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Now that we know what side effects most crazy meds have, what, if anything, can we do about the persistent ones everyone complains about?
1. Whatcha Gonna Do About It?
How to deal with side effects is a factor of the med(s) in question, the condition being treated, and a whole bunch of stuff in the person’s life. When it comes to dealing with some of the annoying, but not deal-breaking side effects common to all of them, you basically have to be patient and wait a couple of weeks. As for the ones that stick around and cause people to stop taking meds that are otherwise working for them, here’s what I’ve found that works anywhere from sometimes to often, for some to many people.1
1.1 Does this Pill Make Me Look Fat?
Weight gain is the number one complaint for meds that actually work. How do you deal with it?
- All the usual stuff still applies, like eating less and exercising more,2 but you’ll probably need more than that.
- Metformin is probably your best bet.
- Unless you have epilepsy or migraines, Topamax usually causes more problems, but every now and then can make whatever you’re taking work better for psychiatric conditions.
- Axid (nizatidine) is used for ulcers and GERD and works the histamine H2 receptors, and drug-induced weight gain stems from the H1 receptors. It failed all over the place.
1.2 I Can’t Get it up with a Forklift
Close behind weight gain in complaints are the various sexual side effects (SSE).
- For SSRI & SNRI-induced SSE the usual methods are:
- Adding BuSpar. This has the added bonus of helping with any anxiety symptoms you may have.
- Adding Wellbutrin. This can augment your antidepressant (AD), but isn’t always a good idea.
- Adding a dopamine agonist like Mirapex (pramipexole) or Requip (ropinirole). This often works better than Wellbutrin. Sometimes a little too much better.
- Adding Remeron. No, really. As long as whoever loves you sees you for your true self and doesn’t care that you weigh twice as much as you used to.
- Using Viagra, Cialis, or some other erectile dysfunction medication. As odd as it might sound, even women use these.
- Switching to another med. Paxil and Lexapro are the worst offenders in the SSRI-induced SSE sweepstakes, Zoloft has the fewest problems. Switching to something completely different is another option, like Wellbutrin or Remeron, but it might not work for you as well, if at all.
- The drug holiday is often suggested, but I don’t recommend it. Not only could you be subject to SSRI/SNRI discontinuation syndrome, but your AD may not work as well each time you do this.
- As SSE caused antiepileptic drugs/anticonvulsants (AEDs) are typically hormonal in nature, there’s not much you can do that won’t mess you up in some other way. So far there is all of one recommended solution: switch to Lamictal.
- Like AEDs, SSE caused by antipsychotics (APs) can be hormonal, but the reason for this is much simpler: it’s the way dopamine is messed with. And as that is ultimately the same reason why SSRIs and SNRIs cause sexual dysfunction, a lot of the treatments will similar. There’s also a lot of overlap with the treatment for AP-induced movement disorders:
- Reducing the dosage and hoping your med still works well enough.
- Trying a different med, which is usually switching from a first-generation AP to a second- or third-generation AP.
- Or switching from whatever you take to Abilify.
- Just remember: frequently changing meds can make you treatment-resistant.
- Adding a dopamine agonist like bromocriptine.
- Using Viagra, Cialis, or some other erectile dysfunction medication.
- Lithium-induced SSE is also hormonal, but the hormones in question are mediated by your thyroid. At least you can get a test and do something about it without messing up your therapy.
- Keep in mind: wanting to have sex five times a day when you’re over 40 (and weren’t living in a monastery or convent most of your life) was probably a symptom of hypersexuality, so a reduced sex drive could be an indication that the meds are working.
1.3 Just Five More Minutes, Then I’ll get out of Bed
Lethargy and excessive sleepiness can be fairly difficult to counter, as most pharmacological treatments will exacerbate the conditions you’re treating with the medications for which somnolence is an adverse reaction. In English: taking pills to treat these side effects usually screw you up more.
- One solution is so simple that most people, including doctors, don’t even consider it: take the damn meds before going to bed instead of in the morning.
- Along the same lines, take them a couple hours before going to bed.
- If you take meds twice a day, and they have a half-life greater than 16 hours, try taking them all at once before going to bed. Or a couple hours before going to bed.
- As always, there’s the option of switching meds.
- Caffeine. Is it your friend? How the hell should I know? I can tell you if it could be a problem:
- If you take Luvox (fluvoxamine). You have to be extremely careful with anything caffeinated if you take Luvox.
- If you take Topamax. Topamax + caffeine can sometimes cause panic attacks. “Sometimes” meaning it sometimes happens to some people who take Topamax.
- If you’re taking anything for anxiety or insomnia, why are you drinking coffee in the first place?
- OK, now we come to pills. And despite all the shit I give Cephalon for managing to get the FDA to sign off on a new disease (shift work sleep disorder) just so they could get Provigil approved for it, Provigil and Nuvigil are really effective in dealing with medication-induced lethargy and excessive sleepiness.
1.4 I Just Want to Tear my Hair Out
Treating hair loss is somewhat nebulous.
- Various shampoo formulations and dietary supplements have worked wonders for some and were a complete waste of money for others.
- All I can really tell you is use extreme caution with any supplement containing selenium. Selenium is a necessary trace element, and not getting enough of it can lead to hair loss.
- One of the first symptoms of selenium toxicity: hair loss.
1.5 Shakin’ All Over
Drug-induced movement disorders are usually caused by APs and handled in ways similar to AP-induced SSE:
- Reducing the dosage and hoping your med still works well enough.
- Trying a different med and hoping that works well enough.
- Taking a dopamine agonist like bromocriptine and hoping that doesn’t interfere with any AP you might be taking.
- Taking a potent anticholinergic such as Cogentin (benztropine mesylate). This option tends to suck the most, but is the least likely to mess with any AP you’re taking.
- Anticholinergics like Cogentin do nothing as far as prolactin-related problems (SSE, enlarged breasts, surprise lactation) are concerned.
- Some newer APs like Zyprexa and clozapine are potent anticholinergics in their own right, which may be the reason why risk of movement disorders when you take them is virtually non-existent.
- If you do take an anticholinergic or crazy med with potent anticholinergic properties, especially Zyprexa, smoking will negate its effects. Which is ironic when you consider that smoking helps to prevent Parkinson’s.
1.6 I Forgot What I was going to Write
The stupids. It’s what I hate the most. I don’t care about the kidney stones, the athlete’s foot on my fingers (and chest, and thighs, and back, and feet, and it just keeps spreading), the extreme photosensitivity or anything else. I’ve tried so many things. I’ve researched my ass off. The only things that work:
- Adjusting your dosage
- Switching meds
- Sometimes taking additional meds help, but they come with their own problems. The most helpful are:
- Stimulants (so much fun if you’re bipolar and/or epileptic and/or have an anxiety disorder)
- Antipsychotics. No, really. As odd as that may sound, APs can help with the brain fog, memory problems, etc. caused by other meds.
- Of course, if the stupids are being caused by an AP, an additional AP isn’t going to help. Unless it’s Abilify or another third generation AP. And mixing stimulants and APs can be counterproductive.
1.7 I am So Sick of Taking these Meds!
What’s the point of taking a drug if you’re just going to puke it up, right?
- Something as simple as taking your meds with food can be all you need to do to deal with nausea, acid reflux and a host of other problems. While there are some meds that work better when taken on an empty stomach, the difference usually isn’t significant.
- To the point where the only med I can think of that significantly works better when taken while fasting (the technical term for “before eating”) is Lovaza (omega-3-acid ethyl esters), and that’s only when used off-label to treat depression.
- Which it rarely is, because it’s way cheaper to buy decent omega-3 fish oil and take that on an empty stomach.
- Most non-prescription/over-the-counter (OTC) remedies will work for practically every GI problem.
- Just check the full PI sheet of your prescription medication for any drug-drug interaction with the active ingredient of the OTC remedy as well as the product name of whatever remedy you’re about to take. You never know what sort of bizarre interaction will crop up.
- Yogurt and other probiotics can be helpful with chronic GI issues.
- Not with everything and not all the time.
- And you can’t combine them with MAOIs that have food restrictions.
- We’re in somewhat better than placebo territory, but still can’t call it one way or the other.
- Getting them in food (yogurt, kim chee, etc.) is usually better than taking them in pill form.
- For chronic constipation, stool softeners are your new best friends.
1.8 Life is Like High School
Sanity before vanity is one thing, but looking like the before picture in a Proactiv ad is another.
- Acne is treated as if you were back in high school.
- Just be careful with any prescription medication.
- In addition to the usual drug-drug interactions, as there can be unexpected ones that won’t necessarily show up in any of the drug-drug interaction checkers.
- Because crazy meds can affect hormones, and once you’ve got different meds messing with your hormones in different ways, well, as IBM used to say, “unexpected results may occur.”
- And antibiotics can trigger mania. It’s common enough to have its own term: antibiomania. While the bipolar are the most at risk for this one, you don’t necessarily need to be bipolar for antibiotics to make you batshit crazy.
- So you should probably make taking meds to deal with acne your last option, because you could wind up seriously crazier.
- As for other dermatological issues, I’m kind of at a loss. It’s one of those things where it’s either minor enough that an OTC treatment takes care of it, or serious enough that you need to switch meds or see a dermatologist. If there’s a middle ground I haven’t found much of one.
2. Only You Can Prevent Treatment-Resistance. Unless You were Born to be Refractory.
If you keep switching medications because you didn’t want to deal with minor and/or temporary side effects you may wind up treatment-resistant. So even if you go back to a med that used to work for you, it may not work as well, if at all. As usual, don’t just take my word for it…
Treatment-resistant depression: managed care considerations
| Quote:
When initial treatment is not effective or tolerable after 6 to 8 weeks of therapy, the American Psychiatric Association (APA) treatment guidelines recommend dose titration, augmentation, or switching. In the case of a therapy switch, the body of evidence suggests that selection of an agent with a different mechanism of action than the initial agent may be the most effective treatment. Furthermore, when patients maintain continuous therapy for the recommended treatment duration, outcomes are improved compared with patients who discontinue therapy early. As a result, the most effective treatment strategies promote improved patient compliance as well as the use of agents associated with a reduced incidence of premature discontinuation and therapy change early in the treatment program. |
There you have it. Patients are idiots for not sticking with their meds if the side effects aren’t dangerous, make symptoms way worse, or are otherwise utterly intolerable and doctors are idiots for prescribing one SSRI after another.
Granted riding the med-go-round for stupid reasons isn’t the only reason for treatment-resistance.
Clinical factors associated with treatment resistance in major depressive disorder: results from a European multicenter study.
Found that frequently changing meds for a good reason (intolerable side effects) was as much at fault as bad reasons (personality disorders, side-effect phobia), as well as comorbid conditions, misdiagnoses and losing the genetic lottery.
When you read between the lines of the discrete aspects in this study the psychological reasons outnumber the psychiatric.
New approaches to managing difficult-to-treat depressions.
This study takes a far more simplistic view: too many drug changes due to people not staying on meds long enough to give them a change to work. Along with substance abuse (something most others don’t take into account and is probably important) and, perhaps, hypothyroidism. Buh? That’s it, a wonky thyroid? At least everyone else acknowledges a genetic factor for some portion of the population, albeit a small one. I think there are more genetic factors than just hypothyroidism.
A view from Riggs: treatment resistance and patient authority - III. What is psychodynamic psychopharmacology? An approach to pharmacologic treatment resistance.
Too many meds, not enough therapy. The basic idea is there is no quick fix. Familiar, no? The study is playing to the audience, being published in a journal dedicated to psychoanalysis, and therapy won’t solve everything, but not enough people with depression are getting the therapy they need to stay on a freaking med long enough to give it a chance.
The effect tends to hang around for some time.
Impact of prior treatment exposure on response to antidepressant treatment in late life.
Many years after their last depressive episode one third of treatment-resistant old people failed to, or took a longer time to respond to Paxil. One fourth of those who had an inadequate response with prior treatment failed to, or took a longer time to respond, while 14% of people who were never previously treated failed to, or took a longer time to respond.
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1 If I tried I probably could be more vague.2 And we can all see how well that worked.
Page created by: Jerod Poore. Date created: 30 May 2011 Last edited by:
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