A bit on the side

Most medications have side effects. Laurie Penny asks what side effects are and explains how to make sense of them

Taking a medication is like going on a blind date with a good-looking stranger. You never know if you’re right for each other until you’ve spent time together, and even when you have, however wonderful they are, they will always have a few annoying tendencies. Some things in life never change; your dream date will probably turn out to hog the bed sheets, and almost every medication you can take to help you deal with mental health difficulties will have some side effects. In both cases, you can either put up with the bad bits and enjoy the good times, or think about looking for someone/something else.

What are side effects?

Side effects are literally the other effects that a treatment has aside from the one that is the reason you are taking it. Psychiatric medications have a range of different effects. As they work on brain chemistry, and because the brain controls your whole body, those effects can be hugely varied, from weight changes, to skin conditions, to changes in mood and behaviour.

It’s important to give any new medication time to settle into your system, to see what is and is not a long-term effect of the drug. Nearly everyone experiences side effects when they start taking a new medication, as their body chemistry adjusts. For example, Selective Serotonin Reuptake Inhibitors (SSRIs) are some of the most commonly taken anti-depressants. They work by increasing your body’s levels of serotonin, a chemical which can stop you feeling anxious and depressed. When people start to take SSRIs like Citalopram or Fluoxetine, they often experience nausea, a dry mouth, flu-like feelings and other symptoms. These side effects nearly always disappear within a few weeks of taking the right dosage. Some side effects keep happening for as long as you take the medication. Which side effects you will experience vary from person to person and depend on the type and dosage of medication you take. Some people need to take medication and deal with the side effects for only a short time, whereas others will need medication on a more long-term basis.

With the help of a doctor, everyone who takes psychiatric medication needs to decide if the benefits of taking the medication outweigh any irritating side effects. For some people, this may involve trying out different types of medication until they find a balance of good and bad effects that works for them. Mark Reed, 36, has been taking medication for his depression for over five years: “The meds make me feel drowsy and numb,” he says, “but the biggest effect is that I no longer want to throw myself under a train. So, if I have to I’ll tolerate the rest! I think life and happiness are a victory in themselves, and these medications, if they enable me to get through a period of misery, are the lesser of two evils.”

Your doctor should know about the side effects of the medication they are prescribing and be able to help you find a balance of side effects and positive results that work for you. For example, some medications cause weight gain as a side effect. If you have an eating disorder or a body image problem this might make you feel even worse, offsetting all the good effects. Your doctor should take this into account.

The trade-off

If it weren’t for side effects, the decision to take psychiatric medication would be easy. As it is, there’s always a trade-off to be made between the good side effects, the ones that help you to manage your mental health and make you feel happier and more stable, and the inconvenient side effects which could cause you discomfort or disrupt your life.

Jerod Poore, who experiences bipolar disorder, runs www.crazymeds.us, a popular American website that lists the side effects of psychiatric medications. He founded the site in 2002 because he wanted to provide a place for people taking psychiatric medication to find out about possible side effects and discuss how to manage them. He says: “Side effects are buried in doctor-speak and no real idea is presented about the chances of them happening, how long they last or if they will go away during the course of taking the medication. The purpose of the site is to help people figure out their treatment options. People should ask their doctors about medications.”

Poore is concerned by the stigma surrounding medication for mental health difficulty, and says he wants to help people considering taking medication to “be informed, not afraid”. There is a tendency both in America and the UK for some people to be suspicious of psychiatric medication, and this is made worse by what Poore calls “fear-mongering websites that condemn all neurological medications as tools of the devil.”

In his opinion, some people allow worry about side effects to stop them taking medication that might help them feel better. “People worry so much about side effects of medications partly so they can have an excuse to not take them,” he says. Poore believes people sometimes focus on side effects too much, especially if they don’t take medication themselves. People don’t advise others to avoid chemotherapy for cancer for example: “Some people get their heads shaved in solidarity with friends going through chemotherapy. And medications used to treat chronic thyroid conditions have side effects that are almost indistinguishable from the common side effects of psychiatric meds.  How many people don’t take those because of the side effects?”

“Side effects are usually a reasonable trade-off for the benefits of meds,” says Poore. “That’s also the first thing to consider if one needs to be medicated: Is the condition bad enough to warrant taking these potent, imperfect medications? It’s an easy call with some things, difficult with others.”

Rhi, 24, has gained weight as a result of taking medication to help her manage depression and Dissassociative Identity Disorder (DID): “I’m currently a size 20, and I’m dieting to deal with the weight gain, but the dieting isn’t helping my mood,” she says. “To be honest, I feel better about myself and my body on the medication, and I don’t mind being the size I am now. When I get to be a size 18, I’ll stop dieting.”

Rhi explains that for her, “depending on the medication, the trade-off is sometimes worth it, and sometimes not worth it. I’m currently taking lithium and lamotrigine, and I love those so much – although initially I was prescribed too much lithium and the whole world felt like a bouncy castle!”

Spot the difference

It can sometimes be difficult to tell the difference between a side effect, the effects of your mental health difficulty and everyday changes to your body and mood. Rhi says that at times she finds it impossible to distinguish between the illness and the medication. Some of the side effects of medication can occur naturally in the course of people’s lives.

When you get your medication, it will usually come with a leaflet that lists a large number of physical and mental symptoms as possible side effects. This can make you very anxious. The reason for the long, scary-looking list of side effects is that the drug companies who make the medication are obliged by law to list every single symptom people displayed during the clinical trials of the medicine that might possibly have been a side effect.

The SSRI, Fluoxetine, lists ‘involuntary tongue protrusion’ as one of its side effects – but only because during clinical trials, one elderly lady wouldn’t stop sticking her tongue out at everyone. Just because something is listed in the leaflet as a possible side effect doesn’t mean that it will affect you. To help people make this distinction, Crazymeds.us lists side effects in different categories: common ones that lots of people who take the medication get, less common ones that only a few people get, and ‘freaky rare’ side effects that it’s very unlikely will happen to you.

Talking to your doctor

When you are given medication, the GP or other healthcare professional who prescribed it to you should explain how and when to take the medication, as well as what side effects to expect. The instruction leaflet that comes with your medication will also tell you how and in what dosage to take the drugs you have been prescribed. If you experience any very unusual or uncomfortable symptoms whilst taking psychiatric medication, it is very important to discuss them with your doctor as soon as you can, even if you have been taking your medication for some time.

You should discuss any treatment that you receive with your GP or other health professional regularly. Even people who are on a stable medication that they are comfortable with should have a medication review at least once a year.

Your GP will also be able to check that you are taking the right doses of your medication at the right time. The amount you take and when you take it is often as important as what you take. If you are having trouble taking your medication on time, your doctor or other professional can work with you to make sure you are making the right use of your medication to help you feel your best.

No silver bullet

One of the things people find difficult to understand about psychiatric medication is that there is no silver bullet for mental health difficulty. Taking medication will not magically ‘cure’ your mental health difficulties. Medication provides a platform for recovery and can help you manage your mental health from day to day. Medication works best if it is part of a care programme designed to help you to cope with your symptoms. Think of it a bit like having a cast put on a broken leg: your body does the healing work all by itself and the cast is there to protect you and stabilise you whilst you recover.

Just as you wouldn’t want to walk around on a broken leg, medication helps many people remain stable and balanced whilst they take care of the business of getting stuff sorted and looking after themselves .

This article first appeared in the Autumn 2009 edition of One in Four magazine

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