THE FIRST TIME I TOOK PROZAC, I HAD A HORRIBLE TIME. THE SECOND TIME IT WENT WELL. WHY?
This phenomenon is not easily explicable but occurs with many medications, both in psychiatry and in general medicine. It is not uncommon to hear that a patient’s first experience with an antidepressant drug was not successful but that the second time it went extremely well.
One possible explanation of this is the so-called placebo effect, present in 10% to 15% of patients. The placebo effect is usually thought of as influencing patients in a positive way: that is, their positive expectations or belief in the doctor may cause them to see immediate improvements even before the drug theoretically is supposed to work. But the placebo effect has a negative side also, for if the patient is worried or even phobic about taking a given drug, the anxiety can produce side effects for which the drug itself is not responsible, and these negative expectations may cause the patient to discontinue the medication prematurely, before it has had a
chance to work. A related issue has to do with the patient’s overall confidence in authorities, in this instance a physician. The more the patient trusts the doctor, the better the reaction to the drug is likely to be.
A second possible explanation has to do with the patient’s metabolism, which may from time to time vary in its fluid and electrolyte balance, either as a result of taking other medications or of changing diet or fluid intake. Or the patient’s metabolism may have simply changed in some way that at first glance is not easily understood by either the patient or the physician.
Finally, the patient may have been given too much of the drug on the first occasion. On the second try, if the drug is given in a much smaller amount, with the dosage being raised gradually, the results may be highly effective, and rewarding.
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