Many of us stop taking our medicines before we should. Why playing doctor can be a dangerous game.
A colleague of mine wants his story told. Like innumerable people in Mumbai, he got conjunctivitis during the monsoons last year. His GP prescribed a week’s course of antibiotic drops. Antibiotics are used to fight bacteria, my colleague was aware, but after he read a newspaper report, quoting a city doctor who said that the conjunctivitis epidemic was viral—a claim that was never proved, my colleague now says—he stopped the antibiotic drops three days into the course, bought an antiviral ointment and used it in his eyes without consulting the GP. “I’ve had conjunctivitis on two earlier occasions,” says my colleague, “and they never lasted more than four or five days. But this time it wasn’t going away even after ten days.” “If you discontinue an antibiotic, even if all the symptoms disappear, and not complete the prescribed course, chances are the infection won’t be eradicated completely. And if you have a rebound, the regular dose or same drug may not work,” says Raj Vaidya, chairman of the Indian Pharmaceutical Association’s Community Pharmacy Division. “And for chronic conditions like diabetes and blood pressure, you have to keep taking the medicines to keep the disease, which is incurable, under control.”
Many of us don’t think twice about ditching our medicines before the dosages run out, although the risks of stopping suddenly are real. Here are the most commonly cited reasons:
“I thought I was fine.”
Amar Shankaran* of Mumbai, who has suffered from bouts of depression, had been on a daily “maintenance dose” of antidepressants for about eight years. This had helped and Shankaran didn’t have to battle depression for a long time. Amar now felt confident and believed he’d never be depressed again, and so—without asking his psychiatrist—he decided to wean himself off the medication. He started taking the antidepressant every other day, sometimes twice a week, and sometimes went without it for days. Within a year the depression returned. “Fortunately, I went to the doctor as soon as I felt it coming back,” says Shankaran. “It was milder this time but a bout of depression, even if it’s mild, it isn’t something you wish for.”
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Dr Kersi Chavda, Shankaran’s psychiatrist and a consultant at Mumbai’s P.D. Hinduja Hospital, says patients who insist on discontinuing their medication must do it only under a doctor’s supervision and keep their family in the loop to watch out for any untoward behaviour. “A better idea is to continue an adequate maintenance dose, no matter how small. It reduces the chances of a relapse to zero,” he states. Amar has since taken his one little maintenance pill every day and has lived a depression-free life for four years.
“I keep forgetting.”
Rathika Kalyani, a 33-year-old Bangalore homemaker, had several other things on her mind instead of her medication for hypothyroidism. With two young children and the early-morning bustle around the house, Rathika was irregular with the medicine for her under-functioning thyroid for over a year. “I was diagnosed with the condition between my two pregnancies and was especially careful about taking my medicines regularly,” she says. But after her second child was born, priorities changed. “My carelessness took its toll—I became overweight, lethargic and was unable to focus on anything for long periods,” Rathika says. “What’s worse, due to poor concentration, I couldn’t care for my younger child the way I did for my older one.”
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“It’s very common for women to become irregular with prescribed medication when they’re no longer pregnant,” says Dr Gayathri Kamath, obstetrician and gynecologist at Fortis Hospital, Bangalore, “but such negligence can have long-term effects.” Doctors like Kamath advise building a daily routine with a focus on your dose of medicines. That way you’re less likely to forget about them. Rathika is regular with her medication once again and having regained her energy, she now works as a preschool teacher.
“I didn’t want to be too dependent.”
Shefali Chaturvedi was always reluctant to take the medication for her migraine. So the 43-year-old New Delhi senior executive took a decision that went against her doctor’s advice. “When the headaches started seven years ago, I put off getting treatment until the condition was debilitating. Once I saw the doctor, I was afraid of getting hooked on to the drugs.
So, after four years of sticking to the prescription, I decided to discontinue my medicines,” she says. Three months after that, she was back in the clinic with headaches of greater severity and frequency.
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Migraine medication works by reducing the frequency, intensity and duration of the attacks. It also helps you abort or cope with the headaches when they occur. “But patients are often ignorant about how the medicines work, so they fear dependence,” says Dr J.D. Mukherji, head of neurology at Max Super Speciality Hospital, New Delhi. “Ensure complete communication with your doctor. To understand why a medicine is prescribed and why you have to take it for a certain period or continuously, meet the doctor when both you and the doctor are not in a hurry and discuss it.” That way, you’ll be at ease and your medication will be able to do its job.
“It wasn’t available.”
Sachin Gaikwad, 31, of Daund, near Pune, had been taking medication thrice a day for epilepsy when he ran out of the medication one day. A chemist told him that the drug was unavailable. “I hadn’t had a severe attack since I’d started treatment six months earlier, so I didn’t worry too much and thought I’d be fine,” he says. He was—for a few days. Then the giddiness and panic started to resurface. Even so, 20 days passed before Gaikwad contacted Dr Rajas Deshpande, his neurophysician at Ruby Hall Clinic, Pune.
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“Patients like Gaikwad need to be very careful. They must have the right amount of drugs in the their bloodstream to keep the problem in control,” says Dr Deshpande. He advises those for whom it is absolutely necessary to follow prescriptions to keep an extra dose of the medicines with them always. In addition, maintain a list of chemists (in your area, along with their phone numbers), who stock the required medication. If you’re still unable to find what you need, contact your doctor immediately. “If Gaikwad had called me from the medical shop, I could have discussed the matter with the chemist and maybe suggested an available alternative for the interim,” says Dr Deshpande, “but he didn’t.”
“I heard about a miracle cure.”
Kolkata homemaker Srabani Banerjee* had been taking prescription medication and insulin injections for diabetes. After about a year of meticulously following the doctor’s orders and stabilizing of her glucose levels, Srabani stopped visiting Dr Nirmalya Roy, her diabetologist at Kolkata’s B.M. Birla Heart Research Centre. But, six months after she stopped going there, she was back at Dr Roy’s clinic just as suddenly. “Srabani had hoped the treatment would be discontinued after her diabetes was in control. But when I explained that that was not possible, she was disappointed,” says Dr Roy. So Srabani, who is in her early 50s, had taken the advice of a relative and started consuming a powder provided by a native healer with every meal. The healer had claimed the powder would cure her and that she’d never have to take doctor’s medicines again. After those six months, during which she was depending only on the “magic” powder, Srabani’s sugar levels became dangerously high again. She also contracted a severe urinary tract infection.
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“Treatment for a condition like diabetes is lifelong,” says Dr Roy. “People struggle to come to terms with the idea that the condition is here to stay and claims by quacks often sway them.” If you hear of a line of treatment different from the one prescribed by a qualified doctor, it’s always safer to speak to the doctor before making a change or even combining it with your prescribed medication. “The two products may react badly, so taking advice even before making any change or addition is important,” adds Dr Roy.
Finally, my sore-eyed colleague. He stopped the antiviral too and started on homeopathic drops. Even after his red, conjunctivitis-affected eyes looked normal again after about three weeks, they burned, itched and watered for months. There were times when he wondered whether his eyes had been permanently damaged. “Anyway, I was lucky I recovered,” he now says. “I should never have stopped the antibiotic or changed medicines on my own. I never studied medicine and I’ve learnt never to play doctor.”
Take the Tried-and-True
All things being equal, it’s prudent to take older drugs whose side effects are known instead of new drugs that have less data. “It has always been unfortunate but unavoidable that some adverse effects may not become apparent until a drug has been in wide use,” says Peter J. Pitts, president of the Center for Medicine in the Public Interest, USA. Sometimes it takes years and millions of users for a pattern to emerge.
When prescribed a new drug, ask your doctor why it is a better choice than something long on the market. Also ask about any known serious side effects.
Speak up. Trust your instincts. If you experience any new physical or mental symptoms, consult your doctor as soon as possible.
Dealing with Side Effects
All medications have risks and benefits. Weigh both sides of the equation with your doctor, and be prepared by asking yourself these questions:
Do I feel normal, or does something feel really out of whack?
Do I feel unusually depressed, anxious, or uncertain?
Do I have blood in my stool or urine?
Am I very drowsy, dizzy, or confused?
Am I troubled by being unable to sleep, eat, or take part in activities that I normally enjoy?
If you answered yes to one or more of these questions, you and your doctor may decide to:
Lower the dose.
Change the way you take the medication (eg: combine it with meals).
Switch to another medication.
Try a drug-free period (sometimes called a drug holiday) to see if side
effects are medication-related.
Discontinue medication completely (perhaps making lifestyle changes or using natural remedies).
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