Fredric Neuman M.D.

Fighting Fear

Psychopharmacology

The Side Effects of Drugs: A Strategy

Possible side effects are not a cause for panic.

Posted May 27, 2012

Most people do not hesitate to take drugs prescribed for them by a physician. They assume that if their doctor orders a particular drug for them that the drug serves an important purpose, and that it is safe. Most patients do not ask about possible side-effects, and most doctors do not mention them, unless a potential side-effect is very common. Certainly, the doctor will not warn about a potential side-effect that is extremely dangerous, if it is also extremely rare.  That would include most drugs; and doctors would be issuing warnings all day long.  It is possible for any drug to cause a serious allergic reaction in a susceptible person. Any food can cause such a reaction also. So what? Extremely rare events are not worth taking into consideration. Potential catastrophe lurks in any human behavior. Standing on a curb puts someone at risk for being struck by a car that jumps the curb. We all stand on curbs every day without worrying.  Trying a new drug is not cause for special concern.

The patients I see, most of whom have a history of an anxiety disorder, are typically much more worried about possible side-effects of drugs. They may prefer “natural” substances, which are untested and are likely to be more dangerous than drugs made by the major drug companies. (By the way, it is not in the interest of the drug companies to foist bad drugs on the public. One bad drug can cost them billions of dollars.) If these patients are very afraid of a drug, they are almost sure of developing some side-effect simply because they are afraid. They are resistant, however, to this explanation.

“Don’t tell me these tingling feelings are in my head! I can feel them.”

“I’ve been urinating all day since I took the drug; and my heart is skipping beats.”

These symptoms are not imaginary. They are real. But they may not stem from the effect of the drug itself. They come out of the idea of the drug.

I run a group therapy for people who have an exaggerated fear of physical illness. The fear of drugs is part of this concern. I usually read to them from a pamphlet printed visibly on the outside with the name “Prozac.”

“Would you be willing to take a drug that is associated with the following side –effects?” I ask them.

Headache—15.5%

Nervousness—8.5%

Insomnia—7.1%

Drowsiness—6.3%

Anxiety—5.5%

Tremor--2.4%

 Dizzyness—3.3%   Also I report smaller percentages  for fatigue, disturbances of sensation, lowering of sexual interest, and decreased concentration

Digestive complaints:

Nausea—10.1%

Diarrhea—7.0%

Dry mouth—6%

 And 8 other assorted digestive symptoms.     And also sweating: 3.8%

By the time I have finished reading, all the patients are shaking their heads or saying “no” in a loud voice. But these are the side-effects from the placebo arm of the study! These are the symptoms of the group that took a sugar pill!

Anyone can develop negative (or positive) placebo responses to a drug. People develop symptoms they are afraid of (or, on the other hand, eagerly anticipate.) Under certain circumstances, placebo responses are the rule:

  1. When the patients are in great pain or distress.
  2. When their conditions are very serious.
  3. When they have a charismatic doctor.
  4. When they start off suspicious of drugs.
  5. When the drugs they are asked to take affect the mind.

Placebo effects are present in any emotionally charged set of circumstances. They feel real, and they are real. It is important, of course, to determine when the drugs, themselves, are causing a serious side-effect. Some side-effects, like a rash, are never placebo effects.  A physician may suspect a placebo effect when the complaint is hard to reconcile with the pharmacological effects of a particular drug. The common placebo effects are those given in the list above. Also, placebo effects tend to disappear within a few days. It is, therefore, not desirable to switch from one drug to another prematurely. The patient, then, has more reason to be afraid of the next drug.

A strategy for Taking Drugs:

Side-effects are sometimes a reason to stop taking a drug. They are not a reason to avoid taking the drug in the first place. There is plenty of time after the drug has been taken to stop it. Even when a side-effect is common, (20% of patients taking Prozac experience nausea temporarily) the great majority (80% in this case) do not get side-effects.

Sometimes, I try to convince a patient to take a drug by taking it along with them. I have taken most psychiatric drugs at one point or another for this reason. (Most recently, today.) Usually, however, instead of persuading them that the drug is safe, I end up convincing them that I am reckless.

 (c) Fredric Neuman2012         Follow Dr. Neuman's blog at fredricneumanmd.com/blog