Managing the side effects of psychotropic medications

533 Pages·2012·6.06 MB·English

by  Joseph P. Goldberg & Carrie L. Ernst & Stephen M. Stahl

Managing the Side Effects of
Psychotropic Medications
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Managing the Side Effects of
Psychotropic Medications
Joseph F. Goldberg, M.D., M.S.
Associate Clinical Professor of Psychiatry,
Mount Sinai School of Medicine, New York, New York;
Director, Affective Disorders Research Program,
Silver Hill Hospital, New Canaan, Connecticut
Carrie L. Ernst, M.D.
Assistant Professor of Psychiatry and Assistant Director
of the Psychosomatic Medicine Fellowship Program,
Mount Sinai School of Medicine, New York, New York
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is
accurate at the time of publication and consistent with general psychiatric and
medical standards, and that information concerning drug dosages, schedules,
and routes of administration is accurate at the time of publication and consis-
tent with standards set by the U.S. Food and Drug Administration and the gen-
eral medical community. As medical research and practice continue to advance,
however, therapeutic standards may change. Moreover, specific situations may
require a specific therapeutic response not included in this book. For these rea-
sons and because human and mechanical errors sometimes occur, we recom-
mend that readers follow the advice of physicians directly involved in their care
or the care of a member of their family.
Books published by American Psychiatric Publishing (APP) represent the find-
ings, conclusions, and views of the individual authors and do not necessarily
represent the policies and opinions of APP or the American Psychiatric Associ-
ation.
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Copyright © 2012 American Psychiatric Association
ALL RIGHTS RESERVED
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Library of Congress Cataloging-in-Publication Data
Goldberg, Joseph F., 1963–
Managing the side effects of psychotropic medications / by Joseph F.
Goldberg, Carrie L. Ernst. — 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58562-402-7 (alk. paper)
I. Ernst, Carrie L., 1975– II. American Psychiatric Publishing. III. Title.
[DNLM: 1. Psychotropic Drugs—adverse effects. QV 77.2]
615.788—dc23
2011039535
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
To our children, Joshua, Brian, and Hannah,
for their patience, encouragement, and love;
to our parents, Ethel and Daniel Goldberg, and Arline and Robert Zinaman,
for their commitment and omnipresence;
and to each other,
for everything in between.
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Contents
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxiii
List of Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . xxvii
List of Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxix
PART I
General Considerations
1
The Psychiatrist as Physician . . . . . . . . . . . . . . . . . . .3
Primary Care Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Differentiating Adverse Drug Effects
From Primary Illness Symptoms . . . . . . . . . . . . . . . . . . . . . . 7
The Nocebo Phenomenon and
Proneness to Adverse Effects. . . . . . . . . . . . . . . . . . . . . . . . 16
Negative Therapeutic Reactions . . . . . . . . . . . . . . . . . . . . 20
Attribution and Causality . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Paradoxical Adverse Effects. . . . . . . . . . . . . . . . . . . . . . . . . 23
Extrapolating “Evidence-Based
Research Findings” to “Real-World” Patients . . . . . . . . .26
Dose Relationships and Adverse Effects . . . . . . . . . . . . . .28
FDA Warnings and Precautions . . . . . . . . . . . . . . . . . . . . . 32
Risk-Benefit Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
General Approach to Assessing
Adverse Drug Effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
2
Pharmacokinetics, Pharmacodynamics,
and Pharmacogenomics . . . . . . . . . . . . . . . . . . . . . 47
Pharmacokinetics and Pharmacodynamics. . . . . . . . . . . 47
Toxic Polypharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Gender and Racial Differences in Adverse Effects . . . . . 57
Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Brand Versus Generic Formulations . . . . . . . . . . . . . . . . . 60
Enantiomeric Versus Racemic Agents, and
Parent Versus Metabolite Compounds. . . . . . . . . . . . . . . 61
Drug Blood Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Pharmacogenomic Predictors of Adverse Effects. . . . . . 63
3
Vulnerable Populations. . . . . . . . . . . . . . . . . . . . . . 71
Patients’ Diverse Proneness to Drug Side Effects. . . . . . 71
Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Medically Ill Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Older Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Patients Prone to Somatization . . . . . . . . . . . . . . . . . . . . . 76
4
Adverse Psychiatric Effects of
Nonpsychotropic Medications . . . . . . . . . . . . . . . . 83
Analgesics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Anticholinergics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Anticonvulsants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Antimicrobials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Antineoplastics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Antiparkinsonian Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Antiretroviral Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Cardiovascular Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Dermatological Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Gastrointestinal Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Immunosuppressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Interferon-α . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
Oral Contraceptives and Intravaginal Rings . . . . . . . . . .93
Smoking Cessation Aids . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
Steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
5
Adverse Psychiatric Effects of
Psychiatric Medications. . . . . . . . . . . . . . . . . . . . . . .97
Activation and Mania/Hypomania
or Mixed States. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
Anxiety and Panic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100
Clinical Trial Subjects With Psychiatric Illness . . . . . . .100
Discontinuation Phenomena . . . . . . . . . . . . . . . . . . . . . . 101
Disinhibition and Impaired Impulse Control. . . . . . . . 101
Emotional Dulling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Psychosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Suicidal Thinking or Behavior. . . . . . . . . . . . . . . . . . . . . . 103
6
What Nonmedical Therapists
Should Know About Adverse Drug Effects . . . . . 105
PART II
Organ Systems
7
Cardiovascular System . . . . . . . . . . . . . . . . . . . . . 113
Arrhythmias and Palpitations . . . . . . . . . . . . . . . . . . . . . .113
Cerebrovascular Accidents . . . . . . . . . . . . . . . . . . . . . . . . .122
Dyslipidemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Hypertension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Myocarditis and Cardiomyopathy. . . . . . . . . . . . . . . . . . 139
Orthostatic Hypotension . . . . . . . . . . . . . . . . . . . . . . . . . . .140
8
Dermatological System . . . . . . . . . . . . . . . . . . . . . 141
Alopecia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141
Hyperhidrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Photosensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143