Drug side effects occur because once the active ingredient of the medication is absorbed and distributed throughout the body, certain target receptors are sought out. The actions of the drug at receptor sites then unleash the intended effect or generate unwanted and often undesirable adverse effects. Most side effects tend to be on the mild side and are time-limited, disappearing within a week or two after starting the drug. Side effects of some psychotropics, however, do persist throughout the course of administration.
Whether it’s a new medication prescribed for a client, or one the client is already taking, I provide them a physical list of the common, most often reported side effects of that drug. I keep the list short — no more than 3 possible adverse effects. No client needs to hear a litany of 10 or more possible side effects; all they need to know at first are the frequently occurring ones. If others not included on the list emerge, I’ll deal with that at the next session with the client or between sessions via telephone or e-mail.
As for potentially serious side effects, don’t withhold information regarding these if asked about them. Some clinicians do so out of fear they will scare a client away from a medication that has been helpful to them, but the truth is, a simple Google search will yield information about any drug on the planet. Serious side effects shouldn’t be on the short list, but if you’re asked, recognize that clients are entitled to weigh the benefits and risks associated with making an informed decision. It’s their choice in the end, as it would be ours if we were in a similar position.
An example: Let’s say a client of yours has been diagnosed with bipolar disorder and started on the drug Lamictal (lamotrigine), which is linked to a possibly serious rash, and the client is fearful of this. Begin by telling the client that serious side effects are extremely rare. Follow up with a fact: Approximately 0.10 percent of those taking Lamictal develops this serious rash, which means 999 out of 1000 does not. Then inform them that to reduce the chances of rash development even further, dosing can begin very low and titrated up very slowly.
After a client has been started on a medication, and if you haven’t heard from them between sessions, it’s good practice to ascertain how they’re doing on the drug. Ask about therapeutic benefits for sure, but also inquire about side effects. Ask: “Have you experienced any side effects since beginning the drug?” If they mention a symptom or two, follow up with “any others?” This will jog their memory a bit, providing you an opportunity to discuss the full range of what’s happening and suggest remedies accordingly.
Side effects are the number one reason people abort psychotropic medications. And some of them stop the drugs when the side effects are right on the cusp of diminishing or disappearing. In most instances, basic interventions such as taking the medication in the morning rather than at bedtime and taking it with food or on an empty stomach will help the client feel better. If this doesn’t work, other drugs can be prescribed to address the adverse effects directly.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.