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Psychiatric Meds Dirty Little Secrets: Side effects including facial grimacing and movement disorder


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Mental illnesses have a jarring, disruptive effect on people’s lives, of that there is no question. The World Health Organization has indicated that nearly 450 million people have a mental disorder, which is among the leading causes of illness and disability worldwide.


Two-thirds of those with a mental disorder will never seek or get help from a healthcare professional. The reasons for the lack of treatment include stigma, discrimination, a neglect of preventive care and treatment, or the inaccessibility of mental healthcare. In the United States, the National Institute of Mental Health has said that tens of millions of people have a mental illness and only half receive treatment.


These statistics are disturbing, but there’s another side to the coin. The horrific side effects may be the reason for not receiving treatment.


The side effects, in some instances receiving a black box warning, are contained in a patient-information sheet placed in the box with the medications. The patient, however, may not receive the medication in its original box and may not be given the sheet. Not informing patients about the side effects is usual, or it is assumed they know them.


Anyone who has taken a psychotropic medication (a.k.a. AP or antipsychotic) knows how distressing, and terrifying side effects can be. Polypharmacy was originally prescribed only for psychotic disorders such as schizophrenia. Now, prescribers are again combining several drugs. The question of polypharmacy has been one of serious negative debate and still has not come full circle into acceptable practice.


The journal, Psychiatric Times, laid out the current state of polypharmacy: “Although polypharmacy is often used in the management of psychiatric disorders, there is very poor awareness of its efficacy. In some situations, polypharmacy also lacks respect and acceptability. This arises out of the fact that most reputed textbooks and clinical guidelines advocate monotherapy and a single drug at high doses rather than clinical practice scenario where multiple drugs targeted at specific symptoms are prescribed.” The medical profession is not totally behind this practice, yet we see adults and children with attentional disorders and mild-moderate depression prescribed this regime.


What Are the Side Effects?


Every medication, including aspirin, has several side effects associated with it. How are side effects determined? In clinical trials, the researcher notes any untoward reaction. The researcher then submits it to the sponsoring pharmaceutical company. The side effect is placed in the database once the pharmaceutical company receives notice. Once discovered, the side effect is published in the Physicians Desk Reference.


The reference book, unknown to many consumers, is available in many different editions all over the world. Not all versions will carry the same information or have the same side effects listed. As noted in Wikipedia, “The compilation (of included medications) is financially supported in part by pharmaceutical manufacturing corporations which create drugs listed within its pages.” Therefore, it might be considered a corporate publication of the pharmaceutical industry.


Side effects are in one of two categories, common side effects, and rare side effects. In some cases, there may also be a third category which is extremely rare side effects This may occur in less than 1% of the cases.


For most patients, the side effects may be uncomfortable but for one group of patients, it is a matter of life and death. Contraindications for this subset of patients include those in nursing homes or the elderly who are in danger of death from specific medications. Not all medical staff are aware of the warning.


The primary side effects seen most often include EP (extrapyramidal symptoms). These effects include drug-induced moving disorders, tremor, Parkinson’s-like symptoms (walking with a shuffle, mask-like facial features) and tardive dyskinesia (TD). Tardive is abnormal, repetitive facial movements including lip-smacking, poking of the tongue, or worm-like movements of the tongue within the mouth.


TD, however, is not limited to these facial abnormalities but may also interfere with the diaphragm muscle in the trunk and cause problems in breathing. Affected patients will show puffing-like mouth breathing.


An additional and highly disturbing side effects is that of spasmodic torticollis, where the neck muscles contract abnormally. The patient suddenly finds their head twisted toward their shoulder, and they cannot move it from that situation.


The last and most often seen side effect is akathisia where the patient is unable to stop moving their feet as they stand upright. The feeling is one of extreme discomfort. Staff, who were unaware of this being a side effect, once told me, “We call it the Mellaril shuffle.” The unrelenting need to move can also interfere with sleep. The staff never understood this problem and refused to believe the patients couldn’t control it.


Mental disorders are affecting people’s lives worldwide, decreasing their ability to lead productive, comfortable lives with appropriate social interactions. But, when we consider the side effects of many psychiatric medications, it is understandable that they may not seek or will discontinue treatment. Discovery of more effective drugs with less toxic side effects is the hope of the future.

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DR. PATRICIA A. FARRELL