Part Three of Four:

Continued from last Week

Synopsis: It is important to remember that any medication that can have a positive therapeutic effect can also have an adverse effect. The most common are weight gain or loss, headaches, hyperactivity (instead of relaxation), and decreased sex drive. People's hair texture and color can change, skin and tongues can dry out, and mouths and extremities can become numb or tingle, one can experience erratic heartbeats, constipation, diarrhea, and insomnia. And, one can feel so sedated that a normal conversation becomes difficult to follow. Probably the most serious lack of information that I typically encounter is that prescribers forget to tell their patients that a mind-altering medication may also impact their sex drive. A typical example of what can happen is the case of Garson and Wilma who entered therapy when their marriage seemed in big trouble. Garson had become impotent and Wilma was sure he was having an affair and didn't love her any more. Trust had eroded and they were fighting all the time. Garson had always enjoyed sex and had no prior history of impotence. He had been anxious at work and his general practitioner had prescribed Paxil. Garson had no idea that his lack of interest in sex was in any way related to this drug. What had helped his job had hurt his marriage. I asked my usual question: "Are you taking any medication?" End of story. Medication was changed, sex improved, and, so did the marriage.

Better Living Through Chemistry: All Drugs Have Side Effects

It is important to remember that any medication that can have a positive therapeutic effect can also have an adverse effect. The most common are weight gain or loss, headaches, hyperactivity (instead of relaxation), and decreased sex drive. People's hair texture and color can change, skin and tongues can dry out, and mouths and extremities can become numb or tingle, one can experience erratic heartbeats, constipation, diarrhea, and insomnia. And, one can feel so sedated that a normal conversation becomes difficult to follow. Probably the most serious lack of information that I typically encounter is that prescribers forget to tell their patients that a mind-altering medication may also impact their sex drive. A typical example of what can happen is the case of Garson and Wilma who entered therapy when their marriage seemed in big trouble. Garson had become impotent and Wilma was sure he was having an affair and didn't love her any more. Trust had eroded and they were fighting all the time. Garson had always enjoyed sex and had no prior history of impotence. He had been anxious at work and his general practitioner had prescribed Paxil. Garson had no idea that his lack of interest in sex was in any way related to this drug. What had helped his job had hurt his marriage. I asked my usual question: "Are you taking any medication?" End of story. Medication was changed, sex improved, and, so did the marriage. Loosely speaking, there are significant differences between the diseases affecting women and men: Men tend to get the killers, while women are more prone to get the cripplers: Average doses are routinely prescribed to people who are not average. In fact, mood altering medications actually discriminate. Until recently, researchers did not know that women and men tend to react differently to medications, or even that they tend to get different types of illnesses. In the past, most physicians were men who unknowingly applied the findings from medical research on male subjects to treatments for women without realizing there were significant differences. Women tend to be smaller and metabolize medication more slowly than do men, and they tend to have a higher incidence of migraines, eating disorders, and heart-valve problems in response to mental health prescriptions. In women, drugs like aspirin and Valium remain in their body longer. Women are twice as prone to depression and anxiety disorders. Men are more subject to violent behavior, alcoholism, and drug abuse. Discrepancies in treatment are equaling out a bit—but not totally. Doctors still tend to evaluate men more thoroughly than they do women. A woman is three times as likely to be told a physical problem is "all in her head" than a man with the same complaints. When a doctor recommends a pill or a procedure, female patients should always ask whether its effects have been studied on women. Learning about gender-specific biology isn't an emotional issue, a feminist issue, or even a politically correct issue. It is a medical issue that should be afforded the attention it deserves. Often, I recommend, with a specialist's approval that a woman, a physically small man, or anyone who seems especially sensitive, begin with a dose lower than originally prescribed and I encourage them to have the confidence to ultimately be the best judge of what their correct dose should be. I call this the scissors or razor blade phenomenon, where, using a pill cutter, scissors, nail clipper, or razor blade, one simply sculpts the pill or capsule into minute pieces, thus providing their own optimum dose. Anna, a small and physically sensitive female client of mine, seemed dopey a great deal of the time. She had done well on Celexa, one of the more recent anti-anxiety medications whose standard dose is a 20mg. tablet. I suggested that we speak with her psychopharmocologist. He advised that she drop down to 2 mg and work her way up from there. Anna settled on a 4 mg dose and reported that it increased her sense of well-being without giving her that dopey—and dangerous when driving—feeling. When I tell this story to other professionals I am sometimes dismissed or laughed at as someone who doesn't understand how science really works. Fortunately, other open-minded psychotherapists, physicians, and psychopharmocologists have confirmed similar tales. Male or female, you must be your own best evaluator of how your medication is working. Just remember, patience may be required as it takes time for most mood medications to take effect. The more anti-depressants we take, the more we experience the complications that can arise from a lowered sex drive. Prozac and other SSRI inhibitors often inhibit libido. As former presidential candidate Bob Dole has made clear, Viagra can be a boon to men who have become impotent due to a physical illness or injury. However, for those who use it as a recreational drug, or to counter impotence induced by other drugs, problems can emerge. Before you know it, you may well be popping more pills than the teenagers did in the sixties. The paradox is that it is those teenagers who are now prescribing the medication, They are the boomers all grown up. My seventy-year old client, Paul, who had been on a small dose of Prozac to combat his tendency towards depression, popped a few of the little blue pills and his forty-year marriage almost immediately disintegrated. His sixty-five-year old wife Marsha had become very comfortable with their relationship and her decreased sex drive, and she was delighted to be using her brain instead of being beset by the hormones of her youth. She felt threatened by Paul's sudden sybaritic interest. Paul took off with a much younger woman and their formerly peaceful household quickly became chaotic. Paul's delightful adventure was soon over and he longed for Marsha and the stability of their life together. Understandably, she was hurt and angry and not particularly welcoming upon his return. It took several months of therapy for them to regain their equilibrium. Nonetheless, the scars remained. Do mood-menders create an artificial paradise? Do these drugs make you who you are or who you were never meant to be? Could Shakespeare have written Hamlet on Paxil? Would Dostoyevsky have written The Idiot on Zoloft, or James Joyce Ulysses on Lithium? There are valid debates and ethical concerns that surround whether drugs are merely cosmetic solutions or genuine agents of change. I believe the answer is that they are both, but the boundaries between the two camps are not well defined. Questions you should always ask your doctor or pharmacist when you are told “Sure I have a pill to change your mood.” What is the medication used for? What are the possible interactions with foods or other medications that I should know about and avoid? Is there a less expensive generic form available for the medication I am taking? How long should I take it? Are there any special instructions for taking this medicine such as before, with, or after meals? What are the possible side effects? What are the possible side effects? And, again, what are the possible side effects? This column's for you, Dr. D. Dorree Lynn, PH.D.

On The Couch with Dr. Dorree Lynn FAMILY LAW Advisor® HOME PAGE These articles are provided for informational purposes only. No materials posted here are intended to constitute medical advice, which by necessity, must relate to each person's individual situation. This site does not constitute a patient-professional relationship. You are urged to seek help from a local mental health professional concerning your specific circumstances. No information or materials posted here are intended to constitute legal advice, nor can we guarantee the accuracy of posted information, especially as to each individual situation. LawTek does not independently check the information contained herein and does not refer or endorse any product, service, or firm. This site does not constitute an attorney-client relationship; local counsel should always be consulted. © 2000 LawTek Media Group, LLC all rights reserved

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