James:

The reasoning behind psych med side effects is usually pretty confusing. For example, I can say with certainty that one popular (highly marketed, highly profitable, and not scientifically understood by its maker) drug sometimes prescribed for depression, has either caused or exacerbated severe depression in every person I have known who took it.

You will often hear that every drug has a different effect on different people. This is true because people have different body masses, different blood chemistry, different blood brain barriers, different unknown genetic variations, different combinations of synapses in their brain, and different causes for similar symptoms. So in theory, every single person will have a slightly different response to any given medication. The medication that works pretty well for me, has exacerbated the symptoms for other people I’ve met. And on top of all that, the actual mechanism of how most drugs work is still largely unknown. Scientists don’t really know why SSRIs can help with depression, there’s just a theory that depleted serotonin causes depression in some (but not all) people with depression.

The individual variation in the “disease mechanism” (etiology) is the real reason that side effects can be backwards. If a serotonin imbalance isn’t responsible for your symptoms, then not only is an SSRI not going to help, but it will do strange things to your brain. Anxiety is not the same as depression, and I’m a bit baffled as to why a doctor would prescribe an SSRI to treat anxiety, unless he was either lazy and only knew the name of 1 psych med, or felt that the anxiety was really a manifestation of depression, which can be treated with SSRIs. Anxiety is usually treated with benzodiazepine-type drugs such as Xanax or Valium.

Another reason for some of the opposite side effects is something you might call a “reverse placebo effect.” Placebo effect means that a person experiences the change they expect a drug to cause, even if the drug doesn’t actually do anything. So sometimes, if a drug doesn’t have the effect that a person is expecting, then the person ends up amplifying the original symptom. This happens with EVERY psych med, because every psych med takes anywhere from a week to a few months to build up in the brain in sufficient quantity to really take effect. During the first few weeks, when the person is taking the drug but not feeling the effect, they will be more aware of the symptoms they already had- and thus, report or experience them to a greater degree. (Plus, at least with depression, it’s even more depressing to feel that your antidepressants aren’t working… this is why many people become more suicidal right after starting psych meds, because they worry that there is no hope.)

To make matters more confusing, some “side effects” of medications are actually “withdrawal effects” that occur if too low a dose is prescribed, or if a patient misses a dose or two, or if a patient decides that the drug isn’t working and stops taking it.

So, I hope that I haven’t used too many words. The bottom line when it comes to researching the mechanisms of mental illnesses and their treatments is that the entire field is simultaneously mind numbingly extensive, and mind numbingly vague. In other words, there’s a reason that psychiatrists have to go through a decade of graduate school, as well as weeks per year of refresher training. Thus the conundrum, that we as patients need to recognize that we are NOT smarter than our doctors- but, we probably care a bit more. So, you should talk to your doctor about any side effects that you actually do experience, but you should not simply stop taking a drug because you’re not sure of its effects, nor should you change the dose on your own.