“I don’t like to take medication” – I hear this sentence very often. Believe it or not, I have absolute understanding for this attitude. Because it is certainly most pleasant when you don’t constantly have to think about taking medication and are completely free and unburdened.
On the other hand, there are situations in which medications, regardless of whether one fundamentally rejects or approves of them, are a blessing. Anyone who has personally experienced how bad one can feel with a bacterial infection and how quickly everything turns for the better after the administration of an antibiotic cannot seriously doubt that medications are a good thing. Or think about medicinal pain treatment – it is fantastic when an unpleasant pain subsides and one is back to normal life. In such a situation, potential side effects are initially unimportant, as long as one is pain-free.
There are also promising treatment approaches for the symptomatic treatment of multiple sclerosis, i.e. the treatment of bladder disorders, mood swings, fatigue, spasticity and many more symptoms. Although the success rate is probably not as high as in infection or pain treatment, there are a large number of patients for whom drug therapies have an excellent effect and come with many advantages, so that the potential disadvantages are not significant.
The basic problem is only, how can I convince sick people of the advantages of drug therapy in view of the generally prevailing negative attitude towards them? Often it is the case that I make a therapy recommendation on the basis of my many years of clinical experience and with the best intentions. However, it is not uncommon for Google to be used first, which means that the medication is either not taken at all, or all symptoms occur immediately after the first tablet intake that the package insert provides.
This happened with a young patient to whom I recommended an antidepressant from the group of selective serotonin reuptake inhibitors (SSRIs) due to severe fatigue symptoms and strong lack of drive. My experience with this group of substances in the treatment of MS-associated fatigue/depression is quite positive. Many of my patients who have followed my recommendation have benefited, were emotionally much more stable and had hardly any side effects. Unfortunately, this patient’s trust in my knowledge was not large enough – at the next presentation she was even worse off, but told me that she had “of course not taken the medication, it would cause headaches, diarrhea and sleep disorders, and because of sexual dysfunction the medication would not work anyway”.
All not wrong – she had studied the package insert diligently – but unfortunately also not very conducive in her personal situation. If she could have followed my recommendation, at least there would have been a chance that she would have had fewer physical problems and perhaps also more joy in her partnership again.
Therefore, I would wish for more pragmatism from many patients. If your doctor recommends a medication to you, then he does so with good professional knowledge and the best of intentions – he certainly does not want to harm you. Why not simply agree to the proposal primarily – avoid the often self-fulfilling prophecy of studying the package insert. If you tolerate the medication and it serves its purpose, then you have achieved something positive. If you should not feel well, share these observations with your doctor, stop the medication, observe whether the symptoms disappear. If no, there may be another reason for the complaints, if yes, it is obvious that you do not tolerate the medication and the suggestion of your doctor is not meaningful for you personally. Often, however, it is also wise to conduct a counter-test – i.e. to see if the complaints reoccur when I take the medication again. If this is not the case, it may have been a competing cause that caused the “side effects”.
For me, this approach is a goal-oriented and pragmatic one. There are hardly any medications that cause permanent damage when taken for a short time – and if they do, your doctor would point this out to you and probably also consider very carefully whether you should take this risk. But most of the drugs used, especially in symptomatic MS therapy, are substances with a large therapeutic range that can be easily tried out.
