Here is a short-and-sweet, easy-to-remember concept that will give you an advantage when navigating your health: Every drug has two names—the trade or brand name and the generic name (a mouthful based on the drug’s molecular structure). If you’ve ever heard your provider refer to a medication you’re taking with an unfamiliar name, this is why. Because medical jargon isn’t already confounding enough, we’ve thrown in one more element of confusion. Here are a few examples:
Trade/brand name—Generic name:
Lexapro—escitalopram
Nexium—esomeprazole
Plavix—clopidogrel bisulfate
Knowing both names of the medications you’re prescribed and the over-the-counter medications you take regularly will not only ease participation in conversations with your providers, but it will also amplify your ability to fend off medical error, which we’ll get to later.
Knowing both names can also help you save money at the drugstore. When you’re trying to choose between three packages of a similar medication, you can look at the ingredient list and know exactly what you’re dealing with! Every drug in branded packaging also has the generic name listed, while bottles dispensed by a pharmacist tend to only use the generic name. A quick Google search of “generic name for [x]” will get you what you need. A comprehensive list of both names of every drug can be found at http://www.rxlist.com.
Ibuprofen, Motrin, Tylenol, Advil. We keep them stocked in our medicine cabinets and store bottles in our handbags. (One time I even woke up next to someone who kept them in a glass jar, like M&M’s, on their nightstand for hangovers.) These anti-inflammatory drugs are the workhorse in our modern apothecary, but like any medication, they can have severe side effects. Here are seemingly random but important things to remember when taking these over-the-counter drugs.
Aspirin (acetylsalicylic acid) is its own animal, since its chemical makeup is distinct from those of other painkillers we take regularly. It’s an acid and a blood thinner, so many people take a “baby dose” daily when they have a high risk for heart disease.
Nonselective NSAIDS (e.g., ibuprofen/Advil and Motrin, naproxen/Aleve) are anti-inflammatory, pain relieving, and fever reducing. (NSAID stands for “nonsteroidal anti-inflammatory drug.”)
Acetaminophen (Tylenol) does not have an anti-inflammatory effect because it works on the central nervous system rather than the peripheral nervous system.
Doctors pour medicines about which they know little, for diseases about which they know less, into human beings about whom they know nothing.
—VOLTAIRE
Medications are a gift of modern medicine, but it’s easy to have too much of a good thing. As soon as there are lots of different meds on board (called “polypharmacy”), they’re bound to start causing problems of their own, either by taxing your body’s system or by interacting with one another.
For example, chronic conditions tend to come with a cabinet full of different medications: One for the pain. Another for the side effect the first medication causes. Another for a separate symptom that came about from the first two clashing. In balancing the many aspects of a chronic illness, providers run the risk of prescribing too many medications. This can include ones that aren’t necessary or that cancel each other out when taken together. It’s especially likely to happen with adults who struggle with more than one chronic illness and must navigate interventions for both.
Problems related to polypharmacy can include:
Taking medications for a symptom when in fact they’re not helping it
Treating one illness with multiple equivalent medications
Using medications that interact with each other
Using an inappropriate dose
Treating adverse drug reactions with other medications
Most healthcare providers have yet to master the art of successfully deprescribing. Studies have shown that most operate on the general principle that the benefits of a drug outweigh the risks; they are also overwhelmingly unaware that they’re overprescribing. Providers are generally inclined to keep you on a medication they believe will help your underlying condition, and then treat its side effects accordingly. Even for those who do want to deprescribe, there’s a dearth of research to help them figure out how to do it best. The majority of studies are about what happens when patients take a drug, not what happens when they stop taking it.
Polypharmacy and its negative effects have to be treated on a case-by-case basis. There are no tests you can run to see what’s interacting, and when you’re taking several medications with overlapping side effects it’s difficult to sleuth out which med is causing what symptom. It’s an area of medicine that requires skill and excellent communication between providers and patients.
A few examples of symptoms that can arise from polypharmacy:
Confusion
Weakness
Tremors
Hair loss
Incontinence
Sensory deficits
Fainting
The worst of the worst!
It’s not unusual to leave an appointment with a new prescription, or leave a hospital stay with a boatload of new medications. These are opportune times to reassess your medication list in full with the prescriber. At each routine exam, visit with a specialist, or hospital discharge, be sure to ask this question: Can we cut anything?
When you are taking several medications for one condition or syndrome, any new symptom might actually be a side effect. If you have a chronic illness and take multiple medications, it’s important to tune in to changes in your body in the first two weeks after starting any new medication. In your notebook or using a symptom tracker app, like Symple, take a moment each day to note any changes you’re experiencing in appetite, sleep, mood, or bowel movement, including things as subtle as malaise or general lethargy.
Antidepressants are prescribed more liberally today than ever before. Prozac hit the American scene in the late eighties, and today one in ten adults takes an antidepressant, with over fifty different types to choose from. And you no longer need to lie on a leather chaise longue and divulge your feelings to get one—primary care providers write scripts for them.
Though I advocate for having a primary mental healthcare provider and supplementing with therapy (see here), it’s fine to work with a primary care provider to find the right medication if it’s convenient and feels right to you. That said, it’s important to consider that most general practitioners (like your family doctor) don’t have extensive training in antidepressant therapy, which is a nascent field and more of an art than an exact science.
No matter who you work with, the first medication you try will simply be an educated guess on the part of the provider. Brain chemistry varies infinitely. Neurotransmission is a complicated dance, and it requires finesse and patience, trial and error, to find the right treatment.
Here are some things to guide you in finding the medication(s) you’ll respond to best:
Approach with patience. I remind patients every day that it can take trials with two, three, or four medications before finding the right one. Pay attention to your body and mood carefully in the first few weeks, and schedule a follow-up call or appointment to assess things with your provider. Request this even if it’s not automatically offered or scheduled.
To avoid enduring so many trials, consider asking your provider about a cytochrome p450 test. This is a simple cheek swab that analyzes your genetic ability to metabolize medications. It may guide the provider in choosing the medication and the dose, and help them avoid medications to which you could have an adverse or blunted reaction.*
If you have tried several antidepressants without noticeable improvement of symptoms, ask your provider about a methylation test. This relatively new, noninvasive genetic test will determine how much folate you metabolize and absorb. Folic acid (a derivative of folate) is necessary to synthesize neurotransmitters like serotonin and dopamine that play key roles in balancing our mood and behavior. Antidepressants can’t work well for you if you don’t metabolize folate—it would be like trying to make meringue without egg whites! The solution is as simple as taking a supplement.