(Part 2 of a 5 part series)
While the focus of this is on the side effects of antidepressants for a detailed example, it is relevant for all mental health/psychiatric classifications of medications.
All medications have the potential for side effects. Before deciding that statement means they should be avoided keep in mind virtually everything that a person consumes or comes into contact with in their environment also has the potential for side effects. There are food allergies (many that are potentially fatal such as peanut allergies), allergies to the fabrics we make clothing out of, sensitivities and reactions to things in the air such as pollen from flowers on the side of the road. The point being that saying medications may have side effects is a given, since everything else does too.
While accepting that everything has potential for an adverse reaction, intentionally adding something to your daily diet that could have adverse reactions is not to be approached lightly. In the end, a person must weigh potential benefits against potential risks and if both they and their health care provider agree the potential benefits outweigh risks then it becomes a valid consideration to begin or try a medication.
Once one has decided to try a medication, the real proof comes in the results for the individual. It is in the actual use of the drug that any individual can determine the true benefits versus the side effects or potential risk. With all medications , making a fair determination of risk/benefit, compliance with taking the medication as directed is essential. The importance of compliance with taking as prescribed cannot be overstated.
With proper adherence to taking medication as directed there can be a reasonable expectation of benefits. Then a more careful look at the adverse effects is needed. There are several considerations such as allergies, tolerance issues, and then adverse effects. The incidence of actual allergies is quite rare, and though rare can be a true medical emergency. The risk of this can often be accessed to some extent by the health care professional based on patient history and allergies to components in the medication. Compared to the reported allergies to penicillin as an example, psychiatric drugs are far lower risk. Penicillin allergies are reported by as many as 10% of patients (though follow up care shows actual allergic reactions are fewer and that “allergic” is misdiagnosed often by the patient). In antidepressants even reports of allergy are well under 1%.
A large factor in the occurrence of side effects has been proven to come from a form of placebo effect in taking medication or placebo amplification. The more informed the patient is of potential side effects, the more likely they are to report experiencing them. While it is difficult to control this, trying to think from a logical rational perspective when starting a new medication can help. Not every headache or upset stomach you have after starting a medication is the “fault” of the medication. If you have occasional upset stomach or headaches already then assuming it is caused by the medication may be a wrong. At the same time it could very well be true, so the real issue is keeping perspective.
Understanding the terminology used in patient information sheets is a key aspect of understanding the risk of side effects. The following terms are typical in drug labeling–
- Frequent side effect = 1% or more reported. So if 1 person out of 100 reports it as a side effect it is labeled frequent.
- Infrequent side effect = less than 1 out of 100 patients report, but more than 1 out of 1000.
- Rare side effect = any reports that effect less than 1 out of every 1000 patients taking the medication.
While reading a label and seeing it is a “frequent side effect” may be disconcerting, if further reading shows it was only one or 2 of every 100 people then that is not what most people would consider “frequent” as common use of the word. The most serious side effects fall into the infrequent and rare categories on the majority of medications or they would not get approval for use.
In antidepressants, increased suicidal thoughts is a serious and often looked at “side effect”, but in reality falls into the infrequent and rare category on antidepressants as rule. This means typically it is attributable to less than 1 out of 1000 patients (and then only measurable in young adults and adolescents under 25) despite it being prominently mentioned on all informational sheets. One also must consider they are being treated for depression already and loss of will to live is in fact a common symptom of depression. Suicide rates are much higher overall in depressed people not being treated at all than those being treated by antidepressant drug therapy.
When taking a new antidepressant medication, it is common for results to take time to fully work as they need to build to a therapeutic level in the blood to experience the full potential benefits. This often takes 2-6 weeks. In the same time period, many of the adverse effects actually diminish with use. This means it would not be uncommon to experience some small negative effects with no real benefit for the first couple weeks. Not giving a new psychiatric drug time to work, or stopping before giving the body a chance to adjust to the adverse effects happens far too often in the real world. The attempts to get positive effects faster by increasing the dose on their own, or to reduce the side effects by skipping doses usually exacerbates the problem.
Managing expectations from antidepressants is another real issue. Taking an antidepressant helps you deal with problems and cope with difficult situations. Many people have expectations of far more and it is not what they are intended to do. They do not –
- They do not cause spontaneous happiness or euphoria like recreational drugs
- They will not solve situations or problems like living in an abusive environment or money problems
- They will not change your personality- for example if you hate a certain kind of work they will not make you suddenly like it or make a shy person outgoing
- They cannot make boredom from no external activities go away
The purpose in antidepressants is to make a person able to cope with problems as well as anybody else can, so they are able to function, and able to pursue normal life activities as well as anybody else could. They can allow to people to find enjoyment in the things they always had enjoyed again, or find motivation and self-reliance needed to cope with many of the above situations.
The 2 large common concerns that lead people to stop taking or not to try many psychiatric medications are weight gain and the feeling of numbness.
- Weight gain is a frequently reported side effect in real world usage that is not always reported in clinical trials. This is less about clinical changes in metabolism than about the fact that loss of despondency and lack of will to live cause feeling of boredom and appetite that the depression has caused to be missing form a person’s life, often for an extended period of time. This results in changes of eating habits and any time that a person consumes more calories than they use in physical exercise they will gain weight. Adding physical activity and exercise will alleviate this adverse effect as well as increase overall well-being, but it does require concerted effort at changing to healthier over all lifestyle that was often forgotten during longs bouts of depression.
- Feelings of numbness are often reported with stronger antipsychotic medications. When these feelings are reported from the typical antidepressants it is very often not that the person is experiencing numbness so much as the lack of extreme emotions like sadness, guilt, and remorse. Even though they are all negative feelings, they are very intense and the person is used to this intense sensory input. The numbness as it is called is very often the lack of pain and fact they have not adjusted lifestyles yet to include positive emotions that take effort – like finding things to make themselves actively happy or excited as a substitute for the active pain.
Antidepressants are not the answer for every person suffering from depression, but their effectiveness for a large number of individuals certainly makes then a valid consideration for any diagnosed with depression. Ultimately, it is a personal choice for every individual, and a choice that should only be made either way after consulting with a trained professional. When considering side effects as a reason for not taking medication however, it should also be strongly considered what the effect of not treating is. What side effects are worse than pervasive sadness, loss of will to live, despondency, and potentially death by suicide? The side effects of non-treatment are of equal importance.
To be continued…..
Part 3 – Do Antidepressants Work?
Part 4 – Explanation of common medication classes and the uses
Part 5 – Is it time to come off my medication? Am I cured?