“Tolerating” medication

This post is about the word “tolerate” in relation to medication for mental illness.

Some of the side effects I experienced from clomipramine:

  • dry mouth – to the extent I couldn’t eat certain foods, had to drink throughout meals and a lot more than usual the rest of the time, had trouble making conversation over dinner and when walking, and was beginning to get sores in my mouth. I used chewing gum if I was going to be talking for a while.
  • tiredness – to the extent that I had to have a nap every day as well as sleeping through the night.
  • light-headedness/dizziness – this was typically when I stood up, but it also seemed to come in after a while of being awake: I could only read for a certain amount of time before reading made me feel sort of light-headed/slightly nauseous and I had to go to sleep to fix it.
  • travel sickness – I got this when taking the bus and sometimes in cars when I wasn’t driving. Chewing gum helped a bit.

On top of all this there was no evidence that it was helping me at all – there was no change in OCD and I’ve realised in hindsight that I was also becoming gradually depressed – this was probably because I wasn’t taking sertraline anymore, and the clomipramine wasn’t having any anti-depressant effect.

I chose to reduce (and eventually stop) clomipramine because I have to drive for five or six hours every couple of weeks, and I didn’t feel that it was safe to do so with some of the symptoms I was experiencing.

The psychiatrist was understanding and said that she wouldn’t want to take clomipramine herself, but she also used the language of “not tolerating” clomipramine. This made me feel a bit hurt – I put up with those difficult side effects for a couple of months without seeing any improvement in my mental health. Even then I was only able to do so because I have a flexible job and an understanding boss – having to nap every day would interfere with most jobs.

I suspect that the psychiatrist and I understand the word “tolerate” in different ways. I looked up a definition which said that tolerate means to “be capable of continued subjection to (a drug, toxin, or environmental condition) without adverse reaction.” To me, tolerating something is mainly based on willpower, but it seems in the medical understanding that’s not necessarily the case.

It’s probably important that clinicians and patients are aware that they might not be on the same page when language like “tolerate” is used.

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