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Visible Side Effects: When People See My Psych Meds

Psych med visible side effects –– graphic of spotlights shining on medication capsules

We live in a world in which people are constantly judging us on how we look.  Sometimes, the effects of mental illness are overtly obvious, like when hygiene goes flying out the window, or when eating pattern changes produce major weight loss or gain. Things like weight gain can also be very visible side effects of some psychiatric medications. So how does one handle living with visible side effects?


I have a tremor as a side effect from lithium, and it’s been surprising how often people comment on it. My tremor is worse with intentional movement than at rest, and people often notice this when I am paying for things in shops.  Clerks may come out with a condescending “take your time” or a concerned “are you ok?”  If I’m at a coffeeshop and carrying a wobbly mug to my seat, this will sometimes elicit comments, either from staff or other customers.

I’m not sure why it’s anyone’s business, but it makes me feel very conspicuous.  I have a mostly invisible illness whose treatment has visible side effects.  I’m lucky that the antipsychotic that’s worked best for me (quetiapine) has a low potential to cause movement-related side effects like tardive akathisia.

Yet it’s hard sometimes to remember that I’m lucky.  One of my nursing jobs involves administering injections and teaching clients how to self-inject medications.  My hands are very much on display.  My tremor is worse with intentional movement than it is at rest, and I worry that clients will think I’m either nervous or incompetent.  I don’t really like either of those options.

I usually take propranolol before doing this kind of work to put a damper on the tremor, but if I’m tired/stressed/caffeinated, the propranolol doesn’t do a whole heck of a lot.  I’ve seldom had clients comment, and if they do I brush it off as too much coffee, but the rest of the world seems to feel quite free to comment.

Weight changes

Another way I’m lucky is that I’ve never experienced a disordered relationship with eating.  I haven’t always been happy with my body, but it hasn’t impacted my relationship with food.  I’ve written before about illness, meds, and weight, but what comes to mind now as I’m writing this is questions about pregnancy.  My meds have caused the weight to pack on disproportionately on my lower abdomen.

The proportions have shifted around over time, but one particular summer, multiple different people asked about my non-existent pregnancy.  I’m of the opinion that you should never ask a woman about being pregnant unless it looks like she’ll probably give birth tomorrow.  When others commented on my “pregnancy”, I felt like I had totally lost control over my body.  I felt really offended, less because of the very real psych med baby I was carrying around and more because others felt they had the right to talk about my body.

No, I didn’t get Botox for looks

There is some evidence that Botox can be helpful for depression, and I recently made the decision to add it to my treatment plan. When I told a friend about it, she shifted the conversation to how she’d thought about getting it cosmetically.  For some reason that made me feel icky.  

And it’s not (at least I don’t think) so much that I would judge someone for getting a cosmetic procedure; it’s more that I don’t even care enough to wear makeup, and the thought of doing something to my body for cosmetic reasons seems utterly bizarre.  Maybe the issue is that I worry others will judge me for getting Botox. My non-crinkling forehead is a sign of desperation to try anything for my treatment-resistant illness, not a sin of vanity.

This post has been a bit all over the place, but I guess my point is that people are judging us.  No matter what we say, what we do, or what we look like, others will judge us.  We can’t stop the judging, much as we might wish to, so all that’s left is managing our own reactions.  And sometimes that’s much easier said than done.

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23 thoughts on “Visible Side Effects: When People See My Psych Meds”

  1. Sorry you have to go through this so often. Being different practically offends some people. I am glad women without makeup is more normal as I age. I would get questioned when young. People are very good about only minding their own business when it is about others suffering from hunger and abuse, but oh don’t you dare have body odor in a public space, they will make it their business. It is that important! /sarcasm

  2. Yes, I think it’s human nature to judge and make a decision on someone. Personally I reckon it goes back to caveman times when we had to decide pretty darn quickly whether the sabre toothed tiger was going to eat us or was in fact just a sweet little pussy cat. We judge, we make conclusions and sometimes we’re completely wrong. I try not to, but do and I hate myself for it. Perhaps it’s just that we’re so used to certain types of people running true to form. Perhaps we like to put people into categories or boxes, quite why I don’t know. I’m rambling now and I’m sorry! As for your tremor, if that is the side effect to you being healthy and happy then I’d welcome it … to be happy is the most important thing in the world. I loved your post, it really made me think. Thanks and don’t worry a hoot about people judging! Pah! They’re not worth the effort ❤️

    1. I agree that it’s human nature to judge, but one would hope that the evolution that’s happened since caveman times would allow people to reevaluate those judgments. I guess there are still a lot of cavemen still running around in our midst 😉

  3. I think a lot of us grew up with alcoholics and the ‘DTs’–delerium tremens, ‘the shakes’ from being an alcoholic. That might be in some people’s minds if they see hands shake. Mine do a lot lately, for no reason other than being stressed and ill, and sometimes I wonder if they think that, especially since I have a kind of rosacea that makes my face red, and together those used to be considered a big sign of drinking in the popular mind–ironically, I may have had something like a dozen or two dozen drinks total in my entire life, since the alcoholic parents were not good examples of lifestyles I wanted to imitate, and I turned out not to be addicted to it. Best wishes to us all and our seen and unseen and misunderstood symptoms.

  4. I can relate. I’ve also had tremor from meds at times, generally worse in social situations (because of social anxiety). I’ve done public speaking while shaking like a leaf and everyone assumed I was just scared of public speaking. Having my hair cut was the worst. I hate that generally, but the fear that I would shake and ruin the haircut or even get cut would, in itself, trigger the shaking. I do still worry when talking to people at work that I will start shaking.

  5. This is my biggest character default, judging and that it is human but the thing about me is I do not speak on it. You can wonder all day long but don’t be stupid and say or ask. I have had tremors due to alcohol and I am sorry that you have to deal with that daily. It is aggravating to say the least.

      1. Exactly!!! Ever.. The way I see it is how would you like it if someone were to say it to you.

  6. Unfortunately Ashley, people are going to judge other people no matter how sympathetic we maybe become of others in the far distant future. If a person is not a carbon copy of those you see in the media, or like those people you surround yourself with, then they are *fair game*.
    What people do not understand they will judge. It could be something as small as a person not wearing expensive clothes, or it could be their weight, skin colour or religion.

    I was always told “Never judge a book by it’s cover”, yet the person that taught me this became worse with judging others the older they became. Following that is the old “If you have nothing nice to say, don’t say anything at all”.
    Nice in theory but you WILL be treated differently, most people are not good actors, and those of us that know how to read others can see what they are thinking from a mile away.

    I have noticed that even when I dress up and am not in the grips of a depressive funk, I will STILL be judged when I am down this the street (This was before I stopped caring completely, before I had all the noticeable problems I do now.). I don’t know if it is because I now live in a pre-dominantly Lebanese-Muslim area, or because of something else. They may not say anything to my face but you are treated much differently to those around you. I am different to other people, and a number of people can *sense* this.

    I’m not without fault either, of course. I judge others. I don’t like that I do this, but it is part of being human. Unless genetics takes a really weird turn in the future, those of us who are not the norm will be judged for any number of reasons. It cannot be helped.

    As for weight gain Ashley, I’ve been there. When I spent three years giving anti-depressants at good darn try, I stacked on a heap of weight. I tried 3 different meds. I can’t remember names, I’d have to get them from my doctor.
    It wasn’t just weight I stacked on, but I started to lactate on one of these meds!
    OMGawd embarrassment! I haven’t stopped friggin lactating. Not a lot, but it’s there. I was terrified at the time, I hadn’t been with a man in forever, so there was no way I could be preggies. I had read cancer can cause lactation. I was a mess until I asked my doctor about it. It was the meds. ~laughs~

    I wish I could offer some helpful suggestions Ashley, unfortunately you seem to be like me and overthink things. This, I still do not know how to stop, or even dampen. Not even sure if we can. It just seems to be how our brains are wired. 🙁

    I am thinking of you though, that has to count for something Ashley!
    ~smiles and runs off with a wave~

  7. Oh I do not miss the tremors! I do take an AI and worry I will end up with tardive dyskinesia, i can only imagine the stares. People are nosy and judgemental. I carry my weight in my stomach, disproportional to the rest of my body, luckily thus far no one has made a pregnancy comment, tears would follow. 🙁 My hands do shake from anxiety sometimes and people comment, but it’s not as bad as when i had tremors and could barely carry a cup of coffee without spilling it. I found that if i switched the cup to the other hand it helped.

  8. When I’m depressed I “wear it” in my face, and often get comments from family about it. Or I space out and stare into space. Happened when I was getting my nails done in an effort to try to cheer myself up a bit and force myself to get out of the house, and the nail tech commented on me staring. It was embarrassing.

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