Antidepressant Side Effects: In A New York Times Expose, A Doctor Describes Her Own Reaction To An Antidepressant Drug
But She Doesn't Explain Why Antidepressant Side Effects Occur and How to Prevent Them. This Article Does
In the Times' Sunday health section, psychiatrist
Nanette Gartrell reveals her personal experience -- and lack of awareness
-- about antidepressant side effects ("A Doctor's Toxic Shock").1
Grieving over a friend dying of liver cancer, Dr. Gartrell began taking buproprion,
better known as Wellbutrin, but her reaction could just as easily have occurred
with Prozac, Paxil, Zoloft, Celexa, Lexapro, Luvox, Effexor, Sarafem or other
antidepressants, or Zyban, the smoking-cessation drug that's identical to
Wellbutrin. "Within 10 days, I developed insomnia,
agitation and tremors," Dr. Gartrell writes. "I lost the ability
to distinguish between sadness and the drug's side effects.... panic attacks
started... I needed every ounce of energy to concentrate at work.... I forced
myself to eat but still lost 10 pounds. Sometimes I felt paranoid, and I wondered
if I was delusional. When I wasn't working, I was curled in a fetal position,
contemplating whether I should hospitalize myself." Antidepressants help millions of people, but
antidepressant side effects can be wicked. Even worse, many doctors cannot
identify even common antidepressant side effects and frequently give patients
the wrong advice. Dr. Gartrell did what she told patients to do: stick it
out until the drug's benefits kick in. That's the mainstream medical party
line, but many side effects are so unpleasant or vicious, such advice is downright
dumb. Worse, in a few patients, panic, agitation,
sleep deprivation, and impaired judgment may reduce impulse control, and antidepressants
have been linked to people acting out, sometimes violently. Thus, the headlines
about homicides and suicides by people who never were violent before starting
on antidepressants. Yet, although there's considerable literature on this
problem 2-16 , few doctors know about it because
their information sources are heavily influenced by the drug industry, whose
research somehow keeps missing the problem. The Devil Is in the Dosage "These reactions are occurring because
the standard starting doses of many antidepressants are excessively strong
for many people. One clue is that most of these reactions occur shortly
after people have been started on antidepressants or after the dosage has
been bumped up. These are called `first-dose' reactions by mainstream
medicine, and they almost always indicate a mismatch between the patient
and the dosage <17."
My book, Over
Dose: The Case Against The Drug Companies , which received a glowing
review by JAMA (Journal of the American Medical Association), explains
that most side effects are dose-related and that the standard starting doses
of many top-selling drugs are too strong for millions of patients.18
No doubt, Dr. Gartrell started with the standard dose of buproprion. It was
too strong for her. Many standard drug doses, based on studies in which most
subjects are male, are too strong for many women. Studies prove this. The standard starting dose
of Prozac is 20 mg/day, yet even before Prozac was marketed, a large study
showed that 54% of patients did fine with just 5 mg.19
But drug companies like to keep their dosage guidelines simple because that's
what doctors prefer. So Prozac was marketed at a one-size-fits-all initial
dose of 20 mg/day -- 400% more medication than many patients needed -- and
the package insert made no mention of the safer, proven-effective 5-mg dose. Many experts besides me recognized the problem.
A 1993 study concluded "that starting fluoxetine [Prozac] at doses lower
than 20 mg is a useful strategy because of the substantial fraction of patients
who cannot tolerate a 20-mg dose but appear to benefit from lower doses 20 ."
An even earlier report warned: "Clinically, we have observed fluoxetine
to be effective over a wide range with many patients requiring very low dosages...
21 ." With buproprion, the standard initial
dose is 150 or 200 mg/day, which is often quickly increased to 300 mg/day.
But 50 mg twice-daily is often enough, and doctors report that some patients
tolerate only 50 mg/day.22-24 Similar problems
plague other antidepressants, yet few doctors challenge drug company guidelines
and instead follow them without question. This explains why doctors prescribe
the same strong drug doses to young and old, big and small, healthy and frail.
Or prescribe the same doses to people taking no other medications and people
taking a dozen. Such methods defy medical science and common sense, but if
that's This is unfortunate, because so many side effects
can be prevented by simply starting lower. If a lower dose isn't effective,
it can be easily increased. I call this "precision prescribing,"
and my new nonprofit organization, the Center for the Prevention of Medication
Side Effects, is dedicated to promoting this better, safer, patient-friendly
paradigm and to providing information about lower, proven-effective drug doses
to doctors and patients. Dr. Gartrell's new attitude speaks well of her.
But her previous approach, which her colleagues and most doctors share, speaks
poorly of medical education, which provides no time for in-depth training
in pharmacology and, in most cases, not a single lecture on identifying and
handling side effects.25 So it's not surprising
that when patients complain of legitimate side effects, their doctors respond
with ineffective interventions or downright denial. That’s why the New
York Times deserves credit for publishing Dr. Gartrell's confessional, because
it not only confirms that patients' complaints about side effects are legitimate,
but it also reveals why their doctors refuse to believe them or take appropriate
action. No wonder so many patients are dissatisfied, quit treatment, and seek
alternatives. Yet, sometimes medications are necessary. What
can you do? You must become your own researcher, using books and the Internet,
learning enough to choose selectively from the information you see. Access
my data on lower, safer medication doses via my published articles and books,
and the MedicationSense.com website. Take your information, like Dr. Gartrell's
and this article, to your doctors. Spread the word and help us change the
system. NOTE TO READERS: The purpose of this E-Letter is solely informational and educational. Theinformation herein should not be considered to be a substitute forthe direct medical advice of your doctor, nor is it meant to encourage the diagnosis or treatment of any illness, disease, or other medical problem by laypersons. If you are under a physician's care for any condition, he or she can advise you whether the information in this E-Letter is suitable for you. Readers should not make any changes in drugs, doses, or any other aspects of their medical treatment unless specifically directed to do so by their own doctors.
If you have questions about your medications or medical care, Dr. Cohen is available for consultation at his office or by telephone.
If you find this article informative, please tell
your friends, family members, colleagues, and doctors about www.MedicationSense.com and the free MedicationSense E-Newsletter.
Dr. Gartrell's side effects began shortly after
starting buproprion. This is a common story. Why? I explained this in a previous
newsletter:
what the drug company guidelines say, that's what most doctors do. And if
drug companies claim that side effects are infrequent and mild, doctors believe
this rather than believing their own patients.
An Indictment Of Mainstream Medical
Education
Dr. Gartrell says that she is now much more
sensitive to patients' complaints about side effects, and she is quicker to
adjust their medications to halt their reactions. But why did it take so long
for her to learn this lesson? Why wasn't she trained to do this from the start?
References
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