For anyone who needs to take medications for a chronic condition like mental illness, dealing with side effects may end up being part of the reality of taking meds. The pros should always be outweighing the cons, but the right balance can be hard to find.
No side effects is possible
All medications have potential side effects, but not everyone who takes a given medication will experience any. I’m not particularly prone to side effects, and they didn’t become an ongoing thing for me until I started lithium. For anyone who’s starting, or considering starting medications, you don’t have to accept side effects as a given right from the get-go. Side effects may end up being a compromise worth making, but you shouldn’t have to make that compromise right from the start.
Medication factors
The dose may or may not make much of a difference, depending on the particular medication and side effect. For some medications, certain side effects are more likely to occur at a lower dose. For example, mirtazapine is most likely to be sedating (which may or may not be desired) at lower doses.
Within a given medication class, certain individual medications may be more likely to cause particular side effects. For example, some antipsychotics have a higher likelihood to cause weight gain than others.
Some side effects happen early on, and if they don’t happen near the start, they’re unlikely to happen at all. Others happen if you’ve been on the medication for a while, like tardive dyskinesia and metabolic syndrome with antipsychotics.
Is it the meds or is it the illness?
Sometimes it’s hard to tell if certain symptoms are due to side effects or the illness, as there can be overlap. Timing can be helpful in teasing out what’s going on.
I used to have periods of full remission of my depression before it became treatment-resistant, so I know what it feels like for me to be fully well and be on medication at the same time. While I have a lot of cognitive difficulties now, I know that I’ve experienced that before when ill and on different meds, and I’ve also been on these same meds and not had any cognitive impairment. So, while I know long-term lithium can have cognitive effects, based on my pattern over time, I think that if it’s an issue at all, it’s quite a small part of the overall picture that’s dominated by my illness.
Symptoms are more likely to fluctuate over time than medication side effects are, unless there’s some other factor at play. For example, dehydration can increase blood levels of lithium and therefore worsen side effects; in that case, it’s the dehydration that needs to be addressed, not the lithium. But if my lithium level is nice and steady and I suddenly start getting dizziness, chances are it has nothing to do with the lithium, even though lithium has the potential to cause dizziness.
Balancing pros & cons
The harder an illness is to treat, the more likely it is that you’ll be stuck in the position of having to do a careful weighing of the pros and cons of therapeutic effects vs. side effects of medications. That balance isn’t going to be the same for every person or at every point in time.
I’m quite lucky, as I have pretty minimal side effects overall, and I’ve never had any discontinuation effects. I have a lithium-induced tremor and impaired coordination, as well as increased thirst. I’ve gained a lot of weight, and three of my meds (lithium, quetiapine, and mirtazapine) are probably contributing to that. None of these side effects is a game-changer for me, though; the pros in terms of benefit in managing my illness clearly outweigh the cons.
I’m very nausea-averse. I’m not emetophobic; I just find nausea very distressing. There were a couple of medications I tried over the last year that I quickly ixnayed because I couldn’t handle the nausea. There would have to be some major pros for me to accept nausea as an ongoing side effect. The effects that make for an automatic ixnay aren’t going to be the same for everyone, and what I might be prepared to tolerate, someone else might find totally unacceptable. And on a side note, is Pig Latin (as in ixnay) something that’s still out there in the world?
Conspicuous side effects
Some side effects are noticeable by others, which can be awkward. People may comment on weight gain, since we live in a society where people feel entitled to do that.
The proportions of my psych med weight 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.
My tremor is worse with intentional movement than at rest, and people often notice this when I am paying for things in shops. Store clerks may come out with a condescending “take your time” or a concerned “are you ok?” If I’m at a coffee shop and carrying a wobbly mug to my seat, this will sometimes elicit comments. I’m not sure why it’s anyone’s business, but it makes me feel very conspicuous.
Head-up-ass prescribers
I strongly believe that if people are experiencing side effects that they aren’t willing to tolerate, prescribers should be willing to do some (or a lot of) trial and error to see if an alternative can be found where the pros clearly outweigh the cons. There are quite a few options, and there can be variability in side effects even within the same medication class.
I think sometimes prescribers fall into the trap of thinking that a medication is a good choice because it works in terms of what’s easier for them. And of course, they’re the prescriber and they know best 🙄. Not good enough. Each of us deserves to be on the most effective medication regimen possible with the lowest side effect burden possible.
What’s your experience been with side effects? Has the balance of pros and cons been difficult to establish?
Related posts
- Antidepressant Side Effects & Delayed Therapeutic Effect
- Antipsychotics and the Likelihood of Weight Gain
- Bias in Online Stories of Psych Med Side Effects
- Do I Look Fat in this Seroquel? Psych Meds & Weight Gain
- Letters from Generation Rx—Weighing Medication Risks & Benefits
- Living with Psych Med Side Effects
For more on psychiatric medications, there’s a Psych Meds 101 series that covers:
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Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
I have a bit of weight gain. Not a huge amount, but I’m a little overweight and that annoys me as I used to have a healthy weight, and increasing exercise didn’t help. I tried to cut eating, but I don’t eat a huge amount of junk; I could cut it completely, but I can’t bring myself to do that as, while I’m not hugely depressed, sometimes I do need a biscuit or something to lift my mood slightly before bed. Maybe I’ll get to a point where I feel able to cut junk completely. More significant is that I do tend to get very hungry between meals and want to eat carbohydrates, which is probably where the weight gain came in. I try to contain that too, but again, maybe I’m not doing it well enough (*self-blame*).
The other issue is oversleeping and tiredness. As you’ve probably seen on my blog, I’m beginning to wonder if that’s a symptom of something else, as it seems to be getting worse. Of course, I worry that that’s just laziness (*self-blame again*).
The weight thing is tough. Even if you eat the same and exercise the same as pre-med, weight gain can still happen.
Yeah. It’s a pain.
I used to think the side effects from Topamax were tolerable (increased mental fog & physical slowness), but once the med quit working that well, I said NOPE!
Not working and shitty side effects… Yeah, that would be a hard no for me too!
For me I always feel drowsy. I blame it on amitriptyline. I call it a med hang – over. There are other side effects because the doctor has to balance my physch meds along with my Warfarin. When there are changes to any of my medications I can usually expect a jump or a slide when it comes to my I.N.R results. When that happens the Warfarin levels have to be adjusted. It is a never ending circle.
There are times I wish I could do a complete purge but that will never happen. The side effects are minor compared to what I am like without them. Without the Warfarin I am a candidate for clots, which heightens the risk of a heart attack or a stroke.
Yeah, that’s definitely worth putting up with some side effects for.
I also have a lot of weight gain due to meds. I take clozapine as well as a couple of other meds. So far, the weight gain is not a game changer since I have reacted well to this medication for 12 years now. I have to take the good with the bad. I am trying also to get some of the weight off which has meant losing 5 to 7 pounds. Don’t know if I can get beyond that plateau…? My heart goes out to anyone who is trying to figure out what meds work for them. For me, that has been a matter of trial and error. Sometimes it feels like the doctors do not know what they are doing. I think this is more a reflection of the fact that meds work one way for some people and another way for other people. Just because I have been relatively stable on clozapine for 12 years does not mean it will work that way for my friend. I have heard it said that medication management is more an art than a science.
Don’t know if that rings true for you. Here’s to a Holiday Season where everybody gets meds that work for them whatever their diagnoses or struggles (if meds are needed at all….)!
Yes, there’s definitely an element of art, and probably a lot of that art lies in good communication.
What’s your experience been with side effects?
During my journey with depression, I had to go through a LOT of anti-depression medication ‘trials’ (let’s try them and see how they work, not actual clinical trials). Zoloft has proven to be the best fit for me, but because of concerns (I guess) about long term use and perhaps because some medical practitioner wanted to try a ‘new’ thing on me, I’ve been on perhaps ten or twelve different anti-depressants over the years. Prozac caused horrible vertigo, increased paranoia, weight gain and lethargy. Wellbutrin (sp?) made me so nervous that I was almost clawing my face off, yet the provider kept telling me “You need to give it more time!” and refused to take me off it. I eventually changed providers after stopping Wellbutrin on my own (dangerous to do). There have been others, but two examples are plenty. Zoloft seems to control my depression fairly well, except during my ‘S.A.D. cycle’ and nothing much helps that, except being vigilant and avoiding triggers. When my anxiety disorder joined my depression, and the long term insomnia (helped by some anti-depressants) became more of a factor; I was put on Valium. I didn’t notice it, because it was very subtle (I suppose), but my depression worsened to the point I tried committing suicide taking an overdose. Lunesta, a popular sleep aid at one point, had an addictive side effect. When I realized I’d come to rely on that stuff, I took myself off it and the withdrawals made me firmly convinced I should avoid those kind of sleep aids. Xanax has proven to be best for my anxiety (because I can use it as per need, and it has not proven addictive to me); and trazadone (an older anti-depressant) works very well for my insomnia.
The three medications keep my symptoms manageable. The only concern I now have is my sometimes uncontrollable anger and worsening outbursts of it in public. Fortunately Covid has kept that from becoming a serious problem. And I continue my therapy regularly to work on it.
Has the balance of pros and cons been difficult to establish? Yeah. It’s taken forty plus years to find the combination that works best for me. It can be a very frustrating thing to do. Patience and listening to ones’ own body and symptoms is key.
I agree, along with the willingness to tell a doctor to go fuck themselves and stop the damn face-clawing medication already…
This is a helpful and informative information piece. Am sharing!
Thanks! 😊
I have gained a lot of weight, and lost a lot of weight as interesting side effects, but I think when one of my meds gave me a strange metallic taste in my mouth, that was one of the low points. I had one that gave me tremors and that freaked out my mom. And the one my wife loved was when I could get an erection, but never finish.
At least there was a bright side!
For her. For me it was like running up a down escalator.
I’m sure!
I’ve had pretty mild side effects but the “invisible damage” from my anti psychotic on my cholesterol levels etc is concerning.
For sure.
We have not noticed any pros from mental health meds we taken except xanax, and at the end of taking it, the prescriber said it was addiction that was at work, not actual benefits. So no mental health drug has ever contributed positively to our condition. And the side effects have always been there—from over-fatigue, to deadening mood, to fogginess. So we’re done trying medication for mental illness. We’ve tried meds for depression, OCD, trauma—with no short-term or long-term improvement in condition. That sucks for us. Oh well.
Fair enough. Sucks, but not much choice but to deal with it. And perhaps blame the grizzly cub; he’s cute enough that he can handle it.
Lol. 💕❤️😂
This is a very well-balanced article, covering lots of bases one often wonders about. I think I’ve shared my own experience (more-or-less) which so far has been pretty negative in terms of finding a med that will work for me. Usually, the side effects have been pretty intolerable and yet the intended effects have been almost unnoticeable. However, I do want to qualify that statement.
I will admit that I lose patience with side effects fairly quickly. In some cases, I didn’t last out the two to three week period where things were supposed to be uncomfortable, before the intended effects make themselves known and discernible side effects wane. Meds that were given me under the premise that I was “bipolar” — i.e., Geodon, Abilify, Lamictal — had side effects from the start that so hugely interfered with what how I needed to present myself day to day, I stopped taking them very soon after their being prescribed. However, since I had a hard time believing I was bipolar in the first place, that may not have been a bad choice.
As far as ADHD, the only med I’ve tried is Straterra. I think I mentioned this, but it gave me urinary retention, which made it hard to get back to sleep immediately after nighttime bathroom breaks, which led to insomnia, which led to sleep paralysis. The level of sleep paralysis was then worse than at any time in my life, though I’d been having it off and on since I was fourteen.
I’ve been meaning to ask you if you know of good ADHD meds that might work for me. It my own amateur research, there always seems to be a reason why I either shouldn’t take it or why they would be unlikely to prescribe it. I don’t know if you can ethically answer that question, however; so if not, that’s fine.
Some people really get the short end of the stick when it comes to susceptibility to side effects. It seems like that if you’re prone to side effects with everything else, you’d probably get side effects with a stimulant. I take dextroamphetamine and don’t have any side effects with it, but I don’t think that’s predictive of much of anything.
I looked up dextroamphetamine and also Adderol – which they said was a mix of amphetamine and dextroamphetamine — only because the mother of one of the people on my team is a psychotherapist and she suggested Adderol is the one that might really work for me, (According to her daughter, she later said, after meeting with me once for about an hour, “Andy is the most ADHD person I’ve met in a long time.”)
But what you say makes sense — at least empirically. If I’ve always been unusually adverse to side effects, it’s likely that the pattern will continue with any new med I try to take. Maybe I just have an unusually sensitive metabolism, or am in some other way kinda fussy . . .