Would You Like Sides With That?

SIde effects are weird things. 

Now, when I prescribe medications for patients, one of the things I always do, after talking about the reason for the med, the dosing, the cost and the the like, is to discuss the most common side effects that I expect they might experience. Why? Because they are likely to have one or more of these obnoxious effects, and if I predict them in advance it makes me look like a smart guy. 

I was taught in medical school that “if you hear hoof beats, look for horses, not zebras”. Or, stated another way, “common things are common”. 

I always tell patients NOT to go home and Google the drug I have prescribed for them. They will be hit with every side effect in the book, legalese out the wazoo, and they will come away afraid to take not just that medication, but any medication that anyone might prescribe for them in the future, ever! I ask that they trust me to give them the lowdown on how the medication should work, how long it will take, and what very common side effects they are likely to see. 

Dry mouth, dizziness, weight gain or weight loss, hair loss, dry skin, sedation and confusion are all side effects that I might mention to a patient. 

Note that these are side effects of the medication itself

But what about side effects of another kind? Side effects of the treatment as a whole? 

By this I mean, what if the patient, after adequate treatment, starts to evidence behavior that he or his spouse or family is not expecting, and even dislikes? What do I mean by this?

Well, if a very depressed woman starts to get better, feels like going out and demands that her couch potato husband take her to dinner and a movie once a week, when he’d rather stay at home, that might be a problem. Her treatment has been very successful, she is more energetic, her interest in doing things has picked up and she is more assertive in asking that her spouse accompany her to do these things that she wants to do. He got used to the “old” her, the person who was lethargic and passive and never made demands on him. He does not like this “new” less depressed wife he now has. This is a side effect of the treatment that is unwanted, in the husband’s opinion.

What if a young woman who has schizophrenia is put on medications and in therapy groups that begin to slowly help her get out of her social isolation and enjoy being around others, even members of the opposite sex? Once again, her parents have gotten used to her being at home,  watching TV on the couch all day, for the last decade. Now, she wants to get out and go places, see people and even date. They are worried that she might even want to have (gasp!) sex! To them, she seems manic, out of control, hyperactive, when in fact she is now able to act like a normal young woman her age and experience things that she never expected to again. 

Side effects can come from medications, from the treatment as a whole, and sometimes can be seen as negative, even when to the patient thinks things are going much better. 

As in many aspects of mental health care and treatment, communication about these kinds of effects and behavioral changes should be attended to early on so that doctor, patient, and family are all on the same page. 

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