm. There is no guarantee here; there is still risk. Unpleasant side effects to medications are common. Some of these are mild and of no consequence. Others are warning signs of danger. Think of medication side effects (whether you are going up or down on the dose) as the body's attempt to warn you away from severe medication toxicity. Why would doctors prescribe medications that can cause so much harm? Everything your doctor says or does is based on averages. On average, the medication being prescribed will provide more benefits than harm, if the condition has been diagnosed correctly. But there is a whole lot of room for things going wrong here! You are not "average." You are just you. On average, your prescriber’s advice to you to try the medicine (or to come off of it) will do you no harm. But there are a minority of patients who will do poorly and potentially experience a serious reaction to the medicine change.

So which side effects are harmless and should be put up with versus which ones should lead you to stop [the change in] the medicine? This depends on the nature of the medication and the condition being treated. Some medications for cancer have severe side effects (e.g., all your hair can fall out!), but they can save one's life. Some psychiatric medications can cause persistent, unpleasant, moderate side effects. This is sometimes the case of the medications used to treat schizophrenia and bipolar disorder. But the vast majority of psychiatric conditions can eventually be treated with medications that cause very little side effects, once the right medication has been found. You will need to see if your prescriber agrees with this,but the following is a handy rule of thumb: put up with mild side effects for up to 7 days. Our bodies are quite adaptable and will be working to neutralize the side effects with the first dose taken (or removed). So these side effects will usually go away within 7 days and will rarely lead to harm. Back in the day of my own practice, I would advise my patients if having persistent mild side effects, if having moderate or severe side effects, if having any side effect that you or others find alarming in any way, then STOP YOUR MEDICINE! (or stop going down on the medicine if it is a side effect emerging as part of stopping the medicine). Consult with your own prescriber about what they want you to do. Here are some definitions: Mild side effects: any side effect that does not last all day, that one can distract oneself from for hours at a time (if one is busy enough) & that does not last longer than 7 days. Moderate-severe side effects: any side effect that lasts all day (even if it is a mild headache, if it lasts all day, without relief, I would call this a moderate side effect), or any side effect that you or another reasonable adult would find to be "alarming" (e.g., rash, nose bleed/bruising, numb hands, purple spots (even if you like purple!)). More and more of the psychiatric medications are being shown to have increasing suicidal thoughts and feelings as an uncommon but potential side effect. Certainly, this would be a good reason to stop your medication! Which side effects can be expected? Just about every medicine has the risk of nausea, dizziness, rash, sedation (“feeling too medicated”) and headaches. But there are countless other odd, unusual reactions to medications, and listing them all would be pointless, since you could not remember them all. If you want more specific information about the potential side effects of your specific medications, www.drug.com will give you more information than you want to know. But in general, you will do well to suspect ANY new physical, mental, emotional, or spiritual sensation to potentially be a medication side effect when starting a new medication. Most side effects will emerge within the first 2 weeks. It is rare for side effects to develop months down the road (though this is possible with rashes, in the elderly, or if your physical health has suddenly deteriorated). Hopefully, at this point, you are asking yourself "with all these risks, is it really a good idea to take medications?" This indicates that I am giving you sufficient information to give you pause in taking medications. This is my point, because having this kind of respect for medication will protect you from coming to harm from them. There are treatments for your condition that do not involve medication. These treatments have their own risks. So taking a medication might be reasonable. But too often I have encountered patients that persist in taking medications despite having significant side effects to their medicines reasoning that the doctor must have known that this might happen and so having a false sense of assurance that they would come to no harm. Unfortunately, doctors cannot predict who is going to have good or poor outcomes on medications. The doctor's responsibility is to provide you with information that medications have risks; your responsibility is to protect yourself from these risks. To be clear, you are not doing your prescriber any big favor in taking your medicine despite feeling sick as a dog on them! Specific information for patients of child-bearing age: do not get pregnant on your medicine without talking to your prescriber first. Some psychiatric medications are linked to birth defects. Specific information for patients taking birth-control medications: some psychiatric medications decrease the effectiveness of birth-control. Discuss this with your prescriber or PCP and use alternative control methods in the meanwhile. When in doubt about any of these issues, consult with your prescriber.