Let the Patient Beware

About 15 years ago,  I convinced one of my doctors to prescribe some generic Wellbutrin (bupropion XL ) for me. The product had been advertised as a game changer for depression. My doctor, at that time, was reluctant at first; but he eventually succumbed to my repeated requests and wrote the prescription.

Now, unlike many people, I actually read some of the warning fliers that come with medicines. Bupropion had an interesting list of precautions, along the lines of: if thoughts of suicide or violence occur, call your doctor right away.

That warning jumped out at me.

One might go to sleep waiting for the medicine’s effect to kick in, like Dr. Jekyll, and wake up as Mr. Hyde. The problem is that in a Mr. Hyde operating state, one may not be predisposed to call the doctor for advice. True, this may not happen to most people, but it happens to enough to be newsworthy.

Antidepressants have been linked to 28 reports of murder and 32 cases of murderous thoughts, in cases referred to the UK medicines regulator over the past 30 years, a BBC investigation has discovered. -- The Telegraph

So I decided not to chance things. I did not take the drug after all.  When I told my doctor -- who had been reluctant to begin with -- he was happy. I had made the right choice. I tossed the pills out, years ago.

No doubt, many are aware how often school shooters are on psychiatric medications.

While mass killers generally have guns in their hands, another commonality is that they often have psychiatric drugs in their blood. The difference, though, is that it isn't guns that have the side effect of "homicidal ideation." -- The New American

I have a preacher friend of mine who, every time he hears of a mass killing, tells me to wait… just wait… in a few days it will come out that the shooter was on psychiatric medications. Invariably, this preacher is right.

Science is still unsure of how these drugs work, and what they do to the brain.

Researchers report that, in addition to the drug's known action on serotonin receptors, fluoxetine [Prozac] could rearrange nerve fibers in the hippocampus of mouse brains. Science Daily -- 2019

But, it is not only psychiatric medications.

Chantix, a medicine presribed to help people stop smoking, has been known to cause hallucinations.

Two years ago, [Linda Ware]... began taking a new prescription medication aimed at fighting nicotine addiction: Chantix. She experienced hallucinations a few days later. While driving in a remote area with her cousin, she saw a vision of a sign that read, "God is in the realm."...

The next day, a family friend found her slumped in front of her bed with a suicide note by her side. -- SF Gate

Prednisone, a corticosteroid, is prescribed for many conditions from severe arthritis to asthma to Crohn’s disease -- and it can be a major lifesaver. But how many patients are told that it has horrific mental side effects? Very few, indeed. Often the only warning given to patients is that one might experience some weight gain.

[T]oo few patients are warned about the psychological side effects of prednisone, and patients can be surprised and confused. -- Med Shadow

In some cases, prednisone can cause roid rage or psychotic events.

I find myself suddenly overcome with a number of different emotions depending on the exact moment. Sometimes I fill with rage, other times it’s anxiety, and sometimes it’s brain fog or something else. It’s very unnatural. -- Gunnar Esiason

One wonders how many people have been arrested for aggressive actions taken while on prednisone, when in actually it was the medicine, not a moral failing on the person’s part.

Worse, yet, like Prozac, prednisone has been shown to alter the hippocampus, that part of the brain which regulates emotion.

Glucocorticoids are known to cause hippocampal damage in animals resulting in memory function disturbance. This study illustrates that the frequently used drug prednisone can cause. -- NEJM  Journal Watch

One of medicine’s answers to the side effects of prednisone is the steroid inhaler for lung problems. The official premise is that the smaller dose of steroids in inhalers are only topically absorbed by the lungs, going no further, thus avoiding the secondary side effects so common with oral prednisone.

To that line of official hogwash, I have asked more than one doctor, “Are you telling me that the nicotine in cigarettes goes no further than the lungs?”

This usually produces wide-eyed shock. The doctors had not thought the issue through. Then I point out, “The lungs are a semi-permeable membrane. Outside of direct injection into a vein, there is no faster and more efficient way to get a chemical into the body than through the lungs.”

Two doctors eventually broke down in laughter when I pointed this out. They realized how preposterous the official claims were. A third doctor could only answer, “Well, that is what the medical papers say.”

From what I see on the internet, steroid inhalers have problems similar to oral prednisone, albeit not as severe.

My son has been on [inhaled steroids] for almost a year now... but very quickly I saw that the meds were almost worse than his symptoms. He rages, he's violent, he cannot control himself and several times I've considered calling a child psychologist. -- Circle of Moms

There are some common antibiotics -- such as levaquin -- which can cause depression.

A wide range of drugs can cause mental status changes. Fluoroquinolones are one among them and are underrecognised.The CNS side effects of levofloxacin like headache, dizziness, restlessness, tremor, insomnia, hallucinations, convulsions, anxiety and depression are well documented. -- NIH

So what is one to do?

The first thing is to read the warning labels. Don’t discard them.

The second thing is to take those warnings with a grain of salt. My experience has been that the fliers are not sufficient. They can overstate or understate the side-effects.

The third thing to do is google up information about any medication, and especially check out forums.

Much of this information only became generally available to the public with the advent of the internet. Frazzled mothers on chat rooms looking for answers about what is happening to their child have done more to bring these problems to the public’s attention than the official sources.

“My 16-year-old family member recently had a psychotic reaction to prednisone. The drug was prescribed for a week to treat an asthma attack. His inhaler also had a steroid, which he used as needed.

“He ended up confined to a psychiatric ward for seven days.” -- Peoples Pharmacy

I am not suggesting that one never take medication -- these drugs can save lives. I am suggesting that doctors and pharmacists are not always aware of the full panoply of side effects. One should check out the internet for information that the official channels rarely dispense, if they even know about it at all.

In my own experience, I have found better advice on internet forums than I have from medical professionals. Apparently, Moms notice the side effects on their kids before anybody else, and unlike the professionals, Moms do not try to dismiss or suppress the reports.

Just knowing ahead of time what to expect can make a world of difference.

In the free market of medicine, the burden is on the user.

Mike Konrad is the pen name of an American who wishes he had availed himself more fully of the opportunity to learn Spanish better in high school, lo those many decades ago.  He runs a website, Latin Arabia, about the Christian Arab community in South America.

About 15 years ago,  I convinced one of my doctors to prescribe some generic Wellbutrin (bupropion XL ) for me. The product had been advertised as a game changer for depression. My doctor, at that time, was reluctant at first; but he eventually succumbed to my repeated requests and wrote the prescription.

Now, unlike many people, I actually read some of the warning fliers that come with medicines. Bupropion had an interesting list of precautions, along the lines of: if thoughts of suicide or violence occur, call your doctor right away.

That warning jumped out at me.

One might go to sleep waiting for the medicine’s effect to kick in, like Dr. Jekyll, and wake up as Mr. Hyde. The problem is that in a Mr. Hyde operating state, one may not be predisposed to call the doctor for advice. True, this may not happen to most people, but it happens to enough to be newsworthy.

Antidepressants have been linked to 28 reports of murder and 32 cases of murderous thoughts, in cases referred to the UK medicines regulator over the past 30 years, a BBC investigation has discovered. -- The Telegraph

So I decided not to chance things. I did not take the drug after all.  When I told my doctor -- who had been reluctant to begin with -- he was happy. I had made the right choice. I tossed the pills out, years ago.

No doubt, many are aware how often school shooters are on psychiatric medications.

While mass killers generally have guns in their hands, another commonality is that they often have psychiatric drugs in their blood. The difference, though, is that it isn't guns that have the side effect of "homicidal ideation." -- The New American

I have a preacher friend of mine who, every time he hears of a mass killing, tells me to wait… just wait… in a few days it will come out that the shooter was on psychiatric medications. Invariably, this preacher is right.

Science is still unsure of how these drugs work, and what they do to the brain.

Researchers report that, in addition to the drug's known action on serotonin receptors, fluoxetine [Prozac] could rearrange nerve fibers in the hippocampus of mouse brains. Science Daily -- 2019

But, it is not only psychiatric medications.

Chantix, a medicine presribed to help people stop smoking, has been known to cause hallucinations.

Two years ago, [Linda Ware]... began taking a new prescription medication aimed at fighting nicotine addiction: Chantix. She experienced hallucinations a few days later. While driving in a remote area with her cousin, she saw a vision of a sign that read, "God is in the realm."...

The next day, a family friend found her slumped in front of her bed with a suicide note by her side. -- SF Gate

Prednisone, a corticosteroid, is prescribed for many conditions from severe arthritis to asthma to Crohn’s disease -- and it can be a major lifesaver. But how many patients are told that it has horrific mental side effects? Very few, indeed. Often the only warning given to patients is that one might experience some weight gain.

[T]oo few patients are warned about the psychological side effects of prednisone, and patients can be surprised and confused. -- Med Shadow

In some cases, prednisone can cause roid rage or psychotic events.

I find myself suddenly overcome with a number of different emotions depending on the exact moment. Sometimes I fill with rage, other times it’s anxiety, and sometimes it’s brain fog or something else. It’s very unnatural. -- Gunnar Esiason

One wonders how many people have been arrested for aggressive actions taken while on prednisone, when in actually it was the medicine, not a moral failing on the person’s part.

Worse, yet, like Prozac, prednisone has been shown to alter the hippocampus, that part of the brain which regulates emotion.

Glucocorticoids are known to cause hippocampal damage in animals resulting in memory function disturbance. This study illustrates that the frequently used drug prednisone can cause. -- NEJM  Journal Watch

One of medicine’s answers to the side effects of prednisone is the steroid inhaler for lung problems. The official premise is that the smaller dose of steroids in inhalers are only topically absorbed by the lungs, going no further, thus avoiding the secondary side effects so common with oral prednisone.

To that line of official hogwash, I have asked more than one doctor, “Are you telling me that the nicotine in cigarettes goes no further than the lungs?”

This usually produces wide-eyed shock. The doctors had not thought the issue through. Then I point out, “The lungs are a semi-permeable membrane. Outside of direct injection into a vein, there is no faster and more efficient way to get a chemical into the body than through the lungs.”

Two doctors eventually broke down in laughter when I pointed this out. They realized how preposterous the official claims were. A third doctor could only answer, “Well, that is what the medical papers say.”

From what I see on the internet, steroid inhalers have problems similar to oral prednisone, albeit not as severe.

My son has been on [inhaled steroids] for almost a year now... but very quickly I saw that the meds were almost worse than his symptoms. He rages, he's violent, he cannot control himself and several times I've considered calling a child psychologist. -- Circle of Moms

There are some common antibiotics -- such as levaquin -- which can cause depression.

A wide range of drugs can cause mental status changes. Fluoroquinolones are one among them and are underrecognised.The CNS side effects of levofloxacin like headache, dizziness, restlessness, tremor, insomnia, hallucinations, convulsions, anxiety and depression are well documented. -- NIH

So what is one to do?

The first thing is to read the warning labels. Don’t discard them.

The second thing is to take those warnings with a grain of salt. My experience has been that the fliers are not sufficient. They can overstate or understate the side-effects.

The third thing to do is google up information about any medication, and especially check out forums.

Much of this information only became generally available to the public with the advent of the internet. Frazzled mothers on chat rooms looking for answers about what is happening to their child have done more to bring these problems to the public’s attention than the official sources.

“My 16-year-old family member recently had a psychotic reaction to prednisone. The drug was prescribed for a week to treat an asthma attack. His inhaler also had a steroid, which he used as needed.

“He ended up confined to a psychiatric ward for seven days.” -- Peoples Pharmacy

I am not suggesting that one never take medication -- these drugs can save lives. I am suggesting that doctors and pharmacists are not always aware of the full panoply of side effects. One should check out the internet for information that the official channels rarely dispense, if they even know about it at all.

In my own experience, I have found better advice on internet forums than I have from medical professionals. Apparently, Moms notice the side effects on their kids before anybody else, and unlike the professionals, Moms do not try to dismiss or suppress the reports.

Just knowing ahead of time what to expect can make a world of difference.

In the free market of medicine, the burden is on the user.

Mike Konrad is the pen name of an American who wishes he had availed himself more fully of the opportunity to learn Spanish better in high school, lo those many decades ago.  He runs a website, Latin Arabia, about the Christian Arab community in South America.