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    Alfred Adler, posted by David Baxter

David Baxter

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Making sense of medication side-effects
April 30, 2005
by David J. Baxter

You've just come home from a visit to your doctor with a new prescription. If you are like many people today, one of the first things you will do is read the leaflet your pharmacist gave you and then go to the internet to look for more information. For many people, what they find there can be alarming.

Websites like www.RxList.com include tables of possible side-effects that patients in various research studies may have experienced. Sometimes, this can be quite a long list, but on closer inspection in most cases you will see that no individual side-effect is experienced by the majority of people taking the medication. You should also note that in most cases the information provided will include a group called "Placebo" -- a group which is given a "sugar pill" instead of the actual drug -- and often patients in this group will also report experiencing those side-effects.

So what does it all mean? How does one read these sometimes frightening data tables to make sense of them?

Read the fine print
Let's look at a popular drug in the family of newer antidepressant/antianxiety medications: Effexor (venlafaxine). On this page from RxList, you will find a table (Table 2) with possible side-effects listed vertically down the left hand side and data from studies comparing Effexor XR (the extended release version of this medication) to placebo in three different patient groups: Major Depressive Disorder, General Anxiety Disorder, and Social Anxiety Disorder. In this table, virtually all of the listed side-effects are reported as occurring in less than 3% of patients who continued to take the medication over an 8- to 12-week period. However, it is important to note that the data presented in Table 2 are side effects experienced during discontinuation of the drug after taking it for 8 to 12 weeks.

Look at the Placebo Group
Now scroll down that page a bit until you find Table 3. The data here summarize reported side-effects for the three groups (Major Depressive Disorder, General Anxiety Disorder, and Social Anxiety Disorder) versus Placebo during the 8- to 12-week period the patients were actually taking the drug: This is probably more meaningful information for someone just beginning the medication.

Notice first that many of the listed side-effects are associated with numbers like 4 per cent, 3 per cent, 2 per cent, 1 per cent, or less than 1 per cent. That means that 96 per cent or more of the people taking this medication will not experience those symptoms, so they are not things you need worry greatly about.

Looking next at the bigger numbers, it seems that 31 per cent of people on Effexor complained of nausea. Two things to note about that: First, this means that almost 70 per cent did not experience this side effect so the odds are you may be one of the lucky ones; and, second, that 12 per cent of people in the placebo group also complained of nausea. The difference in this case (12 per cent vs. 31 per cent) is probably meaningful and I would probably consider this to be a significant side-effect for this medication. But it does raise the general question of whether a reported symptom is associated with the illness rather than the medication.

A better example of this is seen a little further down the page: Some individuals taking Effexor complain of sleep disturbance. However, note that about equal numbers complain of somnolence (excessive sleepiness or drowsiness) and insomnia (17 per cent for each symptom). It is also noteworthy that for individuals taking the placebo 8 per cent complained of somnolence and 11 per cent complained of insomnia. Now, changes in sleep patterns are known symptoms of depression -- there are suggestions in these data that Effexor may exacerbate that particular problem in some individuals but it is still worth noting that over 80 per cent of patients taking the drug do not report these side-effects.

Then we come to a couple of side-effects that seem to be clearly caused by the medication: First, excessive sweating is reported by 14 per cent of patients taking Effexor but only 3 per cent of placebo patients. Second, abnormal (delayed) ejaculation in males is reported by 16 per cent taking the drug while less than 1 per cent of those in the placebo group complain of this side-effect. Again, it is worth noting that the vast majority (approximately 85 per cent) will not experience this side-effect but when it occurs it is probably safe to attribute it to the medication.

If you're one of the unlucky ones...
Finally, with modern medications, there is now a considerable range of alternative medications to treat most illnesses. If you are experiencing one of the listed side-effects or even one that isn?t listed but that you think might be related to the medication, let your doctor know. In most cases, the problem can be solved by switching to one of the alternative drugs used to treat your condition.

comments
 

stargazer

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Not even being a psychiatrist, I'm starting to think they've mis-diagnosed me and that the meds they are trying on me are just all wrong for whatever it is that I am. I stopped taking the geodon because I couldn't handle all the side effects, and the same goes for the depakote and the abilify. (Well, the depakote itself wasn't so bad, but they seemed only to want to give it to me along with the abilify--the depakote for the evening, and the abilify for the morning.)

Am I really bipolar?

Outside of the side effects, I found I was having a hard time handling the INTENDED effects. So, for the time being, I haven't been taking my meds at all. Admittedly, I am more depressed than manic these days. But could I not simply be exhausted? After all, I was on a manic/hypomanic/quasimanic run for almost a year.
 

stargazer

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Not even being a psychiatrist, I'm starting to think they've mis-diagnosed me and that the meds they are trying on me are just all wrong for whatever it is that I am. I stopped taking the geodon because I couldn't handle all the side effects, and the same goes for the depakote and the abilify. (Well, the depakote itself wasn't so bad, but they seemed only to want to give it to me along with the abilify--the depakote for the evening, and the abilify for the morning.)

Am I really bipolar?

Outside of the side effects, I found I was having a hard time handling the INTENDED effects. So, for the time being, I haven't been taking my meds at all. Admittedly, I am more depressed than manic these days. But could I not simply be exhausted? After all, I was on a manic/hypomanic/quasimanic run for almost a year.
 

comfortzone

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Messages
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The side effects of going off your meds or taking them infrequently can be dangerous unless under the supervision of a physician or psychiatrist. Please talk to you doctor and find out about this. I realize that the side effects are not the greatest but the sudden stop of some medications can cause more problems. I tell my clients to follow the prescriptions and keeping notes in a journal so that they can tell their doctor what symptoms they are experiences as well as the side effects. Explaining to the doctor how a particular medication does not appear to help is also good to share. However, if a person does not take the medication consistently as prescribed it is harder for the doctor to find a good replacement. It is for certain a Catch 22. I hope you are able to find the appropriate medication that alleviates your symptoms. Best wishes,
 

comfortzone

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Messages
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The side effects of going off your meds or taking them infrequently can be dangerous unless under the supervision of a physician or psychiatrist. Please talk to you doctor and find out about this. I realize that the side effects are not the greatest but the sudden stop of some medications can cause more problems. I tell my clients to follow the prescriptions and keeping notes in a journal so that they can tell their doctor what symptoms they are experiences as well as the side effects. Explaining to the doctor how a particular medication does not appear to help is also good to share. However, if a person does not take the medication consistently as prescribed it is harder for the doctor to find a good replacement. It is for certain a Catch 22. I hope you are able to find the appropriate medication that alleviates your symptoms. Best wishes,
 

stargazer

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I hear what you are saying, however I had only been on the meds for a single day in each case. I was so blown away by the initial side effects that I didn't want to continue.

I ought to have clarified that earlier. This was not an instance of my having been on meds for a while, and then suddenly having stopped them. It's only a case of my reluctance to begin, and to deal with adverse reactions to them.
 

stargazer

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I hear what you are saying, however I had only been on the meds for a single day in each case. I was so blown away by the initial side effects that I didn't want to continue.

I ought to have clarified that earlier. This was not an instance of my having been on meds for a while, and then suddenly having stopped them. It's only a case of my reluctance to begin, and to deal with adverse reactions to them.
 

comfortzone

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Oh I see! Gotcha. Some of those meds take time to actually make a difference and then your doctor can figure out if the dose needs to be changed or such. The side effects are like a dragon but without the meds life can be like a much more fierce dragon. I hope for the best in your situation and look forward to hearing about the outcome. Thanks for explaining your situation to me. Take care,
 

comfortzone

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Oh I see! Gotcha. Some of those meds take time to actually make a difference and then your doctor can figure out if the dose needs to be changed or such. The side effects are like a dragon but without the meds life can be like a much more fierce dragon. I hope for the best in your situation and look forward to hearing about the outcome. Thanks for explaining your situation to me. Take care,
 

stargazer

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Yes, thank you as well. I'm confident that the right med & dosage will be found if I can persist with this, and not give in.
 

stargazer

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Yes, thank you as well. I'm confident that the right med & dosage will be found if I can persist with this, and not give in.
 

Retired

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I see medications and the issue of side effects as a benefits vs risk or benefits vs personal discomfort proposition.

When one's quality of life or quality of health is affected to the point where help is required, then in consultation and in partnership with one's physician, decisions on mode of therapy are made.

After weighing the benefits of therapy to potentially improve one's quality of life vs the risk or discomforts caused by that therapy a decision on how to proceed can be made.

If the choice is to begin medication therapy, it should be kept in mind that when body chemistry is altered there is a potential for adverse effects. However in most cases the improvement in quality of life is worth the price of putting up with a few discomforts.

Newer medications are less prone to long term side effects, but remaining in communication with one's physician to report side effects can alert the physician to consider changing the dose or even changing the medication.

The key to successful medication therapy, IMO, is keeping in contact with the doctor, reporting intolerable adverse reactions and weighing the potential benefit against discomfort of the side effects.

Are most physicians available for reporting and discussing the side effects experienced with the medication which has been prescribed?
 

Retired

Member
Joined
Aug 17, 2005
Messages
8,966
Points
36
I see medications and the issue of side effects as a benefits vs risk or benefits vs personal discomfort proposition.

When one's quality of life or quality of health is affected to the point where help is required, then in consultation and in partnership with one's physician, decisions on mode of therapy are made.

After weighing the benefits of therapy to potentially improve one's quality of life vs the risk or discomforts caused by that therapy a decision on how to proceed can be made.

If the choice is to begin medication therapy, it should be kept in mind that when body chemistry is altered there is a potential for adverse effects. However in most cases the improvement in quality of life is worth the price of putting up with a few discomforts.

Newer medications are less prone to long term side effects, but remaining in communication with one's physician to report side effects can alert the physician to consider changing the dose or even changing the medication.

The key to successful medication therapy, IMO, is keeping in contact with the doctor, reporting intolerable adverse reactions and weighing the potential benefit against discomfort of the side effects.

Are most physicians available for reporting and discussing the side effects experienced with the medication which has been prescribed?
 

David Baxter

Administrator
Joined
Mar 26, 2004
Messages
37,570
Points
83
The key to successful medication therapy, IMO, is keeping in contact with the doctor, reporting intolerable adverse reactions and weighing the potential benefit against discomfort of the side effects.
Absolutely. Always remember that when you leave the doctor's office, you leave his sphere opf awareness until he hears from you again, directly or indirectly. If he does not receive feedback saying, "this medication isn't working" or "this medication is causing me bad side-effects", the assumption will be that there are no side-effects and that it's working well and doing what it should. There are ALWAYS other choices in medications these days and in the vast majority of cases a change in medication will avoid the adverse effects and still provide the benefits.

Are most physicians available for reporting and discussing the side effects experienced with the medication which has been prescribed?
In my experience, many physicians (and other health professionals) do not score well in this respect. When one of my clients is about to start medication or change medications, I will spend a good 20-30 minutes minimum going into detail about how the medication works, what temporary adaptation effects might occur, what more enduring side-effects might occur, and what to do if there are side-effects. And then I'll generally follow up with the client within a week or two, along with instructions to call in the interim if there is anything unusual happening.
 

David Baxter

Administrator
Joined
Mar 26, 2004
Messages
37,570
Points
83
The key to successful medication therapy, IMO, is keeping in contact with the doctor, reporting intolerable adverse reactions and weighing the potential benefit against discomfort of the side effects.
Absolutely. Always remember that when you leave the doctor's office, you leave his sphere opf awareness until he hears from you again, directly or indirectly. If he does not receive feedback saying, "this medication isn't working" or "this medication is causing me bad side-effects", the assumption will be that there are no side-effects and that it's working well and doing what it should. There are ALWAYS other choices in medications these days and in the vast majority of cases a change in medication will avoid the adverse effects and still provide the benefits.

Are most physicians available for reporting and discussing the side effects experienced with the medication which has been prescribed?
In my experience, many physicians (and other health professionals) do not score well in this respect. When one of my clients is about to start medication or change medications, I will spend a good 20-30 minutes minimum going into detail about how the medication works, what temporary adaptation effects might occur, what more enduring side-effects might occur, and what to do if there are side-effects. And then I'll generally follow up with the client within a week or two, along with instructions to call in the interim if there is anything unusual happening.
 

Retired

Member
Joined
Aug 17, 2005
Messages
8,966
Points
36
How to prepare for a doctor's visit? What questions should be asked?

Some suggestions are contained in this a guide called How to Help Your Doctor which can be viewed and downloaded as a .PDF file.

Another resource is Questions to Ask About Medications, also in PDF format and is a free download from the site provider.

Although the latter article by Dr. Leslie Packer is written in the context of one specific disorder, her advice on the questions to ask about meds could apply to any situation.

Each of these can be printed or saved to your hard drive by selecting Save a Copy in Adobe Acrobat Reader

Do these documents cover all that's necessary for a visit to the doctor, or can other points be added?
 

Retired

Member
Joined
Aug 17, 2005
Messages
8,966
Points
36
How to prepare for a doctor's visit? What questions should be asked?

Some suggestions are contained in this a guide called How to Help Your Doctor which can be viewed and downloaded as a .PDF file.

Another resource is Questions to Ask About Medications, also in PDF format and is a free download from the site provider.

Although the latter article by Dr. Leslie Packer is written in the context of one specific disorder, her advice on the questions to ask about meds could apply to any situation.

Each of these can be printed or saved to your hard drive by selecting Save a Copy in Adobe Acrobat Reader

Do these documents cover all that's necessary for a visit to the doctor, or can other points be added?
 

David Baxter

Administrator
Joined
Mar 26, 2004
Messages
37,570
Points
83
Making sense of medication side-effects
by David Baxter
April 30th, 2005
Reprinted from Psychlinks Blog

You?ve just come home from a visit to your doctor with a new prescription. If you are like many people today, one of the first things you will do is read the leaflet your pharmacist gave you and then go to the internet to look for more information. For many people, what they find there can be alarming.

Websites like www.RxList.com include tables of possible side-effects that patients in various research studies may have experienced. Sometimes, this can be quite a long list, but on closer inspection in most cases you will see that no individual side-effect is experienced by the majority of people taking the medication. You should also note that in most cases the information provided will include a group called ?Placebo? ? a group which is given a ?sugar pill? instead of the actual drug ? and often patients in this group will also report experiencing those side-effects.

So what does it all mean? How does one read these sometimes frightening data tables to make sense of them?

Read the fine print
Let?s look at a popular drug in the family of newer antidepressant/antianxiety medications: Effexor (venlafaxine). On this page from RxList, you will find a table (Table 2) with possible side-effects listed vertically down the left hand side and data from studies comparing Effexor XR (the extended release version of this medication) to placebo in three different patient groups: Major Depressive Disorder, General Anxiety Disorder, and Social Anxiety Disorder. In this table, virtually all of the listed side-effects are reported as occurring in less than 3% of patients who continued to take the medication over an 8- to 12-week period. However, it is important to note that the data presented in Table 2 are side effects experienced during discontinuation of the drug after taking it for 8 to 12 weeks.

Look at the Placebo Group
Now scroll down that page a bit until you find Table 3. The data here summarize reported side-effects for the three groups (Major Depressive Disorder, General Anxiety Disorder, and Social Anxiety Disorder) versus Placebo during the 8- to 12-week period the patients were actually taking the drug: This is probably more meaningful information for someone just beginning the medication.

Notice first that many of the listed side-effects are associated with numbers like 4 per cent, 3 per cent, 2 per cent, 1 per cent, or less than 1 per cent. That means that 96 per cent or more of the people taking this medication will not experience those symptoms, so they are not things you need worry greatly about.

Looking next at the bigger numbers, it seems that 31 per cent of people on Effexor complained of nausea. Two things to note about that: First, this means that almost 70 per cent did not experience this side effect so the odds are you may be one of the lucky ones; and, second, that 12 per cent of people in the placebo group also complained of nausea. The difference in this case (12 per cent vs. 31 per cent) is probably meaningful and I would probably consider this to be a significant side-effect for this medication. But it does raise the general question of whether a reported symptom is associated with the illness rather than the medication. A better example of this is seen a little further down the page: Some individuals taking Effexor complain of sleep disturbance. However, note that about equal numbers complain of somnolence (excessive sleepiness or drowsiness) and insomnia (17 per cent for each symptom). It is also noteworthy that for individuals taking the placebo 8 per cent complained of somnolence and 11 per cent complained of insomnia. Now, changes in sleep patterns are known symptoms of depression ? there are suggestions in these data that Effexor may exacerbate that particular problem in some individuals but it is still worth noting that over 80 per cent of patients taking the drug do not report these side-effects.Then we come to a couple of side-effects that seem to be clearly caused by the medication: First, excessive sweating is reported by 14 per cent of patients taking Effexor but only 3 per cent of placebo patients. Second, abnormal (delayed) ejaculation in males is reported by 16 per cent taking the drug while less than 1 per cent of those in the placebo group complain of this side-effect. Again, it is worth noting that the vast majority (approximately 85 per cent) will not experience this side-effect but when it occurs it is probably safe to attribute it to the medication.

If you?re one of the unlucky ones?
Finally, with modern medications, there is now a considerable range of alternative medications to treat most illnesses. If you are experiencing one of the listed side-effects or even one that isn?t listed but that you think might be related to the medication, let your doctor know. In most cases, the problem can be solved by switching to one of the alternative drugs used to treat your condition.
 
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