And one pill makes you small
And the ones that mother gives you
Don't do anything at all
Go ask Alice When she's ten feet tall
(Lyrics from White Rabbit-Jefferson Airplane)
We get a lot of questions here on MyDepressionConnection about medication and particularly about using a combination of meds. Using a variety of medications to treat a medical condition or mental health disorder is described by some as taking a "medication cocktail." In the field of mental health it is becoming more common than not for doctors to prescribe multiple medications to treat your mood disorder or mental illness. You add your other medications and supplements to the mix and it makes you wonder how all these chemicals are interacting with one another and if the combination is safe.
You don't have to search very far in the news to find incidents where a combination of certain medications proves deadly. The tragic case of seven-year old Gabriel Myers comes to mind. According to news reports, Gabriel was a foster child who had been prescribed several psychiatric medications to treat his childhood Bipolar Disorder. He was found dead in his foster parent's home after he hung himself with an extendable shower head. News reports suggest that the combined effect of prescribed psychiatric drugs were the cause of this child's suicide. This case leaves many unanswered questions. Should psychotropic drugs be prescribed to young children? Did the doctor warn this child's foster parents of the potential side effects of his medication including the increased risk for suicide? Was he being closely monitored for any sudden change in his mood? Were the meds to blame for his suicide or were there other more probable reasons? Some people, such as State Senator Ronda Storms, believe that the cocktail of medications did contribute to Gabriel's state of mind leading to his death. Storm has been an advocate for legislation in Florida to require an independent review prior to administering psychiatric drugs to children who are 10 or younger.
When adults die from a lethal combination of prescribed medications we usually hear about celebrities. Anna Nicole Smith is one celebrity whose death was blamed on her prescription drug cocktail which consisted of three anti-anxiety medications, a sleeping drug, and more. Likewise, the death of mega pop star Michael Jackson was found to be due to a toxic level of prescribed medications. His doctor has been charged with involuntary manslaughter. Recent reports are that the trial for Michael Jackson's doctor will be televised. I am sure the public will be very interested to see if a doctor can be held responsible for prescribing a potentially dangerous combination of prescription medications.
There are no easy answers when it comes to whether or not a particular combination of medications will be safe to take or not. Although there may be some clear cut boundaries and limits of what medications can safely be used when taken together, there are still a lot of grey areas. So much depends upon our unique physical and biological make-up as to which combinations of meds will prove to be safe and effective. As we all know what works for one person may not work for another. Likewise, we will not all experience the same side effects or severity of side effects. You really cannot predict what will happen when you take any medication until you do. Taking medication is always somewhat of a risk or gamble in that you have to constantly assess the potential risks with the potential benefits. A good doctor will guide you on this but certainly there can be mistakes and errors of medical judgment as we have seen in the high profile cases I have discussed.
Patients are also capable of human errors of judgment such as not taking their medication as directed or even abusing their prescription drugs. Your doctor cannot stand over your shoulder and make sure you take your medication as prescribed.
The other issue with regard to the safety of taking multiple medications is that there are not enough studies to know all the possible drug interactions. There may be research showing the potential interactions between two drugs but what if you are using three or more? What happens then? How can science sort this out? This problem becomes magnified when you add supplements to the mix. Manufacturers of supplements do not need FDA approval to sell their dietary supplement. As such, there may be little to no research on how certain supplements react with other supplements or medications.
Despite the horror stories, many of us do take multiple medications to treat our conditions. There are risks which our doctors may or may not tell us about. In a recent post I posed the question:
Do you feel it is the responsibility of the doctor to give you information about your medication or do you think it is the responsibility of the patient to ask the right questions?
One commenter wisely advised that in essence:
It is ultimately up to us, the patient or the caregiver, to research any medication or combination of medications before use.
The answers to the following questions will help you gain the knowledge you need to assess the risk of taking more than one medication to treat your mood disorder or mental illness.
Remember that you are your own best advocate. Ask questions. Be informed. Research your medications before you take them.
Who do I ask about my medications?
The recommendation we give most frequently to members asking if their combination of medications is safe is to speak with the prescribing doctor. I am going to add that it probably is important to speak with all of your doctors and medical specialists and not just the doctor who is prescribing a particular medication. Let's say you are being treated for blood pressure from your general practitioner and you are also being treated for depression from your psychiatrist. You are being prescribed medications from both doctors. In this case both doctors need to know what you are currently taking so that they can provide guidance on possible drug interactions. This way you get a more well-rounded perspective as one doctor will not know everything there is to know about your medications.
In addition to talking to your team of doctors and specialists, it can also be helpful to discuss your medication concerns with your pharmacist. I have found them to be very willing to give detailed suggestions and advice about everything from the most effective way to take a particular medication to how to avoid dangerous drug interactions. Pharmacists have a lot of practical knowledge but they are under utilized by patients seeking answers to medication questions.
Some may balk at this suggestion but the drug manufacturer may also be of assistance in answering questions about possible interactions with other medications and/or supplements. If you are taking a name brand medication there is usually an official pharmaceutical website and a 1-800 number you can call. For example, if you are taking Cymbalta, which is manufactured by Eli Lilly, you can find the Cymbalta website where they provide a toll free number (Lilly Answers Center at 1-800-LILLY-RX or 1-800-545-5979) to answer your questions about their medication.
What do I need to do before adding a new medication to my treatment plan?
Before you agree to add another medication to your regimen it is important to write down all the medications and supplements you are currently using. Don't depend on your doctor to have this information. They don't always ask although they should. You can keep a copy of your medication/supplement list on your computer or you can use an app to keep your information handy. I personally use an app called My Health Records: Health n Family to keep track of my medications as well as those of my family members. Bring your personal medication list in with you when you see your doctor.
The other thing you need to do before you speak with your doctor is to prepare a list of your most pressing questions and concerns. Our Deborah Gray has written a list of questions to ask your doctor about your medications. The two main questions you want to ask your doctor about taking any additional medication include:
- Is this medication combination safe? What side effects can I expect? Are there any possible adverse interactions between the medications I am taking?
- Is this medication combination effective? Can you show me any studies or literature to show that this particular combination of medications is effective for treating my symptoms? How have other patients fared on this combo?
Where can I find other sources of information about my medications?
- On MyDepressionConnection we offer an extensive list of antidepressant medication information which includes things like possible side effects and drug interactions.
- Sites such as WebMD and Drugs.com offer their own drug interaction checkers. Certain pharmacies such as CVS pharmacy or Walgreens also have on-line tools to help you check for possible adverse medication interactions.
When taking any combination of medications, there are degrees of risk. Your job as a patient and a consumer is to be aware of your level of risk. Becoming educated about your medications is one way to lower your risk for adverse effects.
Let us know your thoughts and opinions. Do you currently take more than one medication to treat your mood disorder or mental illness? Have you discussed the risks for drug interactions with your doctor? Do you have any suggestions for other members who must decide whether or not to add a new medication to their treatment plan? We greatly value your input. Please let us know what you think.