12 Tips for Starting New Medications

12 Tips for Starting New Medications

Introduction

Starting new medications can be frightening. One glance at the leaflet from the pharmacy is enough to send anyone into a state of anxiety. But for those of us struggling with mental illness, especially an anxiety disorder, trying new medication can be really difficult. Having gone through a few medication changes myself, I developed a routine that made starting new medications less taxing and stressful. While I have written this list of tips from the perspective of trying out different psychiatric medications, many of the tips on this list are general enough to help anyone trying a medication for the first time.

12 Tips for Starting New Medications

  1. Start low, go slow. ‘Start low, go slow’ is the preferred way of starting patients on a new medication. Some doctors adhere to this guideline, but many don’t. Providing your situation does not fall into the caveat category below, I think it’s fair to ask your doctor their thoughts on this guideline. I have had great success adhering to this guideline myself, because for some of the medications I tried, even at low doses I experienced severe side effects. I cringe to think what would’ve happened had I started at the suggested starting dose that doesn’t follow this guideline. I think starting at the lowest possible dose and then slowly titrating upward, is the best way to start a new medication (if feasible). Now, some medications you have to go slow to avoid serious side effects (e.g., Lamictal and the infamous Stevens-Johnson syndrome). But antidepressants? I’ve seen a lot of people start at high doses, quickly titrate up, then encounter all sorts of unpleasant side effects. Ask your doctor for the lowest possible dose, even if you have to cut a pill into quarters or start with liquid. CAVEAT: The only caveat to this, is if you are in crisis or your illness is severe. There are some cases where getting stabilized on a medication is a life-saving event. In this case, starting low and going slow might not be an option for you. Your doctor will be able to determine this based on your symptoms.
  2. Question the therapeutic dose range. I like to view the therapeutic dose range as more of a suggestion versus a hard-and-fast rule [1-4]. Therapeutic dose ranges are an educated guess by pharmaceutical companies based off of the results from clinical trials. As you might have guessed, not everyone is the same, and not everyone will respond favorably within the designated therapeutic dose range. As an example, the medication I am on, I am taking <100 mg/day of it, whereas most people are up in the 100s-1000s mg/day.  I have stayed on this dose, and it has worked well. Because I am seeing results, I do not feel the need to increase the dose further. Yes, my results at such a low dose might be due to the placebo effect but who cares? The way I am managing my medication is called microdosing. This is an out-of-the-box concept, but I think it works for some people. Just because a pharmaceutical company states the therapeutic dose range to be much higher than the dose that you are on, doesn’t mean that your dose is wrong. It might be the dose that is right for your body and condition. Regardless of what medication you are taking, you always want to take the lowest dose possible, for the shortest amount of time.
  3. Complete chores, errands ahead of time. I found it immensely helpful to take care of any major chores and errands in advance of starting a new medication. While starting a new medication will likely be fine, especially if you follow step 1, you just never know. I would also take care of bills and have meals cooked for the next week or two. The other thing I liked to do, and I know this is horrible for the environment, is to invest in paper plates, plastic cups and silverware to cut down on the dishes that I had to do. In order to figure out which chores and errands need to be completed, I liked to assume that I will be totally incapacitated by trying new medication, and then plan accordingly (obviously, this is highly unlikely).
  4. Reduce your workload. I generally avoided scheduling any medical appointments during this time, and any important work meetings. I also made sure that any important work was done ahead of time. Because you don’t know how the medication is going to affect you, you want to make things on yourself as easy as possible both at work and at home. I would also pare down the social calendar as well.
  5. Have secondary medications ready. What I mean by secondary medication, is a medication to combat the side effects. Medications to combat nauseau, indigestion, diarrhea, constipation, headaches, etc.
  6. Have a friend available. Starting a new medication is nerve-wracking. I found it really helpful to stay with either a friend or a family member when I took my first few doses. This helped ease the worries of what I would do if something went wrong. By having a person around, they can automatically act on your behalf and get medical help if needed. If you don’t have the option to physically stay with someone, another option is to use Skype or a phone call. Have them on the line when you take it. And then setup check-in points for the next few days. And if at any point you fail to check-in, have them notify either medical personnel or the police.
  7. DO NOT GOOGLE. I put this in capital letters, because I have failed at this on multiple accounts. In fact, I have had multiple doctors and therapists begging me to stop. My problem is that I am a scientist, and I like to have all of the information before I make a decision on something. Now, personally, I do not think there is anything wrong with perusing Google Scholar to research your medication. Where the problem can arise, is reading the message boards on various sites where people recount horrific experiences. While a lot of them are likely true, the problem is that we are not them, and we don’t know the circumstances under which they took the medication. What condition was it for? Were they taking any other medications? What was their dose? Were they tapering off another medication at the same time? There are just too many unknowns. However, some of the stuff I saw mentioned on the message boards did turn out to be true for a few of my medications. Googling can be helpful, but it can turn detrimental very fast. If you have significant health anxiety, I would steer clear of it altogether. Which brings me to my next point…
  8. Don’t read the leaflet, but save it. While it is very tempting to read through the leaflet to be aware of the potential side effects, I highly recommend not doing this. What I did instead, was I filed the leaflet away for future reference if I needed it and I asked both my psychiatrist and my pharmacist about any deadly side effects I should be on the look out for, and if there was any blood work that needed to be periodically checked. Because really, that’s all you need to know. You don’t need to know if you are going to get nauseau. Now, I recommend saving the leaflet in case something does go wrong. Then at that point, it’s a good idea to consult it. As an example, I had started mirtazapine (Remeron) and started getting stomach pain and really strong sweet/carbohydrate cravings after a few days on the medication. After I had gotten used to taking the medication, I consulted the leaflet and sure enough, those were possible side effects. But the pamphlet was a lot less scary, because I was used to taking the medication.
  9. Take the medication, then keep busy. The problem with every anxiety disorder is that we are hyper-vigilant about the sensations in our bodies. “Oh, is that dizziness I feel? I think I am going to faint!” The best way to combat this, is to reassure yourself that you and your doctor have performed a risk/benefit analysis and have determined that the benefits of the medication outweigh the risks. Take the medication, and then try to keep busy. If you sit around doing nothing, you will likely focus too much on looking for side effects to convince yourself that yes, medication is evil and you were right all along. There is such a thing called the nocebo effect, which basically states that if you start looking for side effects you will likely get them. This is why I encourage you to stay off Google and don’t read the pamphlet because if you don’t know what side effects to look for, the nocebo effect will be less likely of an issue. That way if you really do have side effects, you can go back to your doctor with confidence that the side effects you are experiencing are real, and are not due to the nocebo effect.
  10. It’s OK to cry and panic the first few doses. In hindsight, I wish I had taken videos of me trying to take medication for the first time so that people can really see how hard it is for some people to take the first few doses. It’s OK to cry. It’s OK to throw a fit and curse the world. It’s OK to stare at the bottle. It’s OK to pledge to take it one night, say screw it, and start it tomorrow. It’s OK to have a panic attack. It’s OK to have any reaction you want, to taking medication for the first time. It likely won’t be easy. It might be scary. But, you’ll never know how good you can feel if you never take that first step. I can remember taking my first dose of mirtazapine (Remeron), and I was practically curled up in bed in hysterics. I swallowed the pill, clutched a stuffed animal, and played game boy (I am in my 30s :)). But you know what? As ridiculous as that sounds, it got me through. So, take your medication, and indulge in some of your comforts no matter how childish you think they are. Pretty sure I colored in my Pusheen coloring book and did some Where’s Waldo too :).
  11. Continue to exercise and eat healthy. Now, depending on the side effects, this can get tricky. I had a few medications that made me a little dizzy and unsteady, which lead to falling over a few times during my yoga poses (warrior poses were not my friend!). But since I was practicing yoga on a carpeted floor, this wasn’t a big deal. I would recommend sticking to easier exercise routines until you know how the medication will affect you. But it is important to keep up with your routine as much as possible, as exercise is helpful for all health conditions. Eating healthy is important for the same reasons. If however you have lost your appetite or are nauseous, it’s OK to eat junk temporarily to make sure you are still eating. Try to sneak in healthy foods every now and then.
  12. Time it wisely. The best time to start a medication is Friday night or Saturday morning, when you aren’t at work. That way you can take it easy for the next few days as you adjust to the new medication. And if possible, I would also recommend taking a few days off around the weekend or even telecommuting for a week or two. This makes it a lot easier to manage side effects, if you do end up getting any.

Conclusion

And there you have it! My tricks and tips for starting new medications. After having tried a few different medications, I have used these tips successfully to make starting a new medication as easy as possible. One other thing I would like to mention here too, is that if you try a medication and the side effects are severe even at a low dose, it might mean that the medication is not a good fit for you because of your genetics. I had this happen to me with SSRIs. I had severe reactions to a few SSRIs at tiny doses, and I requested genetic testing. The results confirmed my experiences, and showed that none of the SSRIs are appropriate for me. As a point of comparison, the only side effect I had with my current medication was fatigue and goofiness the first day. As always, if the side effects are bothersome or worrisome, contact your doctor. If your doctor encourages you to push forward, but you feel that it is a bad idea, then tell them you are stopping. At the end of the day, it is your body, and only you know it the best.

What do you do to make the process of starting a new medication easier? Let us know in the comments below!

References

[1] McCormack, J. P., Allan, G. M., & Virani, A. S. (2011). Is bigger better? An argument for very low starting doses. Canadian Medical Association Journal, 183(1), 65-69. (FREE ARTICLE)

[2] Louie, A. K., Lewis, T. B., & Lannon, R. A. (1993). Use of low-dose fluoxetine in major depression and panic disorder. The Journal of clinical psychiatry.

[3] de Jong, V., & Raz, A. (2011). Sub-Therapeutic doses in the treatment of depression: the implications of Starting low and going Slow. The Journal of Mind-Body Regulation, 1(2), 73-84. (FREE ARTICLE)

[4] Daughton, C. G., & Ruhoy, I. S. (2013). Lower-dose prescribing: minimizing “side effects” of pharmaceuticals on society and the environment. Science of the Total Environment, 443, 324-337. (FREE ARTICLE)

 

 

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