When it comes to taking medicines as directed, Americans have a shaky track record.
Medication non-adherence, the technical term for not taking your medication as directed, can have serious health repercussions. It’s responsible for 50% of treatment failures for chronic conditions and 125,000 deaths in the United States each year.
Those who have a mental health treatment plan don’t fare much better. Only between 40 to 70% of those with depression actually take their antidepressants as prescribed.
Adverse side effects are one of the more common reasons for non-adherence. In one study, more than 30 percent of adults age 65 and older reported they didn’t take their antidepressants because of side effects, including sleeping issues, gastrointestinal problems, and nervous system disturbances.
For those with anxiety and depression, non-adherence can result in worsening symptoms. “You really have to take your antidepressants every single day for them to be effective,” says Melissa Frontino, PharmD, a clinical pharmacist and residency coordinator for Acme Markets. “Side effects should be addressed so they don’t further discourage a patient from taking their medication.”
The good news: Side effects from antidepressants aren’t inevitable. Understanding how to lessen or avoid them altogether can help you better manage your anxiety and depression.
Understanding Side Effect Terms
Side effects are any unwanted or unexpected reaction to the drug that is known by the U.S. Food and Drug Administration (FDA), the federal agency which oversees drug regulation and labeling.
How these adverse events are described can give you pause. It’s the reason you should read the FDA-approved Medication Guide that accompanies medications. It outlines common, possible, and serious adverse events related to certain drugs and drug classes and can help you and your healthcare professional determine what you can do to prevent certain adverse reactions.
Common side effects are usually minor problems and may disappear with use as your body adjusts to the medication. Occasionally, common side effects can interfere with quality of life and daily living.
For instance, the common side effects of selective serotonin reuptake inhibitors (SSRIs), often first line drug therapy for major depressive disorder, include nausea, vomiting, dry mouth, diarrhea, drowsiness, insomnia, shakiness, headache, weight gain or loss, skin rashes, joint or muscle pain, decreased sexual desire, and sexual dysfunction.
Adverse effects include serious complications discovered while bringing the drug to market or that have been reported since. Black box warnings, so-called because they are highlighted within a black box on the medication label, are used to alert consumers to the most severe adverse events. These may be life-threatening, cause significant bodily damage, increase the risk of hospitalization, or result in birth defects if the drug is taken while pregnant.
In 2004, the FDA ruled that all antidepressants be labeled with a black box warning that the drugs increase the risk of suicidal thoughts or behavior in children, adolescents, and young adults. The FDA also requires labeling on over 200 medications to include pharmacogenetic biomarker information due to specific actionable gene-drug associations.
How to Lessen Side Effects from Medicine
Age, gender, health, other drugs and supplements you take, as well as other factors can affect whether you’ll experience medication side effects. Your doctor and pharmacist can often recommend tips to manage common side effects.
“If a medication is causing drowsiness, we can move it to bedtime,” says Frontino. “If it causes stomach upset, we may be able to have them take it with food. It really depends on the medication they’re taking and what they’re experiencing.”
That said, management tactics don’t always work, says Frontino, and side effects can continue.
That’s when Frontino recommends genetic testing. Knowing how medications interact with your genetic makeup—an emerging field known as pharmacogenetics —can further reduce or eliminate associated side effects.
Acme Markets is one of several nationwide pharmacies that have partnered with Genomind to administer its Genomind Professional PGx. Done through a simple cheek swab, this genetic test may help improve treatment by analyzing 24 genetic markers that help determine how quickly your body metabolizes medication, whether you have an increase likelihood of side effects for a particular drug and how well a particular antidepressant will work for your body.
“Anyone can experience any side effect. If they are getting a lot of them, or they become unbearable, that’s where the genomics comes in and we can say, hey, you’re going to be more prone to getting these side effects if you’re on this class of medication,” says Frontino. “Or maybe we can switch you over to another class that makes you less prone to side effects.”
Side effects are often the result of how quickly you metabolize medications, says Roy Perlis, M.D., MSc, a Genomind advisory board member and the principal investigator of the Center for Excellence in Genomic Science at Massachusetts General Hospital.
“Some people may break down medications less efficiently. For those people, if you give them a standard dose, they are actually going to have more side effects on average because it’s like they’re taking twice as much,” explains Dr. Perlis. Others may metabolize drugs too quickly, requiring a higher dose to receive any benefits.
“What we struggle with isn’t just picking the right medicine, but having picked the right medicine, what’s the best dose to get better without having lots of side effects,” Dr. Perlis continues. “Understanding how someone breaks the drug down can help us select appropriate therapy.”
The Importance of Communication
Talk openly to your doctor or pharmacist about your medication treatment plan so they can address questions about antidepressant side effects, and you’ll know what to expect. Getting face-to-face counseling has been shown to improve medication adherence.
Questions to ask your healthcare provider or pharmacist about your antidepressant include the following:
- How often and when should I take it?
- What’s the most common side effect you see in patients?
- How long do common side effects usually last?
- What if I can’t manage the side effects: Is it safe to just stop taking the drug?
- Does it matter if I take my medication with or without food?
- Are there certain foods I should avoid taking with it?
- Will taking it with food help reduce possible gastrointestinal side effects, such as nausea?
- Does it matter what time of day I take my antidepressant?
- Will taking it at night reduce possible side effects of drowsiness or fatigue?
- What should I do if I experience serious symptoms I think are related to the medication?
- Can you go over the FDA Medication Guide with me? (Pharmacies are required to provide a paper version of these guides with each prescription and to give you a consultation regarding new-to-you medication.)
- Is there anything else I need to know that can help me manage the common side effects of this drug?
It’s important to keep communicating with your doctor or pharmacist throughout your treatment. Side effects don’t just happen when you start a new drug. Adverse reactions can be experienced when you stop taking a medication that you’ve taken for a while, when you add new medications, or when your antidepressant dose increases or decreases.
“Some side effects you may start seeing quickly. Depending on the efficacy of the medication, it may take between four, six, eight weeks after taking your medication for other side effects to appear,” says Frontino. “Ideally, we don’t want anyone to experience side effects.”