When Meds Get in The Way

Life is full of little things we take for granted to such a degree that we don’t even ever think of them – until they’re gone. When you begin taking psychiatric drugs, an unexpected plethora of such details opens up before you. What you once considered pleasant, but petty aspects of everyday life suddenly are luxuries you will have to do without, or cut down on, from now onward. You will need to revise and likely modify several of your habits in order to stay safe, and you may feel restricted in your personal freedom. To put it in plain English: you will be forced to redefine the terms “fun” and “freedom” for yourself, at least partially. I know how off-putting this sounds, but the good news is that it is possible as long as you keep an open mind. The following is a list of everyday luxuries I have had to reevaluate since getting on psychiatric medication.

Luxury #1: Booze

Officially, you are not supposed to consume any alcohol while you are taking psychoactive medications. Booze may alter the way your organism assimilates the active ingredients, and it also acts as a depressant. So, if you are already suffering from depression, regular pub-crawling is a no-no. Now, alcohol is an almost ubiquitous substance. What is more, we humans use it as a vehicle for social bonding. Drinking with others is not just about tickling our taste buds and our nervous system, but it is a social ritual. No matter if we are with friends, family or business partners: sharing a drink equals declaring you are on the same page with them, and on friendly terms. As alcohol is known to lower inhibitions, it also serves to break down barriers between people. As a consequence, being offered one or the other alcoholic beverage on all sorts of occasions is virtually unavoidable. Depending on your psychological equilibrium, you may have to reject those offers altogether. Personally, I have found I can have a few glasses of wine or juice with a shot of rum without experiencing any negative effects. As I have never been a heavy drinker, needing to set limits to my alcohol consumption has not been a big issue for me. Essentially, I am having the same amounts as always, only that when I first started taking psychiatric medication I had none at all for a few months and then carefully started experimenting with half a glass here or one shot there, until I felt certain it was doing no harm to me. However, if you are a customary drinker, you will need to become more self-disciplined.

Luxury #2: Caffeine

If you have ever been hospitalized in a psychiatric clinic, you may have noticed they offer decaffeinated coffee or decaf teas to their patients. Needless to say, caffeine is a stimulant. Depending on your diagnosis and your medication regime, you may have to say goodbye to your cuppa or at least reduce your intake. For someone with anxiety or mania, stimulants are not an option. In my particular case, I have found that coffee and tea do not affect me negatively, so I continue having them just as always during the first half of the day. I avoid caffeine after 5 pm, though, and given that I dislike most sodas, I never have coca cola or the likes. I also stay away from energy drinks or any other stimulants stronger than my habitual cup of coffee. Evaluate carefully, if possible together with your therapist or prescribing doctor, if sticking to your caffeinated drinks is alright for you. Try one cup of mild coffee in the morning and observe how you react both during the day and at bedtime, then make a decision based on what you experienced.

Luxury #3: Sugar and carbohydrates

In another article on this blog, I had written about weight gain as a negative effect of psychiatric drugs. Unfortunately, to limit the damage, you should reduce your intake of processed carbs and sugars significantly. Truth be told, if you are interested in healthy nutrition you ought to do so anyways. If you are on medication, avoiding processed foods becomes imperative. Eliminate them from your daily diet. Maybe allow yourself one eat-what-you-want day per week in order to keep cravings at bay. As I have a very sweet tooth, abstinence in this area is tough for me. However, I have found it extremely helpful that my partner and I have both decided to go low carb. In our fridge and around the kitchen, you will find no chocolate, no cookies, no cakes, not even white bread. If I ever felt like being “naughty” I would have to go all the way to the next grocery store, pick something out and stand in line for it, which makes breaking the rules a lot less tempting. Also, once you get the knack of maintaining a low carb and low sugar diet and explore some new recipes, your cravings for processed foods will diminish over time. As of today, I hardly experience any unruly longings and enjoy otherwise forbidden treats all the more when I come across them at parties or other special occasions.

Luxury #4: Foods you had never thought of as dangerous

If point #3 has motivated you to switch from drinking sodas to enjoying natural fruit juices, and you are sipping from a glass of refreshing grapefruit juice as you are reading this paragraph – stop! Grapefruit juice interacts with numerous medications because it alters the way your liver processes them. Interestingly, this fact does not appear on the label of juice packages, so you need to find out through research on the internet or consultation with a pharmacist. There are other natural foods under suspicion of interacting with certain medications: pomegranate is one of them, though studies haven’t yet confirmed how much it really interacts with medication. Some herbal medicines, such as Saint John’s worth and Valerian, potentially exacerbate or weaken the effect of psychiatric drugs. The same goes for some supplements. The following are links to pages with further information about drug-food interactions.

Free PDF on drug and food interactions for downloading by the FDA: http://www.fda.gov/downloads/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/ensuringsafeuseofmedicine/generaluseofmedicine/ucm229033.pdf

Article by the Academy of Nutrition And Dietetics: http://www.eatright.org/Public/content.aspx?id=6442477646

Again, none of this means you necessarily have to avoid these foods and beverages completely, but you need to be moderate in the amounts you consume and extremely attentive about possible negative effects.

Luxury #5: Spontaneous sleepovers or travelling

Before I say anything else: ALWAYS carry one or two extra doses of medication with you! It is rare to be unexpectedly confronted with the option of spending a night away from home or prolonging a trip for an extra day. Yet, in good theory, it can happen. Your flight may have been delayed or cancelled, you are too tired to drive home after a get-together or weather conditions are too bad to get on the road, or you simply wish to stay somewhere nice for a bit longer. All those situations can turn into a problem if you don’t have enough medication with you. Therefore, make sure to take an emergency backup wherever you go – near or far. The longer your trip, the larger your extra supply should be. On a normal work day I will carry a tiny pillbox with one spare dose in my purse. When I go on longer trips, I habitually put enough medications for an extra week in my luggage, and I also keep them in different bags in case one of them gets lost or stolen. Once we’re at it: also record your medication plan – names of substances, doses and schedule – in your agenda or on a piece of paper to keep in your wallet. Accidents happen, and the medical team scraping you up from the street must know about your using psychiatric drugs. Don’t forget to add other basic information, such as your blood type or any chronic conditions and allergies you have.

Luxury #6: Over the counter meds

Have a headache? Before you head to the pharmacy for some Aspirin, make sure you can actually take it. Many over-the-counter drugs interact with psychiatric medications, which can turn a vulgar flu into an adventurous slalom around dozens of red flags. For more information, go to my article on drug interactions.

Luxury #7: Sunbathing

This is an issue I luckily escaped. Some medications, including the ones I am taking, potentially render you more sensitive towards UV radiation. Depending on your individual case, you may need to apply sunscreen to your skin before leaving the house or quit sunbathing and tanning sessions. As I said, my tolerance – and love – towards sunlight is unaltered, but I advise you to monitor your response to it for as long as you are on medications.

Luxury #8: Overall independence

By overall independence I mean the ability to adapt to your surrounding circumstances without having to worry about where you get your medications from. It is only a few exceptional situations that would really challenge your flexibility in this regard: wars, cataclysmic natural events such as floods, hurricanes or earthquakes, social upheaval or economic collapse. Even though these events are not the most likely to occur, they are an inconvenient possibility. When your well-being hinges on the availability of any type of medical treatment, you realize how dependent you are on civilization, the integrity of your society and a functioning infrastructure. You cannot simply revert to an ancestral lifestyle or an existence of scarcity the way most others could – if grudgingly. Unfortunately, I have not yet come up with a way of getting around this problem. Probably, precaution is the best protection from shortages in supplies. Just as it is wise to keep a few gallons of drinking water and some emergency lanterns or candles in your house, also have a backup of your medications. In addition, stock up on your drugs in time. Do not leave picking up your prescription for last minute, but create  a safety margin of maybe a few weeks.

Luxury #9: Hardcore partying

For some, parties aren’t over before daylight. However, if your medication plan includes taking a sedative or tranquilizing drug in the evening, you may have to retire from power-partying and clubbing. Even if you can force yourself to stay awake, you may not be in condition to leave the house or, let alone, drive anywhere. And much less will you be able to enjoy the party. My longest night is usually New Year’s Eve, and even then I hardly make it beyond 2 or 3 am. I take my anti-psychotic at that time and then sleep in the next morning. On all other occasions, I am in bed before or roughly around midnight. Before you give in to feelings of rebellion, take into account that altering your sleep cycle also implies tampering with the regularity of your medication plan, which in turn can affect your psychological stability and performance at everyday activities. Ask yourself if it is worth it.

Luxury #10: Recreational drugs

I have never used any recreational drugs, but now that I am on psychoactive medications I also should not consider trying them. They interfere with your mental functions just as psychiatric medication does, which means all sorts of unforeseeable interactions are possible. Some recreational drugs are actually believed to trigger psychosis. Stay away from them if you can. I have met people who continued using recreational drugs, mostly marijuana, despite taking psychiatric medications, and who were claiming it was not harming them. Yet, in my opinion it is preferable to play it safe. Mental health is one of our most valuable goods! Should you be addicted to street drugs, please consult with your prescribing doctor and/or therapist before making any decisions. Special considerations need to be taken to handle your case.

These were the luxuries I could come up with based on my personal experience with psychiatric medication. If you can think of more aspects of everyday life that turn into luxuries when you are in treatment, please leave a comment.

Some Words on: Drug Interactions

Being on psychiatric medication will force you to question some of your habits. It might also make you wary about other drugs that had seemed harmless to you so far. Little things you took for granted may suddenly become big no-nos. I am talking about interactions your medication may have with other substances. For example, if you are taking a tricyclic antidepressant, popping an Aspirin against your headache is out of the question. You may have to renounce to alcoholic beverages and quit smoking bong. Possibly, you can’t even have caffeinated drinks.

Before you consider suicide, I wish to stress that despite the many restrictions your medication imposes on you, you will still find ways of enjoying life. I am just saying you need to be careful. The first step you need to take is to find out about the interactions your medicines may have with other prescription and over the counter drugs. Personally, I am on Quetiapine (Seroquel) and Sertraline (Zoloft). As a result, when I have pain from flu, from a migraine or caused by some lesion, I pretty much have to rely on Acetaminophen to fix it. It is the only analgesic and anti-inflammatory I can use without putting myself at risk. Every time I am about to try a new medicine I have to check and double-check if it is really safe for me to take. I admit to feeling quite nervous whenever I experiment with a new drug, although it is reported not to interact with my psychiatric medication. However, sometimes there is no way around playing guinea pig. Once I have successfully tried out a new drug I usually stick to it like glue. My list of compatible drugs is still short. Luckily, I don’t get ill often. Yet, eventually I should definitely make a list of all the medications I have found work fine for me.

It can be frustrating to find an entire group of medications is counter indicated for you, especially when you’re having an acute and debilitating health problem. You may have read in my withdrawal diary that I had been suffering from back pain. Unfortunately, I had to stick it out because there seemed to be no compatible muscle-relaxants. Usually, though, in every medication family, there should be at least one variety you can use. For example, there are several antibiotics which would interact with my psychiatric medication, but some are alright for me. The same goes for anti-allergic drugs. A couple of them would be dangerous for me to use, but Fexofenadine (Allegra) is harmless.

Not just other drugs can interact with your medication. Natural substances and food products can, too. All beverages containing caffeine are stimulants, meaning that, if your psychiatric treatment is aimed at calming you down, you will have to cut those out at least for a while. It is no coincidence that mental clinics usually offer their patients decaffeinated coffee and tea throughout the day. This may sound off-putting to the coffee-gourmets among you, but the nice thing about non-stimulating coffee is that you can literally have it around the clock and as much of it as you like. Personally, I love having several cups of coffee and tea per day. Yet, in order not to let it disturb my sleep, I stop consuming caffeine before 5 pm. Alcohol, on the other hand, is a potent depressant. So, if you are already down, having a few shots at your neighborhood bar will dig your grave a bit deeper. Doctors will generally recommend you to abstain from alcohol while taking psychiatric medications, or to enjoy moderate quantities on rare occasions. Your medications are broken down by the liver, so anything that would affect its functioning or strain it unnecessarily should be avoided. Now, alcohol is often a staple at social events. For many, having a glass of wine, a beer or a cocktail is part of the fun of hanging out with friends or colleagues. Probably, you can drink a glass or two without risking any negative effects. As for myself, I can have a few drinks without difficulty. I have never been a heavy drinker, not even a regular one. When I am at a party or at a restaurant, I like my share of red wine or a round of sake at sushi places. I never have booze on an empty stomach and also never let myself get drunk. If you decide you’d like to try a drink, accompany it with a glass of water to dilute and help you flush it out. An exotic item on the list of forbidden foods is the grapefruit. It alters liver function and therefore should not be consumed in combination with any drug at all – psychiatric or not.

Then, there are psychoactive natural remedies, such as Saint John’s Worth or Valerian. Extracts made from those plants are tranquilizing. In other words, they act on your brain. Only use them if you can make sure they won’t interfere with the therapeutic purpose of your current treatment. For the ladies, it might be an interesting fact that Saint John’s Worth, on top of its psycho-activity, also diminishes the effectiveness of hormonal contraceptives. So, hands off this shrub if you would like to enjoy your freedom for a bit longer!

Talking of natural psychotropic substances, there is a host of them. Probably the most commonly used is marijuana. Although it is illegal in most places, it is probably less dangerous than many psychiatric drugs. Still, it should not be used in combination with them. I am acquainted with people who are on anti-psychotics and smoke weed at the same time, but it is risky and therefore not recommendable. It can go well, or it can go wrong, without there being any way of telling beforehand. Unfortunately, little data is to be found about the risk factor here. It appears to be that recreational drugs can actually trigger mental illnesses. During my last stay at a mental clinic, I came across fellow patients whose diagnosis of schizophrenia or psychosis followed the use of marijuana, heroin or other illegal substances. Spontaneously, I can recall four or five cases, just out of the people I got in closer contact with. There is no way for me of knowing whether the physicians at the clinic recognized the cause of mental illness correctly, or whether factors other than recreational drugs were in play. Still, it is a possibility.

Sometimes, an illness or injury can require extra medication with great urgency. If it so happens, you will have to grind your teeth and weigh possible interaction symptoms against the gravity of your condition, then choose the least compromising of the two. Note that not all drug interactions are necessarily dangerous. Depending on their severity, they are usually categorized as major and minor interactions. Hence, if you are seriously ill, you may be willing to risk interactions as long as they are not menacing to your life. Just as side effects, interactions may occur in some individuals and in others not. If an undesired symptom is expressed in a very small percentage of the sample population, the odds are on your side.

Most importantly, you need to find reliable information on the interactions your medication may have. The package inserts (or PILs – Package Information Leaflets), usually only contain a basic paragraph on the subject. You can, of course, ask your prescriber, but he or she will likely not be familiar enough with the specific combination of drugs you are going to take. Remember your doctor sees dozens of patients every day, all of them with their specific medication plan. It is virtually impossible to bear all possible drug interactions in mind. Then, there is the internet. Several sites offer interaction finders where you can type in the combination of drugs you wish to check for safety. It is hard to say whether these webpages have complete data at their disposition. New medications are thrown onto the market and new studies with already existing medications are conducted all the time, so there is a constant need for updates. The advantage of online interaction finders is that you can type in any number of substances, which allows you to learn about the safety of multiple drug use. You can also find interaction lists on the internet. But be warned: the number of interactions for your psychiatric drug can literally be in the hundreds, so prepare for a Sisyphean task.

Last, but not least, your using psychiatric medication may be socially and professionally compromising. Not because you may have to turn down friendly offers of alcoholic or stimulating beverages, but because your medication may render you unresponsive to everyday situations. One day, instead of taking my antidepressant in the morning, I accidentally took the anti-psychotic. What a knockout! That day, I had visits coming over. Later in the afternoon I was supposed to shop for a birthday present and attend a theater rehearsal. I am hard headed as a ram, so I forced myself to pull through with my agenda, but it felt like attempting to pull myself out of a swamp. I won’t forget that day so easily. Normally, I am supposed to use my anti-psychotic right before going to bed at night. Now, there are some evenings where you have no intention of going to bed any time before the early morning hours of the following day. New Year’s Eve is one of those occasions. As a consequence, you may end up flushing your sedating medication down with a fruit punch at 2 am or so. As long as you have nothing important to do the next day, it’s not a problem. Just make sure you have no job interviews, driving lessons or college admission tests coming up, because you will be feeling quite heavy. Luckily, I am not much of a night owl, so the anti-psychotic does not really get in my way much. If you are into clubbing or have to work graveyard shifts, you will need to make adjustments either to your activity schedule or to your medication plan. Discuss this in depth with your prescribing physician. You may have to modify your lifestyle in some regards, but do not feel discouraged. If an aspect of your life is really important to you, there should be ways to conserve it. Stay motivated and think outside of the box.