A Very Big Subject

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AVery Big Subject
Medication Side-Effects
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Approach to this Workshop

• Empower a person to be able to take medication,
  manage side effects, eat a proper diet, sleep
  regularly, exercise, work a job, have a social
  life and  follow a set of life values (eg,
  beliefs)
• all of which may have a chemical effect to some
  degree.
• maybe a good starting point is to inventory
  these?

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Suggested Structure

• Debrief from the main lecture what do you need
  to say?
• Consider issues from the view of a taker of
  medication
• Work through a medication decision tree (aka
  questions for your Doctor)

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Culture of Taking Medication

• Remember the Codral TV commercial?
• Should we just be treated as chemically
  imbalanced brains or something more?

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.feelings have chemical effects
The Brain reflects the Mind
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Side-Effects are REAL

• We know from experience that patients may live
  with unwanted side effects because they do not
  realize that they are in fact side effects. Good
  examples of this are sexual dysfunction and
  weight gain, both common SSRI side effects. It
  took years for most practitioners to recognize
  the extent of these side effects.
• Norman Sussman, MD in Memory Impairment as an
  Underrecognized Medication Side Effect Primary
  Psychiatry. 200613(8)13-14
• http//www.primarypsychiatry.com/aspx/articledetai
  l.aspx?articleid549

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Mind and Body are the Same Thing

• Cartesian Dualism (17th century) scientific
  method
• This dualism can even be seen in the way health
  insurance is treated in the United States. Most
  insurance policies provide much better coverage
  for "physical" disorders than they do for
  "mental" disorders. No such dualism ever existed
  in eastern cultures, and the mind and body are
  seen as intricately connected and unified.

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Does One Size Fit All?

• Individual variation with medications isn't the
  exception it's the rule
• Typical v. Atypical
• The basis of individual variation is well known.
  People differ greatly in how they absorb,
  metabolize and eliminate drugs. The new science
  of pharmacogenetics has revealed wide variations
  in the efficiency of people's liver enzymes in
  processing drugs. People also differ in the
  sensitivity of their tissues to medication
  effects. These factors change with age, and many
  people become more sensitive as they get older.
• from Jay Cohen MD Associate Professor, Dept of
  Family and Preventative Medicine (Voluntary),
  University of California, San Diego
  http//www.lef.org/magazine/mag2003/mar2003_cover_
  effects_01.html

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Maybe its not Mental Illness

• Chronic fatigue, thyroid problems autoimmune
  disorders can mimic depression.
• Pysciatric v. Organic long-running debate over
  whether Chronic Fatigue Syndrome is a
  psychiatric/ psychological illness, or whether it
  is organic/physical and caused by some external
  pathogen or disease mechanism

and so side-effects not recognised
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Trauma and Mind-Body Connection

• Medically unexplained physical symptoms commonly
  present in primary care settings and account for
  a high percentage of disability in the workforce.
  Emotional underpinnings have been noted in
  these conditions. The results of a recent
  meta-analysis by Henningsen and colleagues12
  indicated that 4 somatic syndromes (irritable
  bowel syndrome, nonulcer dyspepsia, fibromyalgia,
  and chronic fatigue syndrome) were related to but
  not fully dependent on depression and anxiety.
  Findings from another study showed that medically
  unexplained symptoms were more often associated
  with depression and anxiety than with somatoform
  disorders.13 http//www.psychiatrictimes.com/dis
  play/article/10168/53811

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Change in Life Circumstances

• Getting pregnant
• Going to TAFE or Uni
• Getting regular work
• Being in a workplace
• Getting involved with RSVP
• Change of seasons - SAD

can affect/ be affected by medications
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How Much do Psychiatrists Know?

• Psychiatrists are specialists many will tell
  you they dont know much about kidneys, lungs or
  arthritis
• They tend to know about psychiatric side-effects
  of psych. and non-psych. medications BUT not so
  much about other sorts of effects
• So .make sure your GP and psychiatrist
  communicate!!!!

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Complex Issues
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Medications v. Foods

• Both available at same places, eg, local chemist
• Different testing of effects
• Different Government Regulators
• Different purposes

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