Many people are concerned about medication side effects. This concern is warranted since the risk of side effects with many medications is high.
A large part of the problem is that doctors are not trained to treat people as individuals. Too often, doctors prescribe the same strong doses to a 105-pound woman, an 80 year-old great-grandmother taking 15 other drugs, a 12 year-old youngster -- and a 300-pound football player. You don't have to be an expert to realize that such methods are dangerous. No wonder side effects are so frequent and severe.
A Safer, Individualized Approach
Because of the high frequency of side effects with antidepressant, anti-anxiety, and sleep medications, Dr. Cohen prescribes these drugs with special care. Unlike most doctors, he uses a flexible, individualized approach that frequently begins with very low doses. He selects therapies and doses based on each person's individual characteristics: age, gender, size, state of health, use of other medications, history of previous problems with medications, family medication history, and other factors. When handled with an emphasis on safety, antidepressant, anti-anxiety and sleep medications (and natural therapies) can make a big difference in a patient's quality of life. The same applies to many other kinds of drugs including statins for elevated cholesterol, medications for high blood pressure, migraines headaches, and many others.
Many people are generally tolerant of medications and do well on standard drug doses of drugs, with few side effects. But they may run into problems if their medication doses need to be adjusted or increased. For these people, selection of the right drug at the right dose is key and dose adjustments should be done gradually. Too often drug companies make pills that require 100% jumps in dosage, which is too big an increase for many people. Side effects develop, doctors deny the drug's role, and people quit treatment. This is unfortunate, because better, safer methods can avoid these problems and allow treatment to reach its intended goal.
Are You Sensitive to Medications?
Many people experience medication side effects from time to time, but there are others who are sensitive to just about every medication they receive. Such people are medication-sensitive. Medication-sensitive individuals comprise about 10% of adults in the U.S., about 20 million people. As one pharmacist said: "You run into patients all of the time who don't tolerate standard drug doses." Some children and teenagers also are sensitive to medications.
If you are medication-sensitive, you may be sensitive to many types of chemicals. For one woman, coffee causes a painful flaring of the cystic disease of her breasts. One doctor gets depressed if he takes a Motrin tablet. A woman is sedated by Claritin (which is supposedly nonsedating, but actually sedates 1 in 12 people). Many people cannot handle alcohol.
Medication-sensitive individuals often think they are the only ones who are intolerant of medications. Yet they have a lot of company.
Who Is Medication-Sensitive?
The majority of medication-sensitive individuals are women. Sometimes, medication sensitivities runs among the women of a family. According to a specialist in women's medicine, "If their mothers are sensitive to a drug, many of my female patients are sensitive, too."
Medication sensitivities are frequently seen in older people. A highly experienced pharmacist noted, "As people age, nearly all of them become medication-sensitive."
Small individuals may be prone to medication sensitivity. To lesser degrees, medication sensitivities also are seen in men, large people, the young or middle-aged. Highly sensitive persons are often medication-sensitive.
Medication-Sensitive Individuals and Mainstream Medicine
If you are medication-sensitive, you have learned that doctors do not understand the problem and have no solutions for it. Many doctors believe medication-sensitive individuals are hypochondriacs. Doctors often ignore or treat medication-sensitive patients' complaints with disdain. Yet the medical literature is packed with reports of people who are highly reactive to medications. Scientifically, such people are known as outliers, because their responses to medications are outside of the norm.
In his work, Dr. Cohen teaches medication-sensitive patients how to discuss their sensitivity with their doctors, so that they will get proper treatment. Some patients ask him to contact their doctors to explain about their medication sensitivities. He is glad to do this.
"I React to Everything!"
One medication-sensitive woman told me, "I react to everything. I don't know what will happen when I really need treatment."
Her concern is warranted. Medication-sensitive individuals are often switched from drug to drug to drug. The drugs are prescribed at strong, standard doses, doses that medication-sensitive individuals cannot handle. The result is a series of vexing side effects. Such people become more afraid of the treatments than of their conditions. Some people delay seeking treatment for serious, yet treatable disorders.
A letter published in the Peoples' Pharmacy column illustrates the problem.
We visited my mother over the holidays, and she just isn't her old self. I'm convinced the
problem is her medicine. She has been on Prozac, Paxil, Effexor, Zoloft, and Celexa. She has
suffered from anxiety and restlessness, insomnia, dry mouth, and nausea. Her doctor is ready to
give up. She is currently taking Remeron, but she is tired and dizzy all of the time. She also has
gained weight.
All of these medications are antidepressants, and they often cause many side effects if not prescribed properly. Treatment must be individualized. The dose must be matched to the patient's characteristics.
Lower doses must be used for medication-sensitive individuals. These are the strategies I employ in every case, yet they were not used by this woman's doctor. Such stories are common.
Dr. Cohen has treated hundreds of medication-sensitive individuals over the years. They do very well if treatment is handled with a light touch. Low-dose treatment is the rule in his office for medication-sensitive individuals. Sometimes he uses very tiny doses. One older woman received 20 mg of Prozac (fluoxetine) from her doctor. It caused terrible side effects. He stopped the medication, allowed her system to settle down, then gave her 1 mg. Her depression lifted. With some patients, he avoids prescription drugs entirely and instead recommend non-drug natural therapies.
Dr. Cohen's Guiding Principle: Individualized Treatment, Careful Methods
The highest ethic of the medical profession is: Do No Harm. At Dr. Cohen's office, preventing side effects is a top priority. This is why he offers a variety of treatments to fit every individual: low-dose medication therapies, standard medication therapies, non-drug natural therapies, and talk therapy (psychotherapy). When applied skillfully, these therapies can be highly effective in treating most anxiety, depressive, phobic, and panic disorders, stress reactions, and many other medical conditions.
If you are interested in seeing Dr. Cohen at his office or consulting with him by telephone, please call 858-345-1760.
Related Articles
Newsweek. One-Size-Fits-All Medications Do Not Fit All: Doctors and Patients Need to look beyond cookbook guidelines from the drug industry. Dec. 6, 1999, page 92.
Life Extension Magazine. Medication Side Effects: Why They Occur and How You Can Prevent Them. March 2003;9(3):46-68.
Bottom Line Health and Bottom Line Personal Newsletters. Multiple articles and interviews on preventing medication side effects. 2002 through present.
Special from Bottom Line's Daily Health News. Four More Drugs with Serious Health Risks. February 28, 2005.
Life Extension Magazine. Tylenol: More Risky Than You Realize.
Dec. 2007.
JAMWA (The Journal of the American Medical Women's Association). Do Standard Doses of Frequently Prescribed Drugs Cause Preventable Adverse Effects in Women? 2002;57:105-110. The first in-depth article to examine why women sustain more side effects than men.
Medscape. Preventing Adverse Drug Reactions Before They Occur. Expert Pharmacology Column. Dec. 1999: www.Medscape.com.
Postgraduate Medicine. Ways To Minimize Adverse Drug Reactions: Individualized Doses and Common Sense Are Key. Sept. 1999;106:163-72.
View all of Dr. Cohen's medical articles, consumer publications, and presentations.
