Practical Management of the Side Effects of Psychotropic Drugs,
Abstract
This is a practical, clinically oriented management guide that summarizes the side effects of psychotropic drugs and presents guidelines for successful management. The editor points out that the incidence of side effects is difficult to estimate because it depends on dose, concomitant medication, age, individual sensitivity, and other factors. The issue of whether advance counseling about side effects causes patients to develop side effects by means of suggestion and thus should be discussed only after they occur is confronted (but not resolved). Should orthostatic hypotension be discussed when giving a tricyclic antidepressant to a 30-year-old or to a 70-year-old? What is frustrating here is that there are so few hard data as to the benefits of different ways to introduce such issues to patients, monitoring side effects, or facilitating patient-physician cooperation. We depend on reasonable conjecture rather than demonstrated fact. There is a certain commonsense quality about many recommendations, therefore, which highlights the need for good clinical sense and experience but at the same time demonstrates the lack of useful factual knowledge. For instance, in the discussion of sexual side effects, the use of adjunctive pharmacological agents (e.g., yohimbine, sildenafil, cyproheptadine) is mentioned, but, in fact, it is