Why? Whatever the issue might be, and whatever might be happening to us, we always want to know why. (Note: you can read a bit more about that in my post on attribution theory.)
For people taking psychiatric medications for mental illness, there’s often a lot going on in both mind and body, and it can be hard to tease out exactly what’s causing what. That doesn’t stop us from trying, though.
Even though the actual cause of mental and physical effects may be ambiguous, I suspect that a lot of our decision to attribute those effects to either medications or the illness itself is based on past experiences.
Sometimes it’s fairly clear to determine the cause of a particular effect based on timing. For example, you start medication X and get effect Y, and then when you stop X, Y goes away. That’s pretty clear-cut as a medication side effect. Often side effects will be most prominent when starting the drug or increasing the dose, and then will start to ease off with time.
But what if you’ve come off drug X, and effect Y shows up? Is that withdrawal from drug X, or is it the effects of the illness bubbling up again without the medication?
Fast vs. slow onset side effects
Certain side effects of medication can take some time to show up. Weight gain can happen gradually. Tardive dyskinesia is a potential side effect of antipsychotics and it doesn’t tend to turn up until after long periods on the medication. In general, though, if certain effects are cropping up out of nowhere after a period of time on a medication, it’s important to look for other potential causes aside from the drug.
Susceptibility to side effects
Our own personal susceptibility to side effects is another factor to consider. Some people are terribly prone to side effects. Luckily, for the most part, I don’t tend to have a ton of side effects from medications. I have my core set of side effects that I live with: weight gain, tremor, and dry mouth.
Because I know my body tends to tolerate meds, if I were to start a new medication and had a migraine the next day, I would likely lean towards the migraine being a coincidence rather than a side effect. On the other hand, if I knew I tended to be prone to side effects and I’d never had a migraine before, I’d be much more likely to blame the new medication.
Patterns over time
My current crop of meds I’ve been on at varying doses for several years now (other than dextroamphetamine, which is relatively newer for me). During the time I’ve been on them, I’ve had several years of full remission of my illness, with no side effects other than the three persistent ones I already mentioned. So now, when weird things are happening in my head or body, I don’t usually attribute them to meds.
While there are certain things worth monitoring periodically, like my kidney function, for the most part, it doesn’t make sense for random side effects to be jumping up out of nowhere at this stage of the game.
Potential overlap between symptoms and side effects
Sometimes there’s overlap between illness symptoms and medication side effects. Changes in sleep, appetite, energy level, and cognition can be influenced by either one. If a new medication is started because of worsening mental illness, it can be hard to tease apart what’s a side effect and what’s just the medication not working and the illness naturally getting worse.
One thing I do wonder about for myself is cognition. Lithium does have the potential to cause cognitive impairment. At the same time, I experienced cognitive symptoms from my depression well before I was ever started on lithium, and I’ve been in full remission and cognitively clear while on lithium. I have fluctuations in the degree of cognitive impairment, which is more consistent with the fluctuating effects of illness rather than medication. But is it possible that there is also some baseline cognitive impairment due to lithium? It’s possible. Then again, does it even matter? Of all my medications, lithium has had the most quickly observable and substantial positive effect on my mental health, so it’s one that I consider absolutely non-negotiable.
I think we’ve all got a direction we tend to lean in when trying to explain unexpected mental/physical effects. Personally, I tend to lean more towards attributing weird things to my illness. But it’s important to keep an open mind regardless of which direction you typically tend to lean, because often things aren’t quite as simple as we’d like them to be.
For more on psychiatric medications, the Psych Meds 101 series covers: