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Considering Drug Side Effects

As a physician, one of the most common reasons I encounter for people refusing to take prescription medications is concern for side effects. This is a reasonable concern, because the point of medication is to make you feel better rather than worse, right?

Here's one example of a side effect list: acute liver failure sometimes requiring transplant and/or resulting in death, allergic reaction, kidney damage, skin rash, serious and potentially fatal skin reactions, increased sugar levels, high ammonia levels, low red blood cell count (anemia), low white blood cell count, low cell counts of all types (pancytopenia), low calcium levels, low sodium levels, low bicarbonate levels, high bilirubin levels, drug interactions.

But wait; those are some of the listed side effects for Tylenol, an over-the-counter pain medication that many people have taken at one time or another for fevers, joint aches, back pain, and other reasons. Most people who have used Tylenol have not experienced any side effects.

Let's try another side effect list: suicidal thoughts, homicidal thoughts, hallucinations, delusions, worseninmood, difficulty sleeping, excessive sleeping, loss of interest in normal hobbies, impaired social interaction, fatigue, difficulty concentrating.

Do you know the associated medication? Actually, these "side effects" are known characteristics and complications of clinical depression. Depending on individuals' unique histories, physicians prescribe medications not uncommonly to treat clinical depression.

These examples highlight a few important points. First, a list of side effects is actually a list of possible side effects. If side effects have been reported for a particular drug, then these effects must be reported on the product insert sheet, even if the effects are reported by less than 1% of people taking the medication. Second, there are risks to not taking medications, and sometimes these are life threatening, deadly, or can have a tremendous negative impact on quality of life.

Still, drug side effects are an important consideration. It's your physician's responsibility to discuss the potential risks, benefits, and alternatives for treating medical conditions. This discussion should include the potential consequences of not treating a condition, along with the possible treatments, and in the case of medication options, the most common side effects and the rare but serious side effects. No matter what, if a person starts taking a new medication and experiences any side effect, he or she should let their doctor know. When I prescribe a medication for a patient, the last thing I want to do is make them feel worse. Most physicians choose their profession due to a desire to improve people's lives.

For doctors, often the most difficult discussions of medication recommendations regard the treatment of conditions that have no symptoms. High blood pressure, for example, often does not cause symptoms until something really bad happens, like a heart attack or stroke. Heart attacks and strokes are not always deadly, but are often crippling, And after heart attacks and strokes, recommendations for a few medications suddenly becomes requirement for numerous and higher-dose medications to lower the risk for repeat heart attacks and strokes. So a person ends up crippled, and on more medications.

Almost no one wakes up in the morning thinking "I'm sure looking forward to taking some medications today. I think I'd like to take more in the future." Your doctor knows that, but takes the time to discuss medications when they are expected to improve your current and future health. You don't have to follow your doctor's recommendations, but carefully consider the reasons for them, and make informed decisions. And remember that what's right for you today might not be what's right for you tomorrow, or nexyear, or ten years from now, so see your physician regularly.

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