Saturday, May 28, 2011

Talking to Your Doctor About Medication Side Effects

© 2011 by Tom King
Anyone who's ever taken meds has experienced a side effect from that medication. If you took aspirin and your headache went away, that was a side effect of the aspirin. Meds all have good side effects (those you want) and bad side effects (those you don't). Physical side effects are obvious, but not so with psychological side effects.

So what can you do if you suddenly start having episodes of dark depression, rage or anxiety?

Step 1: Identify the culprit
It could be you're just responding to something stressful that is going on in your life. Just as likely, something could be causing you to feel the way you do and your mind is looking to find a reason to latch onto to explain the feeling. Ask yourself these questions:
  1. Have I changed medications lately. If yes, suspect the med as the culprit
  2. Have I experienced severe stress, trauma or a strong emotion (wedding, for instance, though joyous occasions are among the more stressful things anyone can endure). If yes, suspect a stress reaction. Some people get hives when stressed, for instance).
  3. Did I eat something new that I've never had before. If yes, suspect allergies.
  4. Have I been exposed to something I could be allergic to? If so, suspect the symptoms may be caused by a reaction to a toxin or allergen.
Step 2: Talk to your doctor
If, for instance, you have a sudden episode of unexplained rage, call your doctor. A friend with bipolar had those. We discussed it with her psychiatrist who suggested taking 12.5 to 25 mg. of Seroquel a day (an almost miniscule dose) along with her anti-depressant / anti-anxiety meds she took for her panic attacks. Small doses of Seroquel helped stabilize the rage episodes for her and she's had virtually no other side effects, except for the elimination of the anger. Fortunately, we had a good relationship with her doctor and the doctor was a whiz with medications.

This doctor believed in starting with low doses and increasing them slowly till you get a therapeutic effect. Many start with the full dose and only back off if you start doing the Thorazine shuffle. This isn't the best way, but docs don't like to take the minimalist approach unless the patient has a really good support system of family and trusted friends around him to observe the patient's behavior. You can thank lawyers for this practice. Unless the patient demonstrates that he or she will trust their support group, the doc will go for the full dose right off the bat to reduce the chance of the patient losing it or committing suicide and suing the doctor for not giving them enough meds. It's a problem.

Step 3: Engage the Scientist in Your Doctor.

Don't let your doctor overdose you just to make you stop complaining. There's good clinical evidence, for instance, for the efficacy of using Seroquel in tiny doses along with other bipolar meds to control anger. Because the doc trusted my friend's family support system, she started her on a very tiny dose of the new med. We had to get a pill chopper and cut the smallest pill they made in half to get the proper dose. Seroquel doesn't come in a pill as small as the one she takes.

So if you are having distress, you should:
  1.  Educate yourself before you go to see the doctor. Go on-line and read up on the side effects of that med first so the doc or his nurse can't B.S. you or blow you off. If necessary take the side effects list for your med with you and hilight where it says your symptoms can be caused by the medication you're taking.
  2. Visit your doctor and calmly discuss adjusting your meds. Don't be adversarial. Have your facts at hand, in writing if possible, but always ask the doctor his opinion about what you've found. Some older docs will think you're a hypochondriac – that's a hazard of knowing too much about what's going on in your own body. On the other hand, the newly minted doctors coming out of today's med schools are being trained to listen to patients and will appreciate your non-adversarial approach and the information you give them about your symptoms. If this is a new symptom, and you report how it's connected with the timing of a new med or a med increase, the doctor will suspect it's an artifact of a new med or med change. If you ask the doctor if the new med could be causing the symptoms you're feeling, he'll likely take the time to educate you about the medication and will often be more receptive to making an adjustment. Get in his face and the doctor may decide you're “non-compliant” with your meds and be more reluctant to change anything.
A Cautionary Tale:

My grandmother took a med called Oxyfloxin, a powerful anti-biotic. She had a brutal panic attack a few days after she started taking it. I didn't have Internet back then, so I went to the pharmacist with the name of the med and asked for a copy of the side effects for that med. The pharmacist gave me the list and when I read it, sure enough one of the reported side effects was "panic attack". I called the doc, but he didn't give me much response, only that the med couldn't be causing it. I finally went down to his office and caught him after his patients were gone and he was getting ready to leave. I explained my grandmother's problem and handed him the handout I'd got from the druggist on Oxyfloxin with "panic attack" highlighted in bright yellow. He had already given her an anti-anxiety med to try and stop the attacks, but it wasn't working. I had pulled a couple of studies on the treatment of panic attack off Med-line at the university (you can get it off the Internet now). I gave him the names of the studies and suggested that maybe a new anti-biotic and adding a small dose of anti-depressant along with the anti-anxiety med might also work for my grandmother's panic attacks. Then (and this is important), I respectfully asked him what he thought.

He said he'd check it out, went home that night and called me in the morning to tell me I was absolutely right and changed my grandmother's meds. After she started taking the new med, the panic attacks stopped immediately and after taking the meds for two weeks, she stopped and never had another panic attack.
One thing I particularly remembered was that the doctor talked to me about how solving this problem had been a scientific puzzle for him and that he had really enjoyed the challenge of working together with us to figure out how to solve it. The trick is to appeal to the doctor's scientific curiosity. Educate yourself, but don't get oppositional with the doc. Tell him what you've discovered and ask him to take a look at it and tell you if he also thinks this might be the problem (whatever new med or med change you suspect could be causing the outbreak of rage you're experiencing). Enlist the doc as your mentor and fellow traveler on the quest to find the med that works for you. If he's willing to listen to you, then you've got a real gem. Don't dump your doc just because he got the meds wrong the first time. Psychotropic meds are very much an experimental process and the chances of hitting the right combination for your condition the very first time are not good. It's particularly rought for folks with mental disorders. Though mental disorders mostly have a physical basis in the form of altered brain chemistry, there's no blood test or X-ray, MRI or CAT Scan that can identify bipolar or schizophrenia or anxiety disorder. You can only tell by outward symptoms and by how the meds effect you. With ADD for instance, the stimulant meds like Cylert or Ritalin work remarkably well – the Ritalin effect is one of the most striking in psycho-pharmacology. If Ritalin works, then you've got ADHD. If these meds don't work, you may be dealing with juvenile onset bipolar, major depression, Tourette's or something else that mimics ADHD. With mental illness in particular, you can't figure out whether you have it, how to treat it or even what specific meds will affect your brand of mental disorder except by hit and miss experimentation.

Stick with Your Doctor!

Don't doctor hop just because the med didn't work the first time. Finding the proper medication regimen, diet, exercise and therapy routine that works for you may take years. Be patient. The doctors usually use a set triage approach. They start with medicine A and if that doesn't work they try medicine B and then C and so on. If you go to a new doctor, he's likely to start the same routine all over again. Don't get mad at your doctor, especially if you find one who will actually listen to you without assuming that simply because you clearly document your symptoms, you're not a hypochondriac.

Information About Symptoms is Critical.

I had a kid I worked with at a residential treatment center. This kid would take a swing at my head, completely without warning, every day at 5:25 pm. Like clockwork! I wrote down all the symptoms I was observing and got a note directly to the psychiatrist that was prescribing his meds. The doc immediately caught that it was happening 25 minutes after his 5 o'clock meds. He changed one medication that had aggression listed side effect. The attacks we discovered had begun the same day he started this particular medication. After we changed the med, the kid stopped attacking me. We had another girl at the center who would wreck the cafeteria a couple of times a week. Turned out it only happened on days we had oranges or orange juice on the menu. She tested violently allergic to citrus. We stopped the OJ and she stopped wrecking the dining room.

Summary:

  1. Find a good doctor. Be respectful. Stick with him. Give him time to track down a treatment for your condition, but make sure he listens to you.
  2. Appeal to his scientific curiosity. Have studies to cite and documentation of the side effects of the meds your on when you come to the office.
  3. Don't threaten your doctor. Try to make the doctor not feel like you're challenging him or trying to tell him his job. Ask questions, don't make demands.. Get him to invite your input as you search for a solution.
  4. Trust your support system. You know what you are feeling, but that feeling may be the result of hormone or neuro-transmitters misfiring in your body and brain and have no real basis in fact. You can be angry for no reason other than you've got too much of one brain chemical and not enough of another in your brain.
  5. Track your symptoms. If you experience an unusual symptom or you started feeling emotional suddenly, take a look at your life and try to figure out what changed before you started having the new symptoms.
  6. Educate yourself. Information is your best ally in getting your condition under your own control so you use the meds to control your condition. Don't let them arbitrarily controlled you. If a med doesn't do what you want, talk with the doc about changing the dose or changing the med. If your doctor or psychiatrist sees you as a reliable reporter of your own symptoms, they'll respect you and listen and finding the proper treatment for you will take far less time.
Tom

No comments:

Post a Comment